Tuesday, January 28, 2014

LIVER & BILIARY TRACT 7 Liver abscess


. HEPATIC ABSCESSES

Pyogenic   bacteria  and  Entamoeba  histolytica  are  the   main
causative agents.  The amebic liver abscess has been discussed in
the chapter on Tropical Diseases.

7.1 PYOGENIC ABSCESSES

Results  from a secondary biliary infection; haematogenic  spread
from portal system or result from septicaemia

Diagnosis is by:

*  Clinical examination aided by the findings of local pain and
   tenderness
*  Fever with chills and rigor
*  Ultrasound and
*  CT scans

Treatment is with antibiotics and drainage.  The initial  attempt
is at aspiration repeated if required.  A laparotomy and drainage
is required if aspiration

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Wednesday, January 22, 2014

LIVER & BILIARY TRACT 6 Hepatic Trauma



. HEPATIC TRAUMA

INCIDENCE

The liver is at greater risk of injury in motor traffic accidents
and penetrating wounds.  This is also true of all blunt traumatic
injuries of the abdomen.

PATHOLOGY

When  the  Glisson's capsule ruptures the liver  blood  and  bile
enter the peritoneal cavity.

*  Patient with injury at the hilus, however, do not survive long
   enough for a surgical exploration.

CLINICAL MANIFESTATIONS

In a case of rupture through the Glisson's capsule, the signs and
symptoms  are  due to shock and peritoneal irritation.   This  is
usually a severe surgical emergency there is:

*  Abdominal pain;
*  Spasm and rigidity are prominent findings

TREATMENT

The  shock  is corrected first of all and surgical  procedure  is
directed  at  control of bleeding by ligating  bleeders  and  the
removal of necrotic devitalized tissue

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Tuesday, January 14, 2014

LIVER & BILIARY TRACT 5 Synthesis protiens carbohydrates lipids


5.1 PROTEINS SYNTHESIS

As the hepatic cell is responsible of synthesis of
   -  albumin,alfa feta protein, cereloplasmin, ferritin and
      Transfenin
   -  fibrinogen
   -  prothrombin and other factors involved in blood clotting I,
      II, V, VII, IX, X, XI, XII, XIII

Estimation  of serum albumin is the most accurate  relfection  of
liver function.

*  Half life of albumin is more than 10 days
*  Flocculation and Turbidity Tests are dependant on albumin  and
   thus;
   - Cephalin flocculation
   - Thymol turbidity
   - Zinc   sulfate  turbidity  tests  are  reflections  of   the
     alteration in the albumin globulin ration in the serum

5.2 CARBOHYDRATES AND LIPIDS SYNTHESIS

Syntehsis of both phospholipid and cholesterol takes place in the
liver  and  the  latter  serves as an  indicator  for  the  lipid
metabolism

*  Biliary obstruction results in a rise in cholesterol

*  The other common effects of hepatic disease is a deficiency of
   glycogenesis with resultant hyperglycemia

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Tuesday, January 7, 2014

Liver Biliary Tract 4 Bile production Lver functions


COMPOSITION OF BILE

Main constitutents of the bile are:

*  Electrolytes
*  Sodium  potassium  calcium  and  chloride  are  in  the   same
   concentration as in  plasma. 

The ether constituents are:

*  Bile salts
*  Protein
*  Cholestrol
*  Fats
*  Bile pigments
The pH of liver bile ranges between 5.7 and 8.6

5. LIVER FUNCTION

The  functioning  liver  cells are capable  of  wide  variety  of
activities.   The metabolic pool in the liver is a reservoir  for
the entire body.

*  Storage  function - Stores glycogen, fat, protein, Vit. A  and
   B12
*  Production  and  secretion  of materials by  the  liver  cells
   including bilirubin and cholesterol
*  Detoxification function (metabolism of drugs and toxins)
*  Metabolism of carbohydrates, fats and proteins
*  Synthesis of plasma proteins, fibrinogens and prothrombin

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