Gastrointestinal Disorders 2: Liver

What are the tests to identify hepatobiliary function?

   1.   Bilirubin Levels

Normal serum bilirubin levels: 1.2mg/dL

Jaundice serum bilirubin levels: 2.0mg/dL (severe jaundice 30mg/dL)

   2.   Liver Enzymes

  i. Aminotransferases and aspartate aminotransferase are liberated into the blood whenever liver cells are damaged.

 ii. Alkaline phosphatase is the main indicator for biliary obstruction

iii. Gamma glutamyl transferase increases as a sensitive indicator of liver abnormality

   3.   Plasma Protein

  i. Albumin

 ii. Coagulative factors

iii. Prothrombin

Liver Cirrhosis

Liver cirrhosis is the necrosis, fibrosis and conversion of the normal liver architecture into abnormal nodules. There are three types of cirrhosis:
  1. Post-Necrotic Cirrhosis (follows hepatitis)
  2. Biliary Cirrhosis (follows obstruction)
  3. Alcoholic Cirrhosis
Below is a summary of the stages of alcoholic cirrhosis:
  1. Fatty liver: accumulation of fat in liver cells causes enlarged liver, with reversible damage, fatigue, vague abdominal discomfort and pain when consuming high fat foods and alcohol
  2. Alcoholic hepatitis: inflammation and necrosis of liver cells which can be reversible, is either symptomatic or asymptomatic with hepatic tenderness, anorexia, nausea, fever, jaundice and ascites
  3. Cirrhosis: necrotic cells are replaced by fibrous scar tissue, liver shrinks, surface becomes bumpy and nodular, blood flow through liver is obstructed
NOTE: NAD is a cofactor required for alcohol and fat metabolism. In alcoholic cirrhosis, NAD is used more for alcohol metabolism, meaning there is a fat build up in the liver. Alcohol metabolism leads to acetaldehyde production, which stimulates collagen synthesis (causes obstruction).

Manifestations of cirrhosis:
  • Jaundice
  • Portal hypertension
  • Ascites
  • Oedema
  • Anorexia
  • Weight loss
  • Abdominal pain
  • Oesophageal varices and haemorrhoids
  • Fatty stools
  • Anaemia due to splenomegaly
  • Pruritus (itchy skin)
  • Hepatic coma

Liver Cancer

Liver cancer may be metastatic or primary, although they are more commonly metastatic. The tutors are drained by the portal vein and may produce diffuse, fine granular calcifications.

Cause: alcoholic cirrhosis, post-necrotic cirrhosis, chronic HBV/HCV

Symptoms: weakness, anorexia, weight loss, fatigue, bloating, abdominal fullness, abdominal pain and jaundice

Diagnosis: CT and MRI

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