women of WisdoM by Dr Rajesh Jain.pptx

it is a presentation of medicine.

1. women of WisdoM Dr Rajesh Kumar Jain, MD Medicine Director : N.T.R. Hospital and Research Centre Founder : Mahaveer Institute of Medical Sciences and Research, Bhopal.

2. Topic : Management of Liver Diseases

3. INTRODUCTION The liver is the largest internal organ in our body, located mainly in the right upper side of the abdomen. It performs many vital functions, such as - D etoxification Helping in digestion, especially of fats Storing vitamins, minerals, and sugar Producing important proteins and bile Thus, a healthy liver is very important for a healthy life.

4. The liver is the largest internal organ of the human body. Weight: About 1.4–1.6 kg in adults. Color: Reddish brown Location: Right upper abdomen, just under the diaphragm. Structure: Divided into two lobes (right and left). Covered partially by ribs for protection It is called the " Chemical Factory " of the body. Importance : If the liver fails (Fulminant Hepatic failure) life can not be sustained for more than 1–2 weeks without intervention.

5. ANATOMY AND BLOOD SUPPLY Gross Anatomy: Right, Left, Caudate, and Quadrate lobes. Microscopic Anatomy: Hepatic lobules centered around a central vein, surrounded by portal triads (portal vein, hepatic artery, bile duct). Blood Supply: Portal Vein (nutrient-rich, low oxygen blood) Hepatic Artery (oxygen-rich blood)

6. Vitamins : Help the fat soluble vitamin absor p tion (A,D,E,K) and B 12 . Protein synthesis : Liver synthesi zes vital proteins like albumin, clotting factor s, globulin, acute phase reactants , etc Cholesterol synthesis : Liver is the pri mary site of lipid metabolism. Cholesterol like LDL, HDL, VLDL, IDL , are all cycled in the liver and is an essential part of hormone production ( li ke angiotensinogen, IGF , Vitamin D synthesis) and bile. Hormone regulation : The Liver breakdown and remove excess hormone like insulin, estrogen and thyroid hormone. Detoxification : The Liver removes harmful substances (toxin, drugs, alcohol) from the blood by conjugation and urea cycle Metabolic Processes : Metabolism of protein, carbohydrate and fat. RBC breakdown - Heme metabolism FUNCTIONS OF LIVER

7. HEME METABOLISM

8. PATHOPHYSIOLOGY OF LIVER INJURY Initial hepatocellular injury → Inflammation → Activation of hepatic stellate cells → Fibrosis → Architectural distortion → Cirrhosis. Key mediators: Transforming Growth Factor-beta (TGF-β), Platelet-Derived Growth Factor (PDGF). Progressive Portal Hypertension results from increased intrahepatic resistance and splanchnic vasodilation.

9. Unknown cause

10. COMMON LIVER DISEASES Hepatitis – Inflammation of the liver, often due to viruses like Hepatitis A, B, or C. Causes : Viral infection (Hepatitis A, B, C, D, E), Alcohol, Autoimmune reaction, Drugs. Types : 1. Hepatitis A (HAV) Cause: Hepatitis A virus Spread: Fecal-oral route (contaminated food/water) Nature: Acute, self-limiting (gets better on its own) Prevention: Vaccine available 2. Hepatitis B (HBV) Cause: Hepatitis B virus Spread: Blood, sexual contact, mother-to-child Nature: Acute or chronic (can lead to cirrhosis, liver cancer) Prevention: Vaccine available

11. 4. Hepatitis D (HDV) Cause: Hepatitis D virus Spread: Needs Hepatitis B to infect (co-infection/superinfection) Nature: Makes Hep B infection worse Prevention: Indirectly prevented by Hep B vaccine 5. Hepatitis E (HEV) Cause: Hepatitis E virus Spread: Fecal-oral route (contaminated water) Nature: Acute; dangerous in pregnant women Prevention: No vaccine

12. 2. Fatty Liver Disease – Fat accumulation in the liver, especially in obese or diabetic people. Non-Alcoholic Fatty Liver Disease (NAFLD): Fat deposits in liver without alcohol use. Related to obesity, diabetes, metabolic syndrome. 3. Alcoholic Liver Disease (ALD): Due to excessive alcohol consumption also leading to alcoholic liver cirrhosis or end stage liver disease.

13. 4. Liver Cirrhosis Definition: Liver Cirrhosis is a chronic liver disease characterized by the progressive replacement of normal liver tissue with scar tissue (fibrosis), which disturbs the normal structure and function of the liver , unable to perform essential functions, such as detoxifying chemicals, metabolizing nutrients, and producing proteins necessary for blood clotting. Pathophysiology : 1. Chronic Liver Injury: Cirrhosis begins with chronic liver damage caused by factors like alcohol, hepatitis, fatty liver, or autoimmune diseases. The liver cells continuously get injured. 2. Inflammation: Ongoing liver damage triggers inflammation. Inflammation is the body’s attempt to heal the damaged tissue, but over time it causes fibrosis (scar tissue formation).

14. 3. Fibrosis and Scar Tissue Formation: In response to repeated injury, the liver tries to repair itself by forming scar tissue (fibrosis). The scar tissue gradually replaces the healthy liver cells, and the liver loses its ability to function. 4. Formation of Nodules Regeneration of liver cells leads to the formation of small nodules within the liver. These nodules are surrounded by scar tissue. As the liver becomes more fibrotic, it becomes hard and lumpy, disrupting blood flow. 5. Portal Hypertension: The scar tissue obstructs blood flow through the liver, causing portal hypertension (high blood pressure in the portal vein, which carries blood to the liver). This results in the enlargement of veins (varices) in the esophagus and stomach, which can rupture and cause severe bleeding. 6. Decreased Liver Function: As cirrhosis progresses, the liver's ability to perform vital functions like detoxification, protein production, and bile secretion is reduced, leading to symptoms like jaundice (yellowing of the skin and eyes), fatigue, and confusion.

15. 5. Liver Cancer (Hepatocellular Carcinoma) Primary liver cancer mostly arises in patients with cirrhosis. Risk factors: Chronic Hepatitis B and C, alcoholism. 6. Acute and Chronic Liver Fail ure Failure of liver functions leading to multiple organ dysfunction. 7. Liver Abscess Pus formation due to bacterial, amoebic, or fungal infection. 8. Coagulopathy (Bleeding Tendency): Decreased clotting factor production. Causes easy bruising and bleeding. 9. Infections: Increased susceptibility to infections, especially spontaneous bacterial peritonitis (SBP).

16. Symptoms of Liver Disease Fatigue – Feeling very tired and weak even without much activity. Jaundice – Yellowing of the skin and eyes due to a buildup of bilirubin Abdominal pain – Especially on the right side where the liver is located. Swelling in legs and ankles – reduction of albumin leads to decreased oncotic pressure Dark urine – Urine may appear darker than usual. Pale or clay-colored stools – stool may lose its normal brown color (post hepatic jaundice) Nausea and vomiting Loss of appetite / weight loss - poor digestion and ascites Itchy skin – Because of bile products building up under the skin. Easy bruising and bleeding – Because the liver isn’t making proteins needed for blood clotting factors

17. Mental confusion - hepatic encephalopathy in advanced liver disease or cirrhosis due to accumulation of ammonia - impaired urea cycle Esophageal and anal varices Upper GI bleed / Hematemesis - leading to shock and death Cirrhotic facies - muscle wasting , ascites , dry skin and facial and nail changes , muddy skin, spider angiomas Important: Sometimes, liver disease shows very few symptoms until it becomes serious. That’s why regular checkups are important if someone is at risk (e.g., heavy alcohol use, hepatitis infections, obesity, etc.).

18. Diagnostic Investigations Liver Function Tests (LFTs) : ALT, AST, ALP, GGT, Bilirubin ( direct/indirect) , Albumin, globulin levels, T otal protein Serology: Viral markers - Hepatitis B Surface Antigen [HBsAg], Anti-Hepatitis C Virus Antibodies [Anti-HCV] , Anti- HAV. Autoantibodies: Antinuclear Antibody (ANA), Antimitochondrial Antibody (AMA), Smooth Muscle Antibody (SMA). Specific T ests: Ceruloplasmin (for Wilson disease), Serum Ferritin (for Hemochromatosis) Tumor Markers: AFP (Alpha-Fetoprotein) for liver cancer

19. IMAGING: USG: First-line to assess liver size, texture, and lesions. CT Scan / MRI: Detailed evaluation of liver and vascular structures. Transient Elastography (FibroScan): Non-invasive liver fibrosis measurement. INVASIVE: Liver Biopsy: Gold standard for definitive diagnosis.

20. Management of Liver Diseases Lifestyle Changes Stop alcohol completely. Healthy, low-fat diet. Maintain ideal body weight. Regular exercise. Control diabetes, cholesterol. Medical Treatment Diuretics for ascites (e.g. Furosemide, Spironolactone). Steroids for autoimmune hepatitis. Antivirals for Hepatitis B, C (e.g., Tenofovir, Sofosbuvir). Lactulose for hepatic encephalopathy. Vitamin K for bleeding issues. Antioxidants and hepatoprotective drugs. Surgical Treatment Liver Transplantation:For patients with irreversible liver failure.Liver is replaced with a healthy donor liver.

21. Specific Disease Management 1. Viral Hepatitis: Hepatitis B: Antivirals like Tenofovir or Entecavir. Hepatitis C: Direct-Acting Antivirals (DAAs) such as Sofosbuvir and Daclatasvir — achieving >95% Sustained Virological Response (SVR). 2. Alcoholic Liver Disease: Complete abstinence from alcohol. Corticosteroid therapy (for Maddrey's Discriminant Function [MDF] >32). Nutritional therapy, Vitamin B1 (thiamine) supplementation. 3. Non-Alcoholic Fatty Liver Disease (NAFLD)/Non-Alcoholic Steatohepatitis (NASH): Weight reduction (7–10% body weight loss recommended). Control comorbidities (Diabetes Mellitus [DM], Dyslipidemia). Investigational therapies: Glucagon-Like Peptide-1 (GLP-1) receptor agonists like Semaglutide.

22. 4. Cirrhosis: Salt restriction (<2 g/day). Diuretics (Spironolactone and Furosemide combination) for ascites. Non-selective Beta Blockers like Propranolol or Carvedilol for variceal bleeding prevention. HCC surveillance: USG + AFP every 6 months. 5. Hepatocellular Carcinoma (HCC): Curative options: Liver resection, Liver transplantation (following Milan Criteria). Non-curative options: Transarterial Chemoembolization (TACE), Radiofrequency Ablation (RFA), Systemic therapies (Atezolizumab + Bevacizumab).

23. Liver Transplant Indications: End-stage cirrhosis, liver failure, hepatocellular carcinoma. Donor : Living donor (part of liver) or deceased donor. Outcome: Survival rate is over 80% at 5 years post-transplant. Challenges: Organ shortage High cost Risk of rejection and infections

24. Prognosis Early-stage liver diseases can be reversible with proper treatment. Late-stage diseases (like cirrhosis) may need transplant or lifelong care. Early diagnosis = Better outcome.

25. Conclusion The liver plays a central role in maintaining health. With the increasing prevalence of liver diseases worldwide due to changing lifestyles, alcohol use, and infections, it is crucial to raise awareness about liver health. Early detection, effective management, lifestyle modifications, and preventive strategies can save countless lives. Public health programs should promote hepatitis vaccination, alcohol control, and education about healthy living to reduce the burden of liver diseases.

26. “Healthy Liver, Healthy Life!”. THANKYOU!