THE LIVER:

A METABOLIC FACTORY

KAZI TOWFIQUL ISLAM

ID : 0423022303

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DEFINITION

The largest solid organ, a half-moon-shaped

organ, vital to the body’s metabolic functions
and immune system , weights around 3
Pounds and occurred more than 500
metabolic functions.
[Source: Healthline]

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ANATOMY

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 Catabolism of certain substances
Control of Energy Metabolism
Detoxification process
Storage of fat-soluble vitamins and minerals such as copper and iron
Bile Production, Secretion and storage in gallbladder
FUNCTION Protein Metabolism
Anabolism of Immune system’s substances
Source of Information:
Production of Blood clotting formation’s protein
1. BYJUS Catabolism of RBCs
Albumin Production
2. Columbia Surgery
Blood Filtration
3. Healthline Control of Glucose
Resistance of Infections
Regeneration Power
Absorption of Bilirubin
Metabolization of Fats
Carbohydrate Metabolization
Angiotensinogen Synthesis

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DIETS AND FOODS FOR
HEALTHY LIVER
(SOURCE: HEALTHLINE)

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 Coffee Tea Grapefruit Blueberries Prickly Beetroot Nuts Fatty fish Olive oil
and pear juice
cranberries
1. To Promote To reduce 1. To contain 1.To contain To protect the 1. A source of 1.Rich in 1. To lower To
liver health. levels of antioxidants such antioxidants such liver from nitrates and several key liver fat associate
liver as naringenin as anthocyanins alcohol antioxidants nutrients and with a
2 To help reduce enzymes in and naringin. toxicity, with such as triglycerides reduced
the risk of NAFLD 2. To take as a its anti- 2. To reduce healthy in those with risk of fatty
cirrhosis, liver patients 2. To reduce the supplement for inflammatory oxidative fats, NAFLD or liver in
cancer and liver through development of six and damage and antioxidant nonalcoholic older
damage. Green tea. hepatic fibrosis, months improved antioxidant Liver s, vitamin steatohepatiti adults.
( A review inflammation and hepatic steatosis properties. inflammation E, s. And less fat
3. Source of the study of protecting cells. and NAFLD beneficial accumulati
antioxidant 2020) patients plant 2. To contain on in the
Glutathione. compounds omega-3 fatty liver and
. acids, healthy improved
4. Positive fats and help blood
effects on liver 2. To to reduce levels
disease and reduce risk inflammation of liver
inflammation of NAFLD. enzymes.

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LIVER DISEASES

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 LIVER DAMAGES

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 DISEASES DEFINITION CAUSE SYMPTOMS DIAGNOSIS TREATMENT
NAME AND
PREVENTION
The healthy tissue of The most common Appetite loss, 1. Liver biopsy (Gold 1. Antifibrotics
Liver Fibrosis liver becomes scarred cause of liver fibrosis difficulty thinking Standard) (cenicriviroc,
and is nonalcoholic fatty clearly, fluid buildup 2. Transient elastography emricasan,
cannot work as well liver disease in the legs or stomach, 3. Nonsurgical tests (an losartan and
(NAFLD), while the jaundice, nausea, aminotransferase-to- liraglutide)
second is alcoholic unexplained weight platelet ratio (APRI) 2. Liver transplant
liver disease due to and loss weakness and a blood test called
long-term excesses of FibroSURE)
drinking alcohol.

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DISEASES NAME DEFINITION CAUSE SYMPTOMS DIAGNOSIS TREATMENT
AND
PREVENTION
Cirrhosis The severe scarring or 1. Alcohol Mild: TEST: 1. Medications (beta-
fibrosis of the liver 2. Hepatitis Decreased appetite 1. A complete blood blockers or nitrates)
3. Nonalcoholic Fatigue, unintentional count 2. Lifestyle changes
fatty liver disease weight loss, mild pain 2. Coagulation 3. Surgery (Liver
4. Nonalcoholic on the upper right side blood tests transplant)
steatohepatitis of your abdomen, 3. Albumin tests
5. Hepatitis D nausea, vomiting 4. Liver function
6. Damage to the and swollen veins tests
bile ducts 5. Upper endoscopy
7. Disorders that Severe: 6. Ultrasound scan
affect the body’s Jaundice, confusion 7. MRI
ability to handle and difficulty thinking 8. CT scan
iron and copper clearly 9. Liver biopsy,
8. Medication very itchy skin,
abnormal color of
urine, ascites and
edema.

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 DISEASES NAME DEFINITION CAUSE
Liver Inflammation Liver cells are damaged 1. Alcohol use disorder
(Hepatitis) 2. alpha-1 antitrypsin
deficiency,
3. Autoimmune disorders
4. Decreased blood flow to
the liver
5. Drugs or toxins
6. Hemochromatosis
7. Non-alcoholic fatty liver
disease (NAFLD)
8. Obstructive jaundice
9. viral infections,
including hepatitis
viruses, Epstein-Barr
virus, and herpes
simplex virus
10.Wilson’s disease
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SYMPTOMS
Severe:
Abdominal swelling or
distention , bloody or black
vomit, confusion, delirium,
lethargy, hallucinations, or
delusions, seizures and
severe abdominal pain
TREATMENT
AND
PREVENTION
1. Drinking plenty of fluids
2. Getting rest
3. Stopping alcohol use
4. Stopping medications
that may damage the
liver, such as
acetaminophen (Tylenol)
5. Stopping medications
that increase your risk of
bleeding, such as aspirin
6. Taking antiviral drugs
for the treatment of
some forms of viral
hepatitis.
11
 DISEASES DEFINITION CAUSE SYMPTOMS DIAGNOSIS TREATMENT
NAME AND
PREVENTION
Hepatic A decline in brain 1. Infections such Moderate – 1. Blood tests - Red 1. Lower protein
Encephalopathy function that as pneumonia Difficulty thinking, blood cells, white diets
occurs as a result 2. Kidney problems personality changes, blood cells, and 2. Medications -
of severe liver 3. Dehydration poor concentration, platelets. Antibiotics and
disease. 4. Hypoxia problems with hand 2. Imaging tests - CT lactulose
5. Recent surgery or movements, confusion, scan or MRI (Enulose), a
trauma forgetfulness, poor 3. Liver function synthetic sugar.
6. Medications related judgment and a musty tests - enzyme 3. Liver transplant
to immune system or sweet breath odor. levels.
and central nervous
system, such as Severe –
barbiturates Confusion, lethargy,
or benzodiazepine anxiety, seizures, severe
tranquilizers personality changes,
7. Higher protein fatigue, confused
digestion speech, shaky hands and
8. Electrolyte imbalance slow movements.

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 HEPATITIS

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DISEASES DEFINITION CAUSE SYMPTOMS DIAGNOSIS TREATMENT
NAME AND
PREVENTION
Hepatitis A A viral infection 1. Hepatitis A virus 1. Light-colored A blood test for 1. Avoid alcohol
causes (HAV). stool viral infection 2. Maintain a balanced diet
inflammation of 2. Sewage-contaminated 2. Dark urine 3. Drink plenty of water
the liver raw shellfish 3. Loss of appetite 4. Limit the use of over-the-counter
3. Intercourse with 4. Unexplained medications
someone who has the weight loss
hepatitis A virus 5. Jaundice
4. Polluted water

Hepatitis B Same 1. Hepatitis B virus 1. Fever. 1. A blood test for Prophylactic treatment
(HBV) 2. Loss of appetite. viral infection I. Vaccination
2. Childbirth. 3. Nausea and 2. liver biopsy II. Hepatitis B immune globulin (HBIG)
3. Sexual contact. vomiting. Acute treatment
4. Contact with an open 4. Abdominal pain. III. IV fluids.
wound. 5. Weakness and IV. IV nutrition.
5. Sharing needles or fatigue. V. Pain relief.
syringes. 6. Joint pain. Treatment for chronic infection
6. Sharing a toothbrush 1. Surveillance - Blood tests, imaging
or razor. tests. and elastography.
7. Accidental stick from 2. Medication - Immune modulator drugs
an infected sharp and Oral antiviral medications.
instrument. 3. Lifestyle changes
4. Surgery
Prevention - Safe intercourse and
Prophylactic treatment.
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DISEASES DEFINITION CAUSE SYMPTOMS DIAGNOSIS TREATMENT
NAME AND
PREVENTION
Hepatitis C Same as Hepatitis 1. Organ 1. Acute hepatitis C 1. Blood tests 1. Medications –
A transplants Fever, lingering fatigue, joint pain, nausea or 2. Genotype Zepatier,
2. Sharing items, stomach pain, loss of appetite, dark urine, gray test Harvoni,
like razors. or pale stools and jaundice. 3. Liver Epclusa, Vosevi
3. Sharing needles 2. Chronic hepatitis C function test and Mavyret.
4. Childbirth Persistent tiredness, unwellness, joint and 4. Liver 2. Liver transplant
5. Sexual contact muscle aches and pains, unexplained weight biopsy
6. Getting a tattoo loss, mood changes, indigestion, bloating, and 5. Hepatitis C
with nonsterile stomach pain, itchy skin, jaundice, dark urine, antibody
equipment difficulty sleeping, confusion and trouble with test
7. Hepatitis C memory and concentration. 6. HCV RNA
virus (HCV) test,
Hepatitis D Same 1. Hepatitis D Yellow skin and eyes (jaundice), stomach Imaging tests 1. Pegylated
Virus (HDV) upset, pain in your belly, throwing up, fatigue, interferon alfa
2. Co-infection joint pain, dark urine and light-colored stool. (peg-IFNa)
( HBV and medications
HDV) 2. HBV vaccine
3. Super-infection Prevention – Don’t
– First attack share needles and
HBV, later wear Gloves
attack HDV.

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 DISEASES DEFINITION CAUSE SYMPTOMS DIAGNOSIS TREATMENT
NAME AND
PREVENTION
Hepatitis E A virus infects our 1. Hepatitis E Virus (HEV) Mild fever, feeling 1. Blood test 1. Rest
liver 2. poor handwashing habits very tired, less hunger, 2. Stool test 2. Eat healthy foods
3. Lack of clean water throwing up, belly 3. Drink lots of
4. Undercooked meat from pain, dark pee, light- water
infected animals, such as colored poop, skin 4. Avoid alcohol
pigs or deer. rash or itching, joint
5. Raw shellfish that comes pain and yellowish
from tainted water skin or eyes.
Hepatitis G Hepatitis G 1. Hepatitis G Virus (HGV) Similar to the other Currently no
(sometimes called 2. Injecting drug users hepatitis viruses (A, recommended
HGV, GB virus C 3. Recipients of infected blood B, C and E) treatment
or GBV-C) can or blood products
cause severe liver 4. Haemodialysis patients. Prevention - clean,
disease sterile needles and
avoid sharing needles,
syringes or other drug-
use equipment

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 DISEASES DEFINITION CAUSE SYMPTOMS DIAGNOSIS TREATMENT
NAME AND
PREVENTION
Autoimmune A chronic liver 1. A family history of AIH Fatigue, joint pain, 1. Blood tests 1. Immunosuppres
hepatitis disease which 2. A history of bacterial or viral nausea or Anti-smooth muscle sant drugs
(AIH) occurs when your infections vomiting, jaundice, antibody (ASMA), anti-liver 2. Corticosteroid
body’s immune 3. Being a cisgender female, or urine becoming kidney microsome type I medications
system attacks being assigned female at birth darker, stool antibody (anti-LKM1), anti- 3. Liver transplant
liver cells 4. Using certain medications becoming lighter nuclear antibody (ANA) and
(minocycline, nitrofurantoin). and skin irritation. immunoglobulin G (IgG)
5. Several HLA genotypes, antibodies
encoding major 2. Liver biopsy
histocompatibility complex
proteins, increase the risk of
developing AIH
Alcoholic An inflammatory Heavy alcohol consumption Dry mouth, weight 1. Complete blood count 1. Getting support
hepatitis condition of the loss, nausea and (CBC) for quitting
liver caused by vomiting, swelling 2. Liver function test drinking
heavy alcohol in the abdomen, 3. Blood clotting tests 2. Taking
consumption over jaundice, fever, 4. Abdominal CT scan medication
an extended confusion, fatigue 5. Ultrasound of the liver 3. Trying vitamin
period of time and easy bleeding. 6. Liver biopsy and nutrient
supplements
4. A liver
transplant
5. Counseling

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FATTY LIVER DISEASES (HEPATIC STEATOSIS)

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 DISEASES DEFINITION CAUSE SYMPTOMS DIAGNOSIS TREATMENT
NAME AND
PREVENTION
Non-alcoholic Drinking too much Lifestyle Abdomen pain, fatigue, 1. A standard blood test 1. Weight loss
Fatty Liver alcohol over a long factors weight loss, ascites, edema 2. An ultrasound of the liver 2. A nutrient-dense diet full
Disease period of time can and jaundice 3. Transient elastography of vegetables, fruits, and
(NAFLD) cause a buildup of fat 4. Liver biopsy whole grains
in our liver. 3. Avoid unhealthy fats,
Nonalcoholic alcohols and added sugars
steatohepatitis 4. Physical activity
(NASH) – 5. Control of cholesterol
Severe Form and blood glucose levels
Alcohol- Being caused to the 1. Family Nausea, loss of appetite, 1. Complete blood count 1. Alcoholic
Related Liver liver damage from history of jaundice, fatigue, (CBC) rehabilitation program
Disease years of excessive ARLD abdominal discomfort, 2. Liver function test 2. Multivitamins – B
drinking 2. Drink increased thirst, swelling in 3. Abdominal computed complex
Alcoholic heavily the legs and abdomen, tomography (CT) scan 3. Liver transplant
steatohepatitis 3. Poor weight loss, darkening or 4. Abdominal ultrasound 4. Vitamin A
(ASH) - nutrition lightening of the skin, red 5. Liver biopsy supplements
Excess fat hands or feet, dark bowel 6. Liver enzyme tests -
movements, fainting, Gamma-
unusual agitation, mood Glutamyltransferase
swings, confusion, bleeding (GGT), Aspartate
gums and enlarged breasts Aminotransferase (AST)
(in men). and Alanine
Aminotransferase (ALT)

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LIVER CANCER

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DISEASE DEFINITION CAUSE SYMPTOMS DIAGNOSIS TREATMENT
S NAME AND
PREVENTION
Liver Primary liver cancer 1. Pediatric age Abdominal discomfort, 1. Liver function tests 1. Partial hepatectomy
Cancer begins in the cells of 2. Heavy alcohol pain, and tenderness, 2. Alpha-fetoprotein 2. Liver transplant
the liver. Secondary use jaundice, pale, chalky (AFP) test 3. Ablation
liver cancer develops 3. Smoking stools and dark urine, 3. Imaging tests - 4. Radiation therapy
when cancer cells 4. Aflatoxin nausea, vomiting, loss Abdominal 5. Targeted therapy - Tyrosine
from another organ exposure of appetite, bruising or ultrasounds, CT kinase inhibitors (TKIs)
spread to the liver, or 5. Anabolic steroid bleeding easily, scans, or MRI scans medications susc as,
metastasize. use weakness, fever and 4. Liver biopsy -Needle cabozantinib (Cabometyx
unexplained weight loss biopsy, Laparoscopic or Cometriq), lenvatinib
biopsy and Surgical (Lenvima) and regorafenib
biopsy (Stivarga).
5. Liver cancer 6. Embolization
screening -ultrasound 7. Chemoembolization
imaging and blood 8. Radioembolization
tests. 9. Chemotherapy
10. Immunotherapy

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DISEASES DEFINITION CAUSE SYMPTOMS DIAGNOSIS TREATMENT
NAME AND
PREVENTION
Hepatocellular Making it the 1. Hepatitis B or Abdominal pain, 1. Blood tests – AFP test 1. Radiation therapy
Carcinoma second leading hepatitis C and tenderness, 2. Imaging tests - an 2. Chemotherapy
cause of cancer- 2. Cirrhosis jaundice, nausea, ultrasound, CT scan, or MRI 3. Percutaneous ethanol
related 3. Heavy drinking vomiting, loss of 3. Liver biopsy injection
deaths worldwide 4. Obesity and appetite, bruising or 4. Targeted therapy
diabetes bleeding easily, 5. Immunotherapy
5. Anabolic steroids weakness, fever and 6. Cryoablation
6. Iron storage unexplained weight 7. Radiofrequency
disease loss ablation
7. Aflatoxin 8. Partial hepatectomy
9. Liver transplant

Cholangiocarc A highly lethal 1. Chronic Jaundice, Dark urine 1. Blood tests 1. Surgery - Liver
inoma (CCA) adenocarcinoma inflammation of and pale stools, 2. Imaging scans - an transplant
(Bile Duct of the the bile ducts Itching, abdomen ultrasound, CT scan, and 2. Radiation therapy
Cancer) hepatobiliary 2. Chronic parasitic pain, Chills, fever, MRI scan. 3. Chemotherapy
system, which can infections loss of appetite, 3. Imaging-assisted biopsy
be classified as weight loss and 4. Endoscopic retrograde
intrahepatic, fatigue cholangiopancreatography
perihilar and (ERCP)
distal 5. Endoscopic ultrasound scan.
6. Percutaneous transhepatic
cholangiography (PTC)

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 DISEASES DEFINITION CAUSE SYMPTOMS DIAGNOSIS TREATMENT
NAME AND
PREVENTION
Liver A high-grade, 1. radiation therapy as a treatment Unintentional weight 1. A physical exam 1. Chemotherapy
Angiosarcoma malignant in the past loss, abdomen pain, 2. Blood work 2. Radiation therapy
neoplasm of lymph vessel damage or swelling stomach swelling, 3. Imaging tests - CT 3. Transarterial
endothelial cells of (lymphedema). fatigue, liver swelling. scans, MRIs, PET chemoembolization
blood or lymphatic 2. Exposure to arsenic or vinyl scans, and (TACE)
vessels. chloride ultrasounds.
3. Genetics syndromes such as 4. Biopsy
Klippel-Trenaunay syndrome,
inherited mutations on BRCA1
and BRCA2 genes.

Hepatoblastoma A very rare liver 1. Premature birth Same as Liver 1. Alpha-fetoprotein 1. Chemotherapy
cancer (malignant 2. Low birth weight angiosarcoma (AFP) tests 2. Transarterial
tumor) that affects 3. Early exposure to hepatitis B 2. Comprehensive chemoembolization
babies and toddlers 4. Biliary atresia metabolic panel (TACE)
ages 1 to 3. It’s 5. Hemihyperplasia (CMP) 3. Radiation therapy
treated with 6. Beckwith-Wiedemann 3. Vascular 4. Ablation therapy
surgery. syndrome ultrasound 5. Liver
7. Edwards syndrome (trisomy 4. Liver and Doppler transplantation
18) ultrasounds
8. Glycogen storage disease 5. Magnetic
(GSD) resonance
9. Aicardi syndrome imaging (MRI)

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GENETICS REALATED LIVER DISEASES

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 DISEASES DEFINITION CAUSE SYMPTOMS DIAGNOSIS TREATMENT
NAME AND
PREVENTION
Wilson's Disease An inherited 1. An inherited defect in the ATP7B gene. Liver symptoms – 1. Eye exam - 1. Medications -
disorder of copper 2. An autosomal recessive disorder Fatigue, muscle cramps, Brown Copper-chelating
metabolism, caused weakness, loss of appetite, Kayser- and muscle
by mutations in ATP7B, nausea, vomiting, weight loss, Fleischer rings tremors.
which encodes fluid in belly or legs, jaundice, ineyes 2. Low Copper Diets
a copper transporting easy bruising, swollen liver and 2. Blood tests 3. Zinc supplements
protein. spleen. 3. 24-hour urine 4. Vitamin B6
test 5. Liver transplant
4. Liver biopsy
5. Genetic testing
Hemochromatosis A disorder where too Primary hemochromatosis – Pain in joints (especially 1. Physical exam 1. Blood removal
much iron builds up in 1. Autosomal recessive disorder knuckles and knees), feeling – stethoscope 2. Chelation therapy
your body. Sometimes, 2. Hereditary tired, unexplained weight loss, a 2. Blood tests - 3. Medications
it’s called “iron 3. Two hemochromatosis mutations, of C282Y bronze or gray color skin, pain Transferrin
overload.” and H63D for inherited case in belly, loss of sex drive and saturation and
4. Mutations of the HJV or HAMP genes for body hair, heart flutter, foggy serum ferritin
teenage symptoms memory. 3. Liver biopsy
Secondary hemochromatosis – 4. MRI
5. Elevated level iron’s diet
6. A lot of blood transfusions because of
conditions such sickle cell anemia or bone
marrow failure.
7. cirrhosis or chronic hepatitis B or C

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 DISEASES DEFINITION CAUSE SYMPTOMS DIAGNOSIS TREATMENT
NAME AND
PREVENTION
Alpha-1 An inherited disease that 1. Genetic Changes Emphysema 1. Blood tests – 1. Augmentation
antitrypsin causes an increased risk of 2. Known Pathogenic Variants Hepatic failure Alpha-1 genotyping test therapy
deficiency having chronic obstructive 3. Disruption in Metabolism Hepatitis Alpha-1 antitrypsin PI type 2. Bronchodilator
(AATD) pulmonary disease (COPD), 4. Deficiency of AAT Hepatomegaly of phenotype test Future treatments –
liver disease, skin problems Jaundice Alpha-1 antitrypsin level 3. Recombinant AAT
(panniculitis), and Nephrotic syndrome test (rAAT)
inflammation of the blood 2. Genetic testing 4. Inhaled AAT
vessels (vasculitis). 3. Liver ultrasound or 5. Gene therapy
elastography 6. Stem cell therapy
4. Liver biopsy 7. Small molecule
therapy
Biliary atresia A condition in infants in 1. Certain gene mutations - PKD1L1, Jaundice, dark urine, ennlarged 1. Abdominal x-ray 1. Liver transplant
which the bile ducts outside CRIPTO, LEFTY, ARF6, EFEMP1, spleen, floating stools, foul- 2. Abdominal ultrasound 2. Kasai procedure
and inside the liver are GPC, NODAL, and ADD3 smelling stools, pale or clay- 3. Blood tests - Total and
scarred and blocked. 2. Problems with bile duct development colored stools, slow or no direct bilirubin levels
in the womb. weight gain, and slow growth . 4. Hepatobiliary
3. Autoimmune reactions iminodiacetic acid
4. Infections – cytomegalovirus, (HIDA) scan, also called
reovirus type 3 and rotavirus cholescintigraphy.
infections 5. Liver biopsy
6. Cholangiogram

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 DISEASES DEFINITION CAUSE SYMPTOMS DIAGNOSIS TREATMENT
NAME AND
PREVENTION
Alagille An inherited JAG1 gene Cholestasis, Hepatomegaly, 1. Physical exam 1. Medication
syndrome condition in which mutation Reduced number of intrahepatic 2. Liver biopsy 2. Skin care
bile builds up in the bile ducts, 3. Heart and blood vessel 3. Vitamin supplements
liver because there are tests 4. High-calorie food
too few bile ducts to 4. Eye exams supplements
drain the bile. 5. Spine X-ray 5. Liver transplant in the
6. Abdominal ultrasound case of liver failure
7. Kidney function tests
8. Genetic testing
9. Imaging tests

Crigler-Najjar A rare genetic Errors or Crigler-Najjar syndrome type I - 1. Blood tests 1. Phototherapy
syndrome disorder characterized disruptions of Jaundice, Kernicterus, lethargy, 2. Molecular genetic 2. Plasmapheresis
by an inability to the UGT1A1 g Moro reflex, opisthotonos, testing 3. Genetic counseling
properly convert and ene spasticity, hypotonia 3. Administration of 4. Liver transplantation
clear bilirubin from phenobarbital 5. Treatment with
the body. Crigler-Najjar syndrome type phenobarbital.
II (Arias syndrome) –
Jaundice, Kernicterus,
concurrent illness, prolonged
fasting and not eating or under
anesthesia

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IMMUNITY RELATED LIVER DISEASES

 AIH - Autoimmune hepatitis

 PBC - Primary biliary cirrhosis
 PSC - Primary sclerosing cholangitis
 Tregs - Regulatory T cells
 PDB-E2 - E2 subunit of pyruvate dehydrogenase
complex
 FTCD - Formimidoyltransferase Cyclodeaminase
 SepSecS - Sep (O-phosphoserine) tRNA:Sec
(selenocysteine) tRNA synthase
 IBD - Inflammatory bowel disease

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DISEASES DEFINITION CAUSE SYMPTOMS DIAGNOSIS TREATMENT
NAME AND
PREVENTION
Primary A chronic disease in Genes and Feeling tired and 1. Physical exam 1. Medications
biliary which the small bile environmental having itchy skin 2. Blood tests 2. Dietary supplements
cirrhosis ducts in the liver triggers 3. Imaging tests - 3. Diet and lifestyle changing
become injured and ultrasound, CT 4. Ursodeoxycholic acid
inflamed and are scan, MRI scan 5. ursodiol (Actigall, Urso)
eventually destroyed. and X-rays 6. Obeticholic acid medication
4. Liver biopsy. 7. Immune-suppressing drugs -
5. Antimitochondrial methotrexate (Rheumatrex,
antibody test Trexall) and colchicine
(AMA) (Colcrys)
Primary A chronic liver disease Experts aren’t Pain in the abdomen, 1. Laboratory tests – 1. Liver transplant
sclerosing in which the bile ducts sure causes of itchy skin, diarrhea, Blood tests. 2. A healthy eating plan
cholangitis inside and outside the PSC jaundice, feeling 2. Liver biopsy 3. A healthy, well-balanced diet
liver become inflamed tired or weak, and 3. Endoscopic
and scarred, and fever retrograde
eventually narrowed or cholangiopancreat
blocked. ography
4. Magnetic
resonance
cholangiography
5. physical exam

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SYNDROME OF LIVER

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 DISEASES DEFINITION CAUSE SYMPTOMS DIAGNOSIS TREATMENT
NAME AND
PREVENTION
Budd-Chiari A disorder affecting the 1. Myeloproliferative Upper abdominal 1. Liver 1. Anticoagulation therapy
syndrome liver and blood vessels, diseases pain, ascites, function 2. Liver transplant
(BCS) where blood flowing 2. Sickle cell disease hepatomegaly, tests (LFTs) 3. Drug therapy
into the liver has 3. Inflammatory swelling of legs and 2. Imaging 4. Transjugular intrahepatic
difficulty in being able bowel disease ankles, cramp in legs tests - portosystemic shunt
to flow out, leading to 4. Pregnancy. and feet, itching and Ultrasound procedure
serious complications. kidney failure. and 5. Percutaneous
computerise transluminal angioplasty
d procedure
tomography
(CT)
3. Liver
biopsy

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SOURCE OF INFORMATION (LIVER DISEASES)

The Hepatitis
WebMD Daily Nature Reviews
Healthline Media LLC Cleveland Clinic Foundation of New
Newsletter Disease Primers
Zealand

. The National Institute

National Human
StatPearls - NCBI JOHNS HOPKINS of Diabetes and
Genome Research British Liver Trust
Bookshelf MEDICINE Digestive and Kidney
Institute (NHGRI)
Diseases (NIDDK)

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BIOMARKERS OF
LIVER DISEASES

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Source of Information:
Molecular Biomarkers in Drug-
Induced Liver Injury: Challenges
and Future Perspectives (Review
Articles)

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Biomarkers for Liver Cancer – (HCC - Hepatocellular Carcinoma)
Biomarker Names
Oncofetal and Glycoprotein Antigens
Alpha-Fetoprotein (AFP) - The first serologic
assay
Glypican-3. Glypican-3 (GPC3) - a membrane-
anchored heparin sulfate proteoglycan
Enzymes and Isoenzymes
Des-Gamma-Carboxy (Abnormal) Prothrombin
(DCP)
Serum gamma-glutamyl transferase (GGT)
Serum Alpha-1-Fucosidase. Alpha-l-fucosidase
(AFU) – lysomal enazyme
Human Carbonyl Reductase 2
Golgi Phosphoprotein 2. Golgi phosphoprotein 2
(GOLPH2)- a Golgi-apparatus-associated protein
and a promising complimentary serum marker.
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Indications Reference Value
Elevation Level: The presence of acute and > 500 ng/mL
chronic viral hepatitis as well as in patients with
cirrhosis caused by hepatitis C.
Significantly higher in the serum of HCC
patients
It is more sensitive and specific to differentiate. > 0.1 AU/mL (100 ng/mL)
HCC from nonmalignant liver disease
its activity increases in HCC tissues
Its activity increases in the serum of HCC
patients.
Inversely correlated to the pathological grading
of HCC
GOLPH2 protein was highly expressed in tissues
of HCC (71%) and bile duct carcinoma (85%)
patients
35
Biomarker Names
Growth Factors and Their Receptors
Transforming Growth Factor-Beta (TGF-
Beta) - a predominant form of growth factor
family in human.
Tumor-Specific Growth Factor (TSGF) - as a
diagnostic marker
Epidermal Growth Factor Receptor Family
Hepatocyte Growth Factor/Scatter Factor - a
cytokine
Basic Fibroblast Growth Factor - a soluble
heparin-binding polypeptide.
Pathological Biomarkers
Indications Reference Value
Serum TGF-beta level has been found to be elevated in HCC patients
Serum levels of TSGF may reflect the existence of tumor > 62 U/mL
High levels of EGFR expression have been associated with early recurrence
of HCC.
It is associated with molecular mechanisms of hepatocarcinogenesis via
paracrine system
Targeted therapy lenalidomide which inhibits fibroblast growth factor (FGF) >10.8 pg/mL
showed promising and dramatic activity in HCC patients

Diagnostic Biomarkers – the combination of heat-shock protein 70 (HSP70), glypican-3 (GPC3), and glutamine synthetase (GS)
Prognostic Biomarkers - Ki67, E-cadherin, VEGF and survivin

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 BIOMARKERS OF LIVER CANCER

Molecular Markers

Circulating Nucleic Acids

Source of Information:
Alpha-Fetoprotein mRNA (AFP mRNA)
Biomarkers for Hepatocellular
Carcinoma (Review Article)
Gamma-Glutamyl Transferase mRNA (GGT mRNA)

Insulin-Like Growth Factor II (IGF-II) mRNA

Albumin mRNA.

MicroRNAs (miRNAs)

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LIVER TESTS

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 TEST INDICATIONS REFERENCE LEVEL
ALT test Very high levels over 1,000 units per liter Females : > 25 IU/L
(U/L) are most often caused by viral hepatitis,
ischemic hepatitis, or injury from drugs or other Males : > 33 IU/L
chemicals.

AST test Elevated AST may indicate heart or muscle Typical range for AST:
disease > 36 U/L
ALP test High levels of ALP may indicate liver The typical range for ALP:
inflammation, blockage of the bile ducts, or 20–
bone disease. 140 IU/LT (Adults)
Albumin test A low result on this test can indicate that your The typical range:
liver isn’t functioning properly. This occurs in Albumin: 35–50 g/L
diseases such as cirrhosis, malnutrition, and
cancer.
Bilirubin test A high result on the bilirubin test may indicate The typical range for total bilirubin:
that the liver isn’t functioning properly. 0.1–1.2 mg/dl
Elevated bilirubin levels with elevated ALT or
AST may suggest cirrhosis or hepatitis.

SOURCE: HEALTHLINE

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 THANK YOU

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