Chronic LiverChronic Liver DiseasesDiseases By Dr. Osman BukhariBy Dr. Osman Bukhari

Chronic liver disease

1- Chronic hepatitis

2-Liver cirrhosis

Chronic hepatitis Def:- Hepatitis lasting 6month or more

Classification

a) According to a etiology

1- Viral : HBV , HCV , HDV

2- Autoimmune

3-Drugs e.g. Methyl dopa, INH.

4-Hereditary e.g. Alpha ATD, Wilson's

5-Inflammatory bowel disease e.g UC

6-Alcohol (rare)

b) Histological

1-Chronic persistent hepatitis (CPH)

-Chronic inflammatory infiltrate

confined to portal tract

-Spotty necrosis

-Normal liver architecture

-Cirrhosis is rare

2- Chronic active hepatitis (aggressive)

-Inflammatory infiltrate in portal tract &

parenchyma (piece meal necrosis)

-Distorted lobular architecture

-Septa linking portal tract & C.V

-Subsequent Cirrhosis can follow.

Clinical features

-Depend on pathology & aetiology

-Mild illness with dyspepsia & variable

increase in liver enzymes without evidence

of chronic liver disease in CPH (DD,

Gilberts)

-Florid progressive liver disease with

evidence of chronic liver disease in CAH.

Chronic HBV hepatitis

-Due to cont. replication of the virus

-Age > 30 years & M > F

-A symptomatic, mild or severe disease

-Non specific symptoms + hepatomegly

-No jaundice or mild

-mod increase in bilirubin & transaminases,

mild increase in ALP & reversed Alb/ Glob

-+ve HBs Ag +_ HDV serology

- -ve Auto anti bodies

-Treatment indications are +ve HBs Ag, HBe Ag & HBV – DNA, Abnormal transaminases

& chronic hepatitis on liver biopsy

*No TR for decompunsated liver disease

*Aim of TR is to eliminate HBs Ag &

HBV- DNA with reduction of liver cell

necrosis

1-Alpha- interferon

5M units daily or 10M units 3times weekly

for 4-6 M

Transient increase in transaminases & flu ـــــ like illness for 6-8 M

Rarely depression , cardiac & renal failure ـــــ

Response rate with sero conversion is ـــــ

25-40 %

2-Famciclovir & Lamivudine PO

3-Liver transplant for decompunsated liver disease

Chronic HCV hepatitis -A symptomatic or few symptoms - +ve HCV Abs & +ve PCR for HCV- RNA, +ve liver biopsy & raised transaminases for > 6/12 -Aim of TR : Elimination of HCV- RNA, to

stop progression of liver disease & to prevent H.C.C.

Alpha IF 3M units three times weekly ــــــ for 12M

Ribavivin + Alpha IF ـــــــ

.Liver transplant for decompsated liver ـــــ

Chronic HDV hepatitis

Cirrhosis ـــــ % 70 - 60-

-Diagnosis by +ve HDV Abs in patients with

+ve HBs Ag, +ve HDV- RNA.

Alpha IF 10M unit 3times weekly ـــــ

Autoimmune hepatitis

-Female in 2nd or 3rd decade

-ass. autoimmune disease

-Remission & relapses

-Insidious onset. Acute in 25 %

-Fever, fatigue, anorexia, arthralgia, epistaxis,

& Amenorrhoea

-Mild to moderate jaundice or absent.

-Spider telangiectasia +H/S

-LFT varies with activity & severity

-Low serum alb. & marked hyper glob.

-Anti smooth muscle Ab (2/3), ANF (1/12) & AMA (2/3)

Prednisolone 30mg/dl , tapering with ــــــ

improvement of LFT & maintain on 10-15mg

for 2years & LFT become normal. Azathioprin

(1.2mg/kg) used as steroid sparing agent.

-Progress to liver Cirrhosis. H.C.C. is uncommon

-50% die with liver failure in 5 years

Drug induced chronic hepatitis

-Similar to autoimmune hepatitis with -ve serology.

-Improve withdrawal of drug.

Alcohol

Chronic alcohol consumption occasionally ـــــ chronic

hepatitis