Although specific treatments for certain chronic liver diseases may favorably alter their natural history by diminishing, halting, or permitting regression of hepatic fibrosis, once major complications of cirrhosis such as ascites or hepatic encephalopathy develop, treatment options are limited and…
Hepatic mass lesions include tumors, tumor-like lesions, abscesses, cysts, hematomas, and confluent granulomas. Hepatic tumors may originate in the liver—from hepatocytes, bile duct epithelium, or mesenchymal tissue—or spread to the liver from primary tumors in remote or adjacent organs. In…
ALF is characterized by a sudden insult to the liver with catastrophic consequences, usually in the absence of preexisting liver disease. Coagulopathy and encephalopathy are the twin cardinal features that reflect the severity of liver injury, and both are required…
Chronic liver disease and ALF disrupt normal homeostasis and cause systemic manifestations that may dominate the clinical features of liver disease. Most of these extrahepatic syndromes are reversible with LT. Hepatic Encephalopathy The term hepatic encephalopathy (HE) encompasses a wide…
Ascites is defined as the abnormal accumulation of fluid in the peritoneal cavity. In Western countries, cirrhosis is the most common cause of ascites, representing over 80% of cases. In the remaining cases, ascites may be caused by other conditions…
Variceal hemorrhage, hepatic encephalopathy, and ascites—the major complications of cirrhosis of the liver (see Chapters 74, 93, and 94 )—result from portal hypertension, defined as an increase in hepatic sinusoidal pressure to 6 mm Hg or greater. Portosystemic collaterals decompress…
Acknowledgments The authors thank Jayant A. Talwalkar and the late Paul Angulo for their contributions to this chapter. PBC is an autoimmune liver disease that generally affects middle-aged women and is the most common chronic cholestatic liver disease in adults…
Autoimmune hepatitis (AIH) is a disease of unknown cause that is characterized by the presence of autoantibodies, hypergammaglobulinemia, and histologic features of interface hepatitis ( Fig. 90.1 ) and lymphoplasmacytic infiltration ( Fig. 90.2 ). Diagnosis requires the exclusion of…
Contemporary inhalation and parenterally administered anesthetics are rarely hepatotoxic. Although halothane hepatitis is now largely of historical interest in Western nations, it remains in use elsewhere, with ongoing reports of acute liver injury. , In contrast to the largely unpredictable…
Hepatic Drug Metabolism Role of the Liver in Drug Elimination By virtue of the portal circulation, the liver is highly exposed to drugs and other toxins absorbed from the intestine. Most drugs tend to be lipophilic compounds that are readily…