LIVER TRANSPLANT
d r u g s
t o r e d u c e a b d o m i n a l s w e l l i n g , m a y
b e t a k e n t o r e d u c e t h e s e v e r i t y o f s y m p -
t o m s . C o n s u m p t i o n
o f a l c o h o l s h o u l d
c e a s e i n a l l c a s e s .
OUTLOOK
T h e p r o g n o s i s f o r s u f f e r e r s o f c h r o n i c
l i v e r
f a i l u r e
v a r i e s
d e p e n d i n g
o n
t h e
c a u s e ,
b u t
s o m e
p e o p l e
s u r v i v e
f o r
m a n y y e a r s . F o r b o t h c h r o n i c a n d a c u t e
l i v e r f a i l u r e , a
l i v e r t r a n s p l a n t
i s n e c e s s a r y
t o i n c r e a s e t h e c h a n c e s o f s u r v i v a l .
liv e r flu k e
A n y
o f v a r i o u s
s p e c i e s
o f f l u k e s
( f l a t -
w o r m s ) t h a t i n f e s t t h e
b i l e d u c t s
i n t h e
l i v e r
. T h e o n l y s i g n i f i c a n t f l u k e i n t h e U K
i s
F a s c i o i a
hepatica,
w h i c h
c a u s e s
t h e
d i s e a s e
f a s c i o l i a s i s
.
F a s c i o l i a s i s h a s t w o s t a g e s . D u r i n g t h e
f i r s t s t a g e , y o u n g f l u k e s m i g r a t e t h r o u g h
t h e l i v e r ,
c a u s i n g i t t o b e c o m
e t e n d e r
a n d e n l a r g e d ; o t h e r s y m p t o m s i n c l u d e
f e v e r
a n d n i g h t s w e a t s .
I n t h e
s e c o n d
s t a g e , a d u l t w o r m s o c c u p y t h e b i l e d u c t s .
T h e i r p r e s e n c e m a y l e a d t o
c h o l a n g i t i s
( i n f l a m
m
a t i o n o f t h e b i l e d u c t ) a n d b i l e
d u c t o b s t r u c t i o n , w h i c h c a n c a u s e
j a u n -
d i c e
.
T r e a t m e n t w i t h a n
a n t h e l m i n t i c d r u g
m a y b e e f f e c t i v e .
liv e r-fu n c tio n te s ts
T e s t s o f b l o o d c h e m i s t r y t h a t c a n d e t e c t
c h a n g e s i n t h e w a y t h e
l i v e r
i s m a k i n g
n e w
s u b s t a n c e s
a n d
b r e a k i n g
d o w n
a n d / o r
e x c r e t i n g
o l d
o n e s .
T h e
t e s t s
c a n
a l s o
s h o w w h e t h e r
l i v e r
c e l l s
a r e
h e a l t h y
o r
d a m a g e d
( s e e
L i v e r f u n c t i o n
t e s t s
t a b l e , o v e r l e a f ) .
liv e r im a g in g
T e c h n i q u e s t h a t p r o d u c e i m a g e s o f t h e
l i v e r
,
g a l l b l a d d e r
,
b i l e d u c t s
,
a n d
b l o o d
v e s s e l s
s u p p l y i n g
t h e
l i v e r ,
t o
a i d
t h e
d e t e c t i o n o f d i s e a s e .
U l t r a s o u n d s c a n n i n g
i s t h e m o s t w i d e l y
u s e d t e c h n i q u e f o r i m a g i n g t h e l i v e r ;
C T
s c a n n i n g
a n d
M R I
a r e a l s o c o m m o n l y u s e d .
R a d i o n u c l i d e s c a n n i n g
m a y
r e v e a l
c y s t s
a n d t u m o u r s
a n d s h o w
b i l e
e x c r e t i o n .
X - r a y
i m a g i n g
t e c h n i q u e s
i n c l u d e
c h o l -
a n g i o g r a p h y
,
c h o l e c y s t o g r a p h y
,
a n d
E R C P
( e n d o s c o p i c r e t r o g r a d e c h o l a n g i o p a n c r e a -
t o g r a p h y ) . I n t h e s e p r o c e d u r e s , a
c o n t r a s t
m e d i u m
,
w h i c h i s
o p a q u e
t o X - r a y s ,
i s
u s e d t o o u t l i n e t h e
b i l i a r y s y s t e m
.
A n g i o g -
r a p h y
r e v e a l s t h e b l o o d v e s s e l s i n t h e l i v e r .
liv e r p a lm s
R e d n e s s a c c o m p a n i e d b y w a r m t h i n t h e
p a l m s o f t h e h a n d s . T h i s c o m b i n a t i o n o f
s y m p t o m s
i s
o f t e n
a s s o c i a t e d
w i t h
c h r o n i c l i v e r d i s e a s e . ( S e e
l i v e r f a i l u r e .
)
liv e r s p o t
S e e
l e n t i g o .
liv e r tra n s p la n t
R e p l a c e m e n t o f a d i s e a s e d
l i v e r
w i t h a
h e a l t h y l i v e r r e m o v e d f r o m a d o n o r . I n
m
o s t c a s e s , t h e d o n o r i s a d e a d p e r s o n ,
b u t s o m e t i m
e s ( f o r
e x a m p l e , w h e n a
l i v e r t r a n s p l a n t i s p e r f o r m e d o n a c h i l d )
p a r t o f t h e l i v e r m a y b e d o n a t e d b y a
l i v i n g r e l a t i v e o f t h e p a t i e n t .
WHY IT IS DONE
L i v e r t r a n s p l a n t s a r e m o s t s u c c e s s f u l i n
t r e a t i n g a d v a n c e d l i v e r
c i r r h o s i s
i n p e o -
p l e
w i t h
c h r o n i c
h e p a t i t i s
o r
p r i m a r y
b i l i a r y c i r r h o s i s
.
P e o p l e w i t h p r i m a r y l i v e r
c a n c e r m a y b e c o n s i d e r e d f o r a t r a n s -
p l a n t i f t h e t u m o u r i s r e l a t i v e l y s m a l l .
STRUCTURE AND FUNCTION OF THE LIVER
The liver is a large organ with numerous functions. It absorbs nutrients from blood
that has come from the intestines, and regulates the blood’s glucose and amino-
acid levels. It helps break down drugs and various toxins, and manufactures
important proteins, such as albumin and blood coagulation factors. The liver also
produces bile, which contains waste products and helps with the digestion of fats
in the small intestine.
H e p a t i c v e in
B l o o d l e a v e s t h e liv e r
v ia t h is v e in a n d c a r r i e s
c a r b o n d i o x i d e a n d
p l a s m a p r o t e i n s .
H e p a t i c p o r t a l v e in
B l o o d fr o m t h e i n t e s t i n e s a n d s p l e e n c a r r i e s
n u t r ie n t s , s u c h a s f a t s a n d g l u c o s e , t o t h e
liv e r v ia t h is v e in . T h e n u t r ie n t s a r e u s e d b y
t h e l i v e r o r s t o r e d w it h in it.
H e p a t i c d u c t
B ile l e a v e s t h e li v e r t h r o u g h a n e t w o r k
o f d u c t s , t h e b i l e d u c t s . T h e y i n c r e a s e
in s i z e u n til t h e y f u s e t o f o r m t h e r i g h t
a n d l e f t h e p a t i c d u c t s , w h ic h j o i n a n d
c a r r y b i l e t o t h e g a l l b l a d d e r .
H e p a t i c a r t e r y
O x y g e n a t e d b l o o d f r o m t h e h e a r t ( a b o u t
o n e q u a r t e r o f t h e h e a r t ’s e n t ir e o u t p u t )
r e a c h e s t h e liv e r v ia t h is a r t e r y . T h e a r t e r y
s u b d i v i d e s in t o m a n y b r a n c h e s w it h in t h e
l i v e r t o p r o v i d e o x y g e n t o a ll t h e l i v e r c e l l s .
Liver lobules
The liver consists of many
lobules, each surrounded by
branches ofthe hepatic artery
and the hepatic portal vein.
B ile d u c t l e a d i n g
t o h e p a t i c d u c t
B r a n c h o f
h e p a t i c p o r t a l v e in
L i v e r c e l l s
r e s p o n s i b l e f o r
a b s o r b i n g n u t r ie n t s
B r a n c h o f
h e p a t i c v e in
B r a n c h o f
h e p a t i c a r t e r y
Section through a liver lobule
Blood passes to the central vein (a branch ofthe
hepaticvein) via pathways between the cells.
L
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