Liver function and disease


Liver function

Deaminates amino acids

Forms urea and uric acid

Converts glucose to glycogen

Desaturates fat

Produces bile

Produces heat

Stores, vit B12, ADEK, iron, copper, some B vitamins

Synthesises vit A from carotene            

Synthesises nor essential amino acids

Detoxifies drugs and alcohol

Inactivates hormones

Synthesises plasma proteins





Hepatitis B or C


Non-alcoholic fatty liver disease

Toxin exposure

Biliary cirrhosis

Cardiac cirrhosis

Autoimmune diseases

Alpha 1 antitrypsin deficiency


Wilson’s disease


Clinical features

Large or small liver

Hard, irregular, painless liver




Endocrine sexual changes


Portal hypertension – splenomegaly

Hepatic encephalopathy

Spider formations

Hepatorenal failure

Liver flap 

Liver palms


Hepatocellular carcinoma

South East Asia, Southern Europe, Northern Europe



Chronic hepatitis B infection



Male sex



May be a single mass

Multiple nodules in cirrhosis


Clinical features

Weight loss


Abdominal pain



Variceal haemorrhage

Possible hepatomegaly

Hepatic rupture with haemorrhage



3-6 monthly ultrasound in high risk patients



Alpha-fetoprotein in 60% of cases                     Ultrasound                    CT, MRI                        Biopsy



Percutaneous ablation injecting ethanol


Intra hepatic arterial injections


Benign liver tumours

Haemangiomas             Adenomas        Focal Nodular Hyperplasia


Portal hypertension


Hypersplenism, thrombocytopenia, possible leucopenia

Collateral vessels develop, abdominal wall, stomach, oesophagus, rectum                      Fector hepaticus

Viral Hepatitis

Five viruses A, B, C, D and E

The five types give a similar clinical picture so seriological diagnosis is required.

Inflammation of the liver

Variable numbers of liver cells die leading to areas of necrosis

Possible fulminating liver failure (FLF)


Clinical features in viral hepatitis

Malaise, lethargy and fatigue with generalised flulike symptoms

A low grade fever is typical

Anorexia and weight loss

Do not feel like smoking

Hepatic inflammation leads to a tender, swollen liver, (hepatomegaly).  



Bilirubin is not taken from the blood and incorporated into the bile ----- bilirubinaemia

Bilirubinuria (like tea without milk)

Pale and foul smelling stools due to lack of bilirubin in the gut

Bilirubinaemia ---- jaundice

Viral skin rashes may present.


Hepatitis A

Incubation 30 days, (range 15-50 days)

HAV replicates in the hepatocytes and is excreted in bile  ----- faeco-oral route

Often occurs in outbreaks or epidemics.

Jaundice -  1 to 10 days after the onset of symptoms

No specific treatment is available

Full recovery after 3-6 weeks.

Vaccination is available and highly advisable for anyone who may be exposed to HAV.


Hepatitis B

Hepatitis B virus is found in the blood - the serum route

Clinical, blood, acupuncture, body piercing and tattooing

HBV infection is more severe the HAV and the patient may feel unwell for several months

Incubation 2 to 3 months

Most patients make a full recovery

1% developing fulminant hepatitis

1-10% of cases, DNA from the HBV integrates itself into the host DNA of the hepatocytes

This causes chronic hepatitis B infection and most of these patients become long term carriers of the disease.

A significant risk of developing cirrhosis and hepatocellular carcinoma.


Hepatitis C

Serum transmission

Intravenous drug users, tattooing

Vertical and sexual transmission are less likely than is the case with HBV

Incubation 6 to 7 weeks

Acute infection with HCV is often asymptomatic

80% of patients develop chronic liver disease with increased risk of cirrhosis and hepatocellular carcinoma

Alcohol not good


Hepatitis D

‘Piggy back’ virus

Serum or sexual route



Hepatitis E

Similar to HAV


Large epidemics

The risk of fulminant hepatitis is about 1-2% unless the patient is pregnant

Incubation about 40 days


Liver failure

Liver failure, end stage of chronic cirrhosis or  fulminant hepatitis


Portal hypertension

Oesophageal varices



Hepatic encephalopathy



Hepatorenal syndrome

Hepatopulmonary syndrome

Endocrine complications


Spider angiomas (also called spider nevi)

Palmar erythema or ‘liver palms’.

Reduced hepatic metabolism of aldosterone

Liver flap

Fetor hepaticus