GASTROINTESTINAL DISORDERS

Liver disorders

Prof Dr Besim Prnjavorac

SSST

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• Normal liver structure
and function
•V. Portae goes from
peripherial part, v.
Centralis in the midle of
liver lobul
•Liver lobul – anatomical
and functional part of
the liver.

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Liver metabolism


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Production and
secretion of bile
acids (A)

• Protein synthesis
in liver (B)

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Physiological liver
functions

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Patterns of liver injuries

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Liver diseases

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Liver metabolism
(hereditary disorders)


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Pathophysiological
bases of symptoms
and signes of liver
disorders

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Clinical classification of
liver injury – according
to severity

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Bilirubin secretion

• Possible
impairment
•MF by phagocytosis
ingests Hb
brakedown products
• No glucuronil
transferase (Gylbert
syndrome),
hepatocytes
incapacity to trap
and adsorb bilirubin,
cholestasis...

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 Liver metabolism
 Enterohepatic
circulation of bile acids

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Liver metabolism –
enterohepatic
circulation of bile
acids


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Laboratory exams in jaundice

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Pathogenesis of
jaundice

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Mechanism and
consequences of
jaundice
 Yelllow colored skin
and sclera
Ichting – pruritus
 Loss of appetit

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Jaundice (icterus)
Types of jaundice

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Different type of viral hepatitis

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Different type of viral hepatitis (ctnd)
A – B - C– D - E

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•Patterns of hepatitis
marker appearance

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Drug induced liver damage
A)Disruption of Ca turnover.,
disruption of actin
fibrile, .¸blebing of cell
membrane. Cell lysis
B)B)Disruption of actin
flaments to next canaliculus-
portion of bile excretion
C)Covalent binding of
Cytochrome P-450 , become a
non functional
D)Migration of drug-enzyme
adducts to cell surface, and
serve af immunogen...T-cell
involved
E)Activation of appoptotic
pathway with TNF
F)F inhibition of mitochondrial
function
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Drug indiosincrasia – liver manifestations

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LIVER CIRRHOSIS
Liver cirrhosis main
patterns of tissue
damage

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Structure of normal and injured liver

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Liver cirrhosis

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Whole body
manifestation of liver
cirrhosis

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Fibrosis and cirrhosis
of the liver


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Liver failure – causes
and consenquences


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Cystic fibrosis


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Ascites formation

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Ascites formation


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Ascites formation


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Portal hypertension

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 Hepatorenal Syndrome

• Renal failure after liver failure

• Decrased of renal blood flow
• Decreases blood flow in glomerulis
• Decreased glomerular filtration rate

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 Other manifestation of liver injury (failure)

• Ascites
• Posibility of spontaneus peritonitis
• Portal hypertension
• Hypoalbuminemia - hypoproteinemic edema
• Coagulopathy
• Hepatic encephaopathy
• Splenomegaly and hypersplenism (no the same)
• Hepatocellular carcinoma
• Pulmonary manifestation – hepatopulmonary syndrome
• Portal hypertension
• Esophageal varices (other, hemorhoidal, caput medusae...)
• Gynecomastia
• Spider nevi, Contractura Düpytren, ...

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