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LIVER DISEASES

Dr Rehan Ahmed KhanFCPS, FRCS, MHPE

Asstt. Prof. Surgery. S.U. 2

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LEARNING OBJECTIVES

To enlist important liver diseases

To enumerate clinical features of liver

diseases To describe surgical aspects of liver diseases

To describe portal hypertension

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MCQs

A 30 year old male presents with h/o high

grade fever, vomiting , tender right

hypochondrium .The diagnostic investigationof choice in this patient is:

A. Abdominal ultrasound

B.CT scan abdomen

C. MRI Abdomen

D. Xray Abdomen

E. FNAC

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MCQs

A 60 year old male presents with pain RHC,

jaundice and confusion.This patient will have

following tremors

A. INTENTIONAL TREMORS

B. FLAPPING TREMORS

C. FINE TREMORS

D. SENILE TREMORS

E. RESTING TREMORS

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MCQs

A. A 62 year old male presents with hematemesis. Hispulse is 120 /m and BP is 90/50 mm Hg. He has pallorand feels difficulty in breathing.Last year he was

diagnosed with hepartitis C.T

he most likely diagnosis is:A. Gastric varices

B. Esophageal varices

C. Bleeding duodenal ulcer

D. GastritisE. Erosive esophagitis

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THE LIVER

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THE LIVER

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THE LIVER

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LIVER DISEASES

Hepatitis A

B

C

Traumatic liver injury

Liver abscess

Cirrhosis Liver failure

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TRAUMATIC LIVER INJURY

Results from blunt abdominal trauma

Pain and tenderness in RHC

Shock Signs of free intraperitoneal fluid

Urgent resuscitation required

Operative repair to be done

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LIVER ABSCESS

Single or multiple

Amebic or pyogenic

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AMEBIC LIVER ABSCESS

Due to entameba histolytica

Usually solitary

Usually in the central part of right lobe Contains chocolate colored pus (anchovy

sauce pus)

Presents with fever, pain RHC, tenderness. H/o amebic dysentry

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AMEBIC LIVER ABSCESS (contd)

Investigate stools for ameba

USS abdomen

Ameba serology (indirect hemagglutinationtest)

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AMEBIC LIVER ABSCESS

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AMEBIC LIVER ABSCESS

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AMEBIC LIVER ABSCESS

Treatment

Conservative

Metronidazole (Flagyl) 800 mg tds for 10 days Tinidazole (Fasigyn)

Secnidazole (Secnidal)

Operative

Aspiration Operation

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CIRRHOSIS

Results from liver cell necrosis, regeneration

and fibrosis

End stage of many liver diseases Marks a degenerative change in liver

parenchyma

Macro- or micro nodular Leads to portal hypertension

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PORTAL CIRCULATION

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ESOPHAGEAL VARICES

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ESOPHAEGAL VARICES

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CAPUT MEDUSAE

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ASCITES

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ESOPHAGEAL VARICES

Upper GI bleed

Massive hemorrhage

Managed by NG intubation, cold saline lavageand IV vasopressin

Prompt endoscopy required

Injection sclerotherapy

Sengstaken tube insertion

?Surgery

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SENGSTAKEN TUBE

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THE TUBE IN PLACE

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LIVER FAILURE

Inability of liver to perform its normal

metabolic and synthetic functions.

May be acute or chronic Main clinical features are neurological in

nature

Confusion, stupor, coma--- hepaticencephalopathy

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CLINICAL FEATURES

Impaired sensorium

Flapping tremor, liver tremor or asterixis

Inability to perform simple tasks eg joiningdots

Maybe precipitated by metabolicderangements, diuretics (hypokalemia),

protien intake, drugs (psychotropics etc) andothers

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MANAGEMENT

Reduce protein intake

Correct hypokalemia

Oral lactulose Antibiotics

Supportive therapy

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MCQs

A 30 year old male presents with h/o high

grade fever, vomiting , tender right

hypochondrium .T

he diagnostic investigationof choice in this patient is:

A. Abdominal ultrasound

B.CT scan abdomen

C. MRI Abdomen

D. Xray Abdomen

E. FNAC

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MCQs

A 60 year old male presents with pain RHC,

jaundice and confusion.This patient will have

following tremors

A. INTENTIONAL TREMORS

B. FLAPPING TREMORS

C. FINE TREMORS

D. SENILE TREMORS

E. RESTING TREMORS