Chapter 18- General Features of Hepatic Disease

Question 1

The liver is vulnerable to a wide variety of metabolic, toxic, microbial, circulatory, and neoplastic
insults.

What is the major primary diseases of the liver?

Answer 1

The major primary diseases of the liver are:

• viral hepatitis,
• alcoholic liver disease,
• nonalcoholic fatty liver disease (NAFLD), and
• hepatocellular carcinoma (HCC).

Question 2

Hepatic damage
also occurs secondary to some of the most common diseases in humans, such as what?

Answer 2

• cardiac decompensation,
• disseminated cancer, and
• extrahepatic infections.

Question 3

The enormous functional

reserve of the liver masks the clinical impact of mild liver damage, but with progression of
diffuse disease or disruption of bile flow, the consequences of deranged liver function may
become life-threatening

Question 4

Liver disease is an insidious process in
which clinical detection and symptoms of hepatic decompensation may occur weeks, months, or
many years after the onset of injury, with the rare exception of what?

Answer 4

fulminant (severe sudden onset) hepatic failure,

Question 5

Why do inviduals with hepatic abnormalities are referred to hepatologists more frequently have chronic liver disease?

Answer 5

The ebb and flow of hepatic injury may be imperceptible to
the patient and detectable only by abnormal laboratory tests( Table 18-1 ), andliver injury and
healing may also occur without clinical detection.

Hence, individuals with hepatic abnormalities
who are referred to hepatologists most frequently have chronic liver disease.

Surveillance
studies in the United States document an annual incidence of newly diagnosed chronic liver
disease of 72 per 100,000 population. [3]

Liver disease accounts for over 27,000 deaths per
year in the United States (1.1% of all deaths).

Question 6

TABLE 18-1 – Laboratory Evaluation of Liver Disease

Test Category

Hepatocyte integrity

Answer 6

Serum Measurement [*]

• Cytosolic hepatocellular enzymes [†]
• Serum aspartate aminotransferase (AST)
• Serum alanine aminotransferase (ALT)
• Serum lactate dehydrogenase (LDH)

Question 7

TABLE 18-1 – Laboratory Evaluation of Liver Disease

Test Category

Biliary

Answer 7

Substances normally secreted in bile [†]

• Serum bilirubin
  
  • Total: unconjugated plus conjugated
  • Direct: conjugated only
  • Delta: covalently linked to albumin
• Urine bilirubin
• Serum bile acids

Plasma membrane enzymes (from damage to bile canaliculus) [†]

• Serum alkaline phosphatase
• Serum γ-glutamyl transpeptidase
• Serum 5′-nucleotidase

Question 8

TABLE 18-1 – Laboratory Evaluation of Liver Disease

Test Category

Hepatocyte function

Answer 8

Proteins secreted into the blood

• Serum albumin [‡]
• Prothrombin time [†] (factors V, VII, X, prothrombin, fibrinogen)

Hepatocyte metabolism

• Serum ammonia [†]
• Aminopyrine breath test (hepatic demethylation) [‡]
• Galactose elimination (intravenous injection

Question 9

What test with an elevation implicates liver disease (†)?

Answer 9

Cytosolic hepatocellular enzymes [†]

• Serum aspartate aminotransferase
  (AST)
• Serum alanine aminotransferase (ALT)
• Serum lactate dehydrogenase (LDH)

Substances normally secreted in bile [†]

• Serum bilirubin
  
  • Total: unconjugated plus conjugated
  • Direct: conjugated only
  • Delta: covalently linked to albumin
• Urine bilirubin
• Serum bile acids

Plasma membrane enzymes (from damage to bile canaliculus) [†]

• Serum alkaline phosphatase
• Serum γ-glutamyl transpeptidase
• Serum 5′-nucleotidase

Prothrombin time [†] (factors V, VII, X, prothrombin,
fibrinogen)

Aminopyrine breath test (hepatic demethylation) [
‡]

Question 10

‡ A decrease implicates liver disease.

Answer 10

• Serum albumin [‡]
• Aminopyrine breath test (hepatic demethylation) [
  ‡]
• Galactose elimination (intravenous injection) [‡]

Question 11

PATTERNS OF HEPATIC INJURY

The liver has a relatively limited repertoire of cellular and tissue responses to injury, regardless of cause.

The most common are:

Answer 11

• Hepatocyte degeneration and intracellular accumulations
• Hepatocyte necrosis and apoptosis
• Inflammation
• Regeneration
• Fibrosis

Question 12

Clinically, a few common syndromes occur that are a consequence of many different diseases.
Before considering specific diseases, we will discuss some of these syndromes, which include:

Answer 12

• hepatic failure,
• cirrhosis,
• portal hypertension,
• and disturbances of bilirubin metabolism causing jaundice and cholestasis.

Question 13

What is the most severe clinical consequence of liver disease

Answer 13

hepatic failure.

Question 14

Hepatif failure results from what?

Answer 14

It may be the result of
sudden and massive hepatic destruction (fulminant hepatic failure), which accounts for about
2000 cases per year in the United States, or, more often, represents the end stage of
progressive chronic damage to the liver.

Question 15

End-stage liver disease may occur by what?

Answer 15

insidious destruction of hepatocytes or by repetitive discrete waves of parenchymal damage.

Question 16

In cases of severe hepatic dysfunction, hepatic failure is often triggered by what?

Answer 16

intercurrent diseases.

Whatever the sequence, 80% to 90% of hepatic functional capacity must be lost before hepatic failure
ensues.

Question 17

How many percent of hepatic functional capacity must be lost before hepatic failure ensues?

Answer 17

80% to 90%

Question 18

When the liver can no longer maintain homeostasis, what offers the best hope for survival?

Answer 18

transplantation

the mortality of hepatic failure without liver transplantation is about 80%.