Hepato-biliary diseases

Additional recommended knowledge

Essential Laboratory Skills Guide

How to ensure accurate weighing results every day?

Daily Visual Balance Check

Liver diseases

Viral hepatitis

• Acute hepatitis A
• Acute hepatitis B
• Acute Hepatitis D -this is actually a superinfection with the delta-agent in a patient already infected with hepatitis B
• Acute hepatitis C
• Acute hepatitis E
• Chronic viral hepatitis
• Other viral hepatitis virusses may exist but are not so firmly established as the previous ones: hepatitis G.

Liver dysfunction in other infectious diseases

• Hepatitis:
  • cytomegalovirus infection
  • herpesviral: herpes simplex infection
• Toxoplasmosis
• Hepatosplenic schistosomiasis
• Portal hypertension in schistosomiasis
• Liver disease in syphilis
• Epstein-Barr virus infection
• yellow fever virus infection
• rubella virus infection
• leptospirosis
• Echinococcosis
• Amoebiasis

Other inflammatory liver diseases

• liver abscess
• autoimmune hepatitis
• primary biliary cirrhosis
• phlebitis of the portal vein
• granulomatous hepatitis
• Hepatic granulomas in:
  • berylliosis
  • sarcoidosis

Alcoholic liver disease

This may cause fatty liver, hepatitis, fibrosis and sclerosis leading to cirrhosis and finally hepatic failure.

Toxic liver disease

This includes mostly drug-induced hepatotoxicity, which may generate many different patterns over liver disease, including

• cholestasis
• necrosis
• acute hepatitis and chronic hepatitis of different forms,
• cirrhosis
• Effects of Acetaminophen (Tylenol)
• other rare disorders like focal nodular hyperplasia, hepatic granulomas, peliosis hepatis and veno-occlusive disease.

Liver damage is part of Reye's syndrome.

Liver tumours

Malignant neoplasm of liver and intrahepatic bile ducts. The most frequent forms are metastatic malignant neoplasm of liver)

• liver cell carcinoma
  • hepatocellular carcinoma
  • hepatoma
• cholangiocarcinoma
• hepatoblastoma
• angiosarcoma of liver
• Kupffer cell sarcoma
• other sarcomas of liver

Benign neoplasm of liver include hepatic hemangiomas, hepatic adenomas, and focal nodular hyperplasia (FNH).

End-stage liver disease

Chronic liver diseases like chronic hepatitis, chronic alcohol abuse or chronic toxic liver disease may cause

• hepatic failure and hepatorenal syndrome
• fibrosis and cirrhosis of liver

Cirrhosis may also occur in primary biliary cirrhosis. Rarely, cirrhosis is congenital.

Metabolic diseases

• metabolic diseases (chapter E in ICD-10)
  • haemochromatosis
  • Wilson's disease
  • Gilbert's syndrome
  • Crigler-Najjar syndrome
  • Dubin-Johnson syndrome
  • Rotor's syndrome

Vascular disorders

• chronic passive congestion of liver
• central haemorrhagic necrosis of liver
• infarction of liver
• peliosis hepatis
• veno-occlusive disease
• portal hypertension
• Budd-Chiari syndrome

Cysts

• congenital cystic disease of liver
• Cysts caused by Echinococcus
• hepatic cyst*

Others

Amyloid degeneration of liver

Gallbladder and biliary tract diseases

• malignant neoplasm of the gallbladder
• malignant neoplasm of other parts of biliary tract
  • extrahepatic bile duct
  • ampulla of Vater

• cholelithiasis
• cholecystitis
• others (excluding postcholecystectomy syndrome), but including
  • other obstructions of the gallbladder (like strictures)
  • hydrops, perforation, fistula
  • cholesterolosis
  • biliary dyskinesia
• K83: other diseases of the biliary tract:
  • cholangitis (including ascending cholangitis and primary sclerosing cholangitis)
  • obstruction, perforation, fistula of biliary tract
  • spasm of sphincter of Oddi
  • biliary cyst
  • biliary atresia

Diagnosis

In hepatology, important signs and symptoms include:

• history of alcohol abuse
• liver function tests
• hepatomegaly
• hypoalbuminemia and ascites
• jaundice or icterus
• Murphy's sign
• liver biopsy

Treatment

Includes:

• motivate patient to stop drinking alcohol
• vaccination for hepatitis
• eradication of causative pathogens
• |liver transplantion
• cholecystectomy