Some 20 million American adults have gallstones and gallstone complications account for as many as 10,000 deaths per year. It is by no means a rare or insignificant disorder but since most people with gallstones are asymptomatic (without symptoms), gallstones often does not get the same attention as other common medical conditions. Many people are not familiar with the symptoms of gallstones as they would be with the symptoms of more common ailments. However, spotting gallstones early and getting medical attention as soon as possible can in some cases even make the difference between life and death.
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Definition and Meaning of PSC
Primary sclerosing cholangitis (PSC) is a condition where the bile ducts are diseased and become thick, hard and narrow. This prevents the flow of bile through the ducts. Although there are many diseases that can damage the bile duct (secondary cholangitis), in primary sclerosing cholangitis there is no underlying disease that can be identified which affects the bile ducts. It appears to occur independently. Over time the narrowing can reach a point where the bile duct is almost entirely occluded with a complete stoppage of bile flow. It may lead to severe and even permanent damage of the liver which can then progress to liver failure.
A biliary stricture is any narrowing of the bile duct, the tube that carries bile between the liver, gallbladder and duodenum of the small intestine. A minor narrowing does not significantly impede bile movement and a person may be asymptomatic. It is only with a severe degree of obstruction or even complete blockage that symptoms arise. There are number of reasons why a narrowing may arise. Sometimes it may be due to cancer but a fairly common benign cause is injury to the duct after gallbladder surgery and diagnostic investigations of the biliary tree. . When left untreated it can lead to complications ranging from gallstones to a bile duct infection and even liver abscess.
Acalculous cholecystitis is the term for inflammation of the gallbladder that is not due to the presence of gallstones. Most cases of acute cholecystitis (inflamed gallbladder) occurs due to gallbladder stones (within the gallbladder) or biliary stones (lodged in the bile duct). In these cases it is referred to as calculous cholecystitis. Since it is so common, acute cholecystitis is considered to be synonymous with calculous cholecystitis. It is therefore important to differentiate acalculous cholecystitis specifically. Although it is less common, acalculous cholecystitis is associated with more serious complications, some of which can be life-threatening.
Portal Hypertension Definition
Portal hypertension is the medical term for elevated blood pressure with the major vein of the liver, the hepatic portal vein. Although it is most commonly caused by liver cirrhosis, it can be due to a number of other causes that may not even involve the liver. Therefore portal hypertension is an important clinical sign of a wide range of diseases. In the long term, the prolonged hypertension can cause a host of complications within the liver and entire body, some of which can be life threatening.
What is Wilson’s disease?
Wilson’s disease is a genetic disorder that hampers the body’s ability to bind and transport copper thereby leading to accumulation of copper in the body. Over time copper deposition occurs in various different organs and tissues. Copper in its free form is toxic and damages the organs where it accumulates. As the body is not able to manage the copper appropriately, the metal builds up in the body from the time of birth. However, symptoms may only be noted by the age of 5 years or even later in life. Wilson’s disease is rare and only affects about 1 in 30,000 people.
What is gallbladder mucocele?
A gallbladder mucocele is a condition where the gallbladder is stretched due to the accumulation of mucus or clear watery fluid in the hollow organ. It is also known as hydrops. This condition should not be confused with a gallbladder empyema where the gallbladder is filled with pus. In a mucocele, the gallbladder is larger in size than normal due to the overdistension caused by the fluid within. When left untreated, the gallbladder can become infected, press on the stomach thereby partly blocking it and gallbladder rupture is also possible. Although a mucocele is not common, it must be suspected and monitored for in the event of gallstones. Most cases of gallbladder mucocele arise as a complication of gallstones disease, and gallstones itself are a fairly common condition.
The human liver is a somewhat triangular-shaped organ that is located mainly in the upper right part of the abdomen, just under the base of the right lung separated by the muscular diaphragm. It is difficult to completely classify the liver under a specific system due to it versatility. Although it is largely associated with the digestive system, the liver has a wide range of functions and influences several other systems including the cardiovascular, endocrine and renal systems, among others.
The adult liver weighs about 1.6 kg (about 3.5 lbs) and extends from the right upper quadrant (RUQ) of the abdomen to protrude into the the left upper quadrant (LUQ). It has four lobes – two anatomical and two accessory – and houses the gallbladder on its visceral surface. The liver is made up of smaller functional units known as the lobules which number anywhere between 50,000 to 100,000. Each lobule is made up of an arrangement of liver cells (hepatocytes) separated by channels known as sinusoids.
Hepatitis is an inflammation of the liver and may be due to a number of insults, from chemical irritants, to infections and autoimmune mechanisms. Viral hepatitis is one of the most common forms of liver inflammation and is caused by an infection with a virus. Although many different types of viruses can cause viral hepatitis, it is the hepatitis viruses A, B and C that are usually responsible. These hepatitis viruses have an affinity for the liver, unlike other viruses which may infect a number of sites in body including the liver.
The liver, apart from being versatile, is a highly resilient organ. It is able to withstand a range of chemical insults on a daily basis and one of its core functions is to reduce the toxic effect of various noxious substances. Despite its ability to neutralize chemical agents and regenerate more prolifically than many other organs in the body, it is not entirely immune to various disruptions in structure that may arise for any number of reasons. Some of the changes seen in the liver, as is the case with most other organs includes inflammation, fibrosis and necrosis which causes varying degrees of liver dysfunction. One of the possible structural changes of the liver is infiltration of the liver cells with fat that coalesces into large droplets. This is fatty infiltration is now the leading form of liver disease although most of these cases remain asymptomatic and undetected.
There are five main types of hepatitis viruses that can infect the liver and cause inflammation. Some of these will cause acute inflammation and resolves spontaneously or with minimal treatment and there is no risk of chronic infection. Others may present with an acute phase but chronic infection persists for life and may lead to irreversible damage. The hepatitis virus, depending on the type, is spread through contaminated food or water or through contaminated bodily fluids like blood, semen and sometimes even saliva. The virus reaches the hepatocytes (liver cells), implants its genetic material within the host cell and causes it to replicate more virions while destroying the host cell in the process. This interaction is between the human host and virus. However, a certain type of hepatitis virus is actually dependent on the presence of another type of hepatitis virus to cause an infection.
continue reading Hepatitis D Virus (HDV) Co-Infection, Superinfection, Symptoms
Viral hepatitis is inflammation of the liver caused by an infection with the hepatitis virus. There are five such viruses which can lead to an infection of the liver, some of which may progress to a chronic infection or only arise as a sequelae to liver disease. Liver function is affected to various degrees and with acute infections there is full recovery. Of the different types of viral hepatitis, it is hepatitis A, B and C that are the most common, with the latter two being leading causes of chronic hepatitis. While there are vaccines for hepatitis A and B, there is currently no vaccine for hepatitis C which in most cases causes severe liver damage. It is therefore considered to be one of the more serious types of viral hepatitis and features high among the causes of liver-related deaths globally.
The liver is a versatile organ that metabolizes nutrients, wastes, toxins, drugs and other substances. It has various secondary roles including acting as a reservoir for blood. The liver has a complex architecture involving lobules containing hepatocytes (liver cells) and weighs about 1.6 kg (2.5% of the average adult body weight). Blood is received via the portal vein and hepatic artery, the former which brings blood to the liver to be processed and the latter nourishes the liver tissue with oxygen and nutrients. Waste products that are not passed out into the blood to be eventually be filtered by the kidneys make up bile which is then dumped in the gut during digestion and expelled in the fecal matter.
The liver is the central processing point of nutrients and wastes in the body. It filters and stores blood, regulates the way nutrients are metabolized and stores excess micro- and macroutrients, forms bile to discard wastes from the body and contributes to blood clotting. The liver is capable of contending with a range of chemical irritants but certain more toxic compounds can have a detrimental effect if consumed in excess or over a long period. Alcohol is one of the compounds and its widespread use globally is one of the leading causes of liver disease.
In most cases alcohol and its byproducts are broken down by the liver enzymes. 80% of alcohol is metabolized by the enzyme alcohol dehydrogenase (ADH) and the remaining 20% by the enzyme cytochrome CYP2E1. This yields harmless substances that can easily be excreted from the system. With alcoholic liver disease, the inability to metabolize alcohol and its byproducts allow these compounds to damage liver tissue.
continue reading Alcoholic Liver Disease (Fatty Liver, Hepatitis and Cirrhosis)
What is a liver abscess?
A liver abscess, also known as a hepatic abscess, is an accumulation of pus within the liver as a result of an infection. Overall liver abscesses are fairly rare and more frequently seen in developing nations. Most liver abscesses are caused by bacteria and amebic parasites (protozoa). However, other protozoa, fungi and helminths (parasitic worms) may also be responsible for hepatic abscesses.
A liver abscess may occur as a single abscess (solitary) or multiple lesions varying in size from a few millimeters to several centimeters in a larger abscesses. The term liver or hepatic abscess is also used to refer to a biliary abscess (gallbladder) which are usually multiple. A liver abscess is one type of intra-abdominal abscess and may be associated with other abscesses in the abdomen.
Cholesterol in the body is thought of as originating solely from the diet through absorption from the gut. However, the reality is that most of the cholesterol is not sourced from food but rather manufactured within the body. Dietary cholesterol or exogenous cholesterol is absorbed from within the intestines. Endogenous cholesterol sourced within the body is synthesized in the liver. It is sometimes commonly referred to as liver cholesterol. Triglycerides on the other hand are primarily sourced from the diet, especially in saturated fats and also synthesized from excessive unused calories as is seen with high carbohydrate diets.
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