Fast Facts: Liver Disorders

118 Pages·2006·8.039 MB·English

by  Thomas Mahl

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LiveDri sorders
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Moret han7 0 FastF actst itliensc,l uding:
Asthma Hypert(etnhseiidroidnt ion)
BenGiygnne coDlioesagsi(ecs aelce odnidt iIonnf)ml aatmoBroywD eils e(asseece odnidt ion)
BeniPgrons Htyapteircp laesdiiat i(ofnIi)rf rtiBhto awbSelylen dr(osmeec ond edition)
BipoDlisaorr der Menop(asuesceeo dnidt ion)
BladCdaenrc( esre ceodnidt ion) MinSourr gery
BleienDdgio srders MultSicplle(ers oescieosdn idt ion)
BreCaasntc ere d(itthiiornd) Osteop(ofroousritsh edition)
ChroOnbisct rPuuctlimyvoD eni asrease ParkiDniessaosne' s
ColorCeacntc(aeslre ceodnidt ion) ProsCtaantc(eef ro uerdtiht ion)
Contrac(espetceiodnoidnt ion) Psioar(ssiesc eodnidt ion)
Dementia RenDaiolsr ders
Depression (second edRietsipooirTnryar)a c Ittn fe(csteicoeondn idt ion)
Diesasetsh Peoa fn carneBdaii sal Trrya ct RheumaAtrothirdi tis
Dyspepsia (second ediStcihoinz)io (apsh erceeondnidt ion)
Eczema anDde rCmoanttiatcits SexDuyafslu nction
Endotmrei(osseicesod nidt ion) SexuTaarlnlsiymt tIenedcf tions
Epileipdres dy i(ttihon) Skin Cancer
ErecDtyislfeu n(cttheiidorindt ion) SmokCiensgs ation
GynecoOlnocgoilcoagly SoTfit sRshueeu matology
Heahdea(scs econd edition)T hyrDoiisdo rders
Hypieprild(etmheiidari dt ion) UrinSatroyne s
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IndexbeyLd a ureEnrcrei ngEtdoinn,b uUrKg.h ,
Glossoafra yb breviatio4n s
Introducti5on
Investilgiavtdeiirns ge ase
Acutlei vdeirs ease
Alcoholliivdcei rs ease
Drug-indluicvdeeidrs ease
Autoimmulnievd eirs eases
Metabolliivdcei rs eases
Chronviicrh aelp atitis
Complicaotfic oinrsr hosis
Benilginv teurm orcsy,s tisn,f ectainodan bss cesses
Hepatoceclalruclianro ma
Pregnaanncdty h el iver 91
Livterra nsplantation
Usefruels ource1s0 8
Index1 10
Glossaorfay b breviations
AFPa:l pfheapt rootein LDLTl:i vdionngol ri vterra nsplant
Alli:a utoimmhuenpea titis LVP:l arge-vpoalruamcee ntesis
ALD: alcloihvdoeilrsi eca se MELDm:o defloe rn d-sltiavgdeeir s ease
ALTa:l anaimnien otransferasNeA FDL:n on-alcfoahtoltliyivd cei rs ease
AMA: antimitochaonntdirbioadli eNsA SHn:o n-alcsotheoaltioch epatitis
ASTa:s paratmaitneo transfera5sNeT 5:' nucleotidase
ATD: antitrdyepfsiicni ency pANCAp:e rinuacnlreianre utrophil
u]
cytoplasmic antibody
BMIb:o dmya sisn dex
PCRp:o lymecrhaasrieen a ction
CT:c omputtoemdo graphy
PELDp:e diaetnrdi-cs ltiavgdeeir s ease
DILDd:r ug-inldiuvdceiersd e ase
PiZZp:r oteianshieit ,bo rvZa riant,
EVLe:n doscvoapriiclc iegaalt ion
homozyg(oamu ust atoifto hne
ESe:n doscsocpliecr otherapy antitrgyepnsei)n
u1
GGT:g amma-glutnasemfryalster a PBCp:r imabriyl icairryr hosis
HBeAglhAebp:a tBi 'tei's PSC: prsicmlaerryco hsoilnagn gitis
anitgen/antibody
PT:p rothbriotnmi me
HBsAAgbi:h epatBi 'tsiusr face'
PTDL:p osrta-ntsplant
anitgen/antibody
lymphoproldiifseeraastei ve
HBV:h epatBiv tiirsu s
SAAGs:e ruams-ciatlebsu mgirna dient
HCC:h epatoccealrlcuilnaorm a
SBPs:p ontanbeaocutsep reirailt onitis
HCV:h epatCi vtiirsu s
TIPtSr:a nsjiungturlaahr epatic
HELLP:he molyesliesv,al tievde r POrtosysshtuenmti c
enzymleoswp, l atceoluentt
TNF: tumonre crofsaicsto r
HFEH:i gFhe ( ge-nmeu tatrieosnusl t
UDCAu:r sodeoxycholic acid
inh emochromatosis)
WBC:w hibtleo code ll
Igi:m munoglobulin
INR: internatnioornmaall ized ratio
4
Introduction
Our aiintm h iboso ikts o p rovais duec cinct andt otu hsee ful guide
clinmiacnaalg emoefpn att iweinttlhsi vdeirs eAacsuept.re e sentations
ofl ivdeirs eaarsceeo mmoann mdo srte soslpvoen tayn.He oowuesevlr,
establainas chciungrd aitaeg naonsdui nsd ersttahniedn idnigc oaft ors
sevderies eaarsveee riym poritnao nrtdt eoar v odiedl aiyd eiynnit nigf
thsem aclolh oirnnt e eodfr efefrorsrap le citarleiasttm ent.
Alcohloilvdieicrs eparsees einnmt asn fyo rmasn,td h eirasen
emergeipnigd eomfsi icm idliasrei anns oen -alccoonhsoulm ers,
particruellaatrtoloe ybd e ys.Ri etcognoifct hiroonh neipca tBiatniCds
iism provwiintmgho, r pea tireenctesi avnitnigvt ihreparyTla.h iisas
particduylnaarmalirycew ai th tnheewr aepmieersgq iunigrt eeg ullya.r
Ther evioeftw h etsoep iipcsis t cahtue ndd ersttahnmedo isntg
importanwti tihtsihsneuc sehesr olniivdcei rs eases.
Increnausmibnegor fps a tiaernuetn sd ergloiivfneugrn cttieosnt s and
ultraesvoanliucao tfti hloeine vr r,e sulitnti hniegd entifoifc ation
abnormatlhianttei eetdsob ep uitn tpoe rspeWceth iavvgeei. v tehni s
clinsicceanlac roinos idaetrtaebnlateswi eob ne,l iev� et haitnt his
situaqtuiioacnck c etsoas c ommon-saepnpsreot aoc hi nvesotrai gation
simpelxep lanwaitlbileoo nfb enefit.
Att hoet heenrod f t hsep ectmraunmny,o n-speacnipdar liimsatrsy
carpeh ysiacrieeann cso untpeartiinegn thsa vbweeh eorn e cipoife nts
livterra nspWlead netasl. s woimtoehft hceo mmoner ascsloicniiactaeld
probltehmamsta yn eeadt tentiocno mimnuy n.ti hte
Weh ope ytohua twf iinltdlh is hbeolopkf ul.
5

Livdeirs oradreeern sc ounftreerqeudie nngt elnyep rraalc tRieccee.n t
datsau ggtehsa5tt. m 5i llAimoenr ichaanvcseh rolniivdcei rs eAats e.
leasto fa1 s y%m ptopmaattiiwecin hltalsv eel evaltiveteder rs ets ults,
althotuhgiehn cidoefan bcneo rrmeasluv latrsci oenss iderably with
thpeo pulasttiuodnTi heegd o.a olfts h peh ysisci inavne'stigation
arteou nderstthaoenr di ogfitn hl ei vienrjy u,t roc orrietccsat u se
antdo p revpeenrtm anoerngtda yns fun(c.iteci.io rnri hsAo)ns.
organaipzperdo taoic nhv estigaatbinnogr mlaaillviletortiw heses
physitcori eaancc ohn clupsrioomtnplsay n,ad voiedxsc escsoisvte
orr itsokt hpea tient.
Acultveie irn rjiues
Acultie vienrj uarrideee sf ibnyeh de patolaostg hioststhesar te solve
with6i mno nthPast.i weinttahsc ultiev deirs etayspei chaalvley no
previhoiussto oflr iyv ienurjr yT.h emya yc omploaffi ant iagnuoer,e xia,
malaainsddei scomifnto hrreti guhptp qeura dr�aft nhtae b domen.
Jaundmiacybe es e'eanntde ndheerp atomeelgiaclAiyct uetde. liver
inujri(ees.v gi.rh aelp atitist,o a t eoxxpiomnse udorirec attyipoinc)a lly
resoolnvcteeh oef fenadgieningrst e movoertd h vei rianlf ection
resolavneudss ,u atlhleyar rene o s equeOlcacea.s liyoh,no awle,vl eirver
inujriyss o s evetrheat th e padtoieneson htta veen ouhgehp atocytes
remaitnoia nlglf oowhr o meos-taac soinsd ictailoflnue ldm inant
hepaftaiiclo urar ceu ltievf eari l(usrpeeae g 2e0 ).
Chornilci vienrji uesr
Thep rimcaarrype r ovimdoeroref teennc ounctherrosrn aitcht,eh ra n
acultiev,de irs ePaastei.te ynptiscp arlelswyei ntfthe swy mptoamnsd,
diagnioossn ti hse boafas binso rbmlaolro eds uolnrt osu tine
examinaTthiemoyan y.c omploaffi ant iagnudme a laise. The examiner
mayf ind sticghmraotlnaii vdcoei frs easea,sg ysnueccho msapsitdiear,
nevtie,l angiaencpdta alsmeiarary thTehmela i.v ieusrs uaelnllya rged
anmda yb ef iramt ;e ndleirvi eusrn commIofan d.v anlcievddei rs ease 7
FaFsatc LtisvD:eio rsr ders
hadse vel(oep.egd. s i)css,iir gronhfpso o rthaylp ertesnuscihoc naa,ps u t
medusoarae s cimtaeybs e,p resent.
Hsitory
Asw itahl l mecdoincdailti itov niistst,a oo l b taati nh oroaungdh
accurhaiotsretyW .i th retsolp ievcetr idtin seiecsaes sets,oa ry
deterimfi nteh erhei sitosof jr aaynu yn dRiicsfeka. c tfoorvrsi ral
hepatiintcilpsur dietor ra nsfmuuslitoinp,l e sextuaatlt opoa rtners,
applicaantndie oends lhea rAilncgo.h oofcl o,u risasec ,o mmohne patic
toxiannp,dh ysimcuisabtnea s d eaptdt e termaip naitnigea nltc'osh ol
consumpUtnifoonr.t u,tn haiitsssei lgynifmiocradeni tflfyti oc ult
accompilnpi rsahc tthiacinent heoArlyc.o hoilasid sims eoafds een ial,
anmda npya tiweinnltolsat d mtioto, re verne alhiozwme u,c ahl cohol
they consume.
Medicamtaiyoa nlssc oa use dlisievsaeoisr te i, mi pso rttoa nt
deterwmhiincmehe dicaatp iaotnisiet sna tk ianngpd,a rtictuhloasrel y
temporraelllatytot e hdde e velopomfte hnleti vdeiorsr d.Se ormoev er­
the-comuendtiecra atnihdo enrsbr aelm edhiaevse alrseop obreteend
toc aulsiev aebrn ormalitiemso.sh teA plattthoioxcuia gnrhnse o
longceorm moinnt hweo rkplaoccec,u paanth iiosntmaoalryr y e veal
releevxapnots ures.
A famihliys tooflr iyvd eirs eiaessq eu ailmlpyo rtIanon utr.
experitehnec el ivetrh amdtoi sscteo mamsoen cllyu sitnaef rasm iilsy
alcohloilvdieicrs e(aAsLe)Db ,u ott hdeirs esausceahssW ilsodni'sse ase
anhde mochrom(aesteCo hsaipst6 e,Mr e tabloilvidecir s eassheosu)l d
bec onsidered.
Livteers ts
Liveenrz ymTehsel. i vteyrp icraelslpyot noid nsj ubryry e leasing
enzymfersoh me patoacnydt/ebosir l ieapriyt heliuml.e vEoelfle sv ated
enzymoefhs e patocoerlilgusilunaca,rhsa sparatmaitneo stfrearnase
(ASaTn)d a lanaimnien oterraan(ssAefL Ts)u,g gestt oi njury
hepatoEclyetveasti.in ao lnksa plhionsep hsautgagsieenus jrtty o
strucotfut rhbeeis l itarreye .
ASTi asm itochondrifaolu inedntn hzleyi mvaeen rod t hteirs sues,
8 sucahss kelaentmda ylo carmduisaclAl LTe i.as c ytopleanszmyimce