PREVALENCE OF CHRONIC LIVER DISEASES IN NON-HCV AND HBV IN OUR POPULATION:
Authors:DRghulamrasoolbhurgri,shamim-ur-rehman,bilawal, anisrehman.
SUMMARY:
Liver diseases are damaged the function of hapetocytes, it may causes hepatocellular necrosis, fibrosis, and regeneration with nodule formation.
In our study there was a group of patients who is negative for both viral markers, there were more females that have chronic liver disease. This group need to the investigated further for other well defined but uncommon causes of chronic liver disease.
Key words: hepatitis, liver disease, chronic liver disease, hepatitis C virus, hepatitisB virus, cirrohosis.
INTRODUCTION:
Chronic liver disease in which liver damage slowly by process and persisting over long time.It means it act as slow poison for healthy human body. It is characterized by replacement of liver tissue by fibrous scar tissue as well as regenerative nodules (lumps that occurs as a result of a process inwhich damage tissue is regenerated.It is already to progressive loss of liver function-cirrhosis is due to alcoholism, but in our population it is prohibited by people due religion, poverty and customs society, Hepatitis C, Hepatitis B virus are main role this dangerous disease in our population.
BASIC STRUCTURE OF LIVER:
“Liver is the largest gland in the body weighing about 1.4 k.g in an adult. It is situated under diaphragm in the upper abdomen cavity and is held in place by several ligaments.It is reddish-brown colour and comprise of four anatomical lobes.When viewed from the front the dominant left and right lobes can be seen which are separated by falciform ligament.Situated in a depression on the posterior surface of the liver in the gall bladder, a pear shaped sac which stores bile synthesis by the liver.The liver performs many metabolic functions. It has ability to store and metabolites useful substances such as nutrients,but it breakdown or detoxifying harmful substances to render then inert and less harmful”(Dr.viva Rolfe 2004)
“Liver weighing roughly 1.2-1.6 k.g performs many of the functions necessary for staying healthy. It is located in the right side of the body under the lower ribs and is divided into four lobes of unequal size. Two large vessels carry blood to the liver, the hepatic artery comes from heart and carries blood rich in nutrients absorbed from the small intestine. These vessels divided into smaller and smaller vessels, ending in capillaries. Each lobule is composed of hepatocytes, add, and remove substance from it. The blood then leaves the liver via the hepatic vein, returned to the heart, and is ready to be pumped to the rest of the blood.
Among the most important liver functions are,
Removing and excreting body waste and hormones as well as drugs and foreign substances.
Synthesizing plasma proteins, including those necessary for blood clotting,12 clotting factors are produced by the liver.
Producing immune factors and removing bacteria helping body fight against infection.
Producing bile to acid digestion.
Excretion of bilurobin
Storing certain vitamins, minerals, and sugars.”(Tzanakakis et al 2000)
“Liver is an organ in vertebrates, including humans. It plays a major in metabolism and has a number of functions in the body including detoxification, glucagon storage and plasma proteins sythesis.I t also produces bile, which is important for digestion. It also starts in hepato or hepatic from Greek word for liver, hepar. Hepatocytes play main role in.
Liver produces and excretes bile required for food, some of the drain directly into duodenum and some stored in gallbladder.
Glyconeogensis (formation of glucose from certain aminoacid lactate or glycerol).
Glyucogenolysis (the formation of glycogen from glucose).
Breakdown of insulin and other hormones.
Lipid metabolism, cholesterol synthesis, production of triglycerides.
Liver produces coagulation factor, 1(fibrinogen) 11 (prothrombin) v, vii.ix, xi, as well as protein c and proteins and antithrombin.
Liver converts ammonia into urea.”(spiritus2005).
PHYSIOLOGICAL FUNCTIONS OF LIVER:
“Liver functions: HEMOSTASISè glucose, protein, fat, cholesterol, hormones, vitamins, in particular fat soluble vitamins (ADEK)
SYNTHESISè protein including clotting factors, bile acids, heparin, somatomedins, promote growth hormones, cholesterol and acute phase of proteins.
STORAGEè vitamins, glycogen, cholesterol. Iron, copper, fats.
EXCRETIONè cholesterol, bile acids, phopholipds, bilurobin, drugs, poison including heavy metals, hormones.
FILTERINGè poisons, nutrients, Iga, drugs, dead damage cells in circulatory system.
IMMUNEè excretes Iga into digestive tract kupffer cells (macrophages) filter out antigens.” (Liver foundations-2002).
“The liver is vulnerable to a wide of variety of metabolic, toxin, microbial, circulatory and neoplastic insults. The dominant primary diseases of the liver are viral hepatitis, alcoholic liver disease and hepatocellular carcinoma. More often, hepatic damage is secondary, to some of the most common diseases in humans, such as cardiac decompensation, disseminated cancer and extrahepatic function. There are following morphological changes in liver:
Degeneration and intracellular accumulation damage from toxin or immunologic insult may cause swelling of hepatocytes.
Necrosis and aptosis, any significant insult to the liver can cause hepatocytes necrosis, in aptosis cell death isolated hepatocytes round up to form shrunken, pykinolic, and intensity esinophilic cells containing fragmented nuclie.
Inflammation –injury to the liver associated with an influx of acute and chronic inflammatory cells is termed hepatitis.
Regeneration hepatocytes have long life spans and they proliferate in response to tissue resection or cell death.
Fibrosis –fibrous tissue is formed in response to inflammation or direct to toxic insult to the liver, fibrosis points toward generally irreversible hepatic damage(kumar,abbas,et al 2004)
ETIOLOGY OF LIVER DISEASE.
“There are following main causes of liver diseases,Hepatitis virus A,B,C,D,E. Epstein-Barvirus,cytomegalovirus,yellowfever virus.Non-viral infection:leptospira, toxoplasma gendi,q fever,Poison-aflatoxin, carbantetrachloride, mushrooms, Drugs- paracetamol ,halothane, alcohal, pergnancy,shock, wilson disease.
CLINICAL MANIFESTATIONS:
SYMPTOMS:anorexia, malaise,fever,jaundice, right abdomenal pain,hepatomegaly, gynicomastacia, pruritus,hematamesis, confusions,
SIGNS: jaundice, hepatomegaly, pale stool, dark colored urine, palmer erythrema, clubbing, jaundice, spleenomegaly testicular atrophy, gynecomastia, with other complications- colateralveins peripheral edema, ascites.”(Davidson-2004)
COMMON LABS:TESTS FOR LIVER DISEASES:
“The diagnosis of liver diseases depends upon a combination of history, physical examination,labortary testing and sometime radiological studies and biopsy.
Alanine aminotranferase: ALT is enzyme produced In hepatocytes, the major cell type in the liver. All types of hepatitis (viral, alcoholic, drug induced etc) cause hepatocyte damage that can lead to elevation in the serum ALT activity.
Aspartate aminotransferase: AST similar to ALT but less specific for liver disease as it is also produced in muscle and can be elevated in other condition (heart attack). Alcoholic hepatitis and viral hepatitis may it.
Alkaline phosphatase: It is an enzyme, produced in bileducts, intestine, kidneys, placenta and bone.It is elevated in case chronic liver diseases.
Gamma glutamyl tranferase: It is an enzyme produced in bile duct, in alcohalism and biliary disease it is elevated.
Bilurobin: Bilurobin is the major breakdown that results from the destruction of old blood cells.It is removed from the body by the liver, chemically modified by process call conjugation, secreted into bile passed into intestine and some extent reabsorbed by intestine.In chronic liver disease, acquired liver diseases, the serum biliurobin is elevated.
Albumin:Many factors necessary for blood clotting are made in liver. When liver function is impaired, their synthesis and secretion into blood is decreased.In chronic liver disease, it highly elevated.
Platelets count: These are smallest blood cells in liver disease, spleen becomes large, blood flow through liver is impaired platlets are fallen from normal.
Serum protein electrophoresis: In cirrohosis, the albumin may decreased and the gamma- globulin can be significantly elevated.”(Howard,J.Worman 1998).
METHOD;
One hundred patient diagnosed as chronic liver disease,from which 35 patients were enrolled in this study protocol,after consent,after screening, duration of study was between 2005-2006, admitted in NonHCV,HBV, liver cirrhotic disease ward, in Muammad Medical College Hospital,
AIM AND OBJECTIVE OTHIS STUDY:
To evaluated the causes of liver diseases without virus,because liver was deterioate in its function due to HCV,and HBV,it was common concept in our community.No doubt it was still a big danger for our population.
RESULTS:
These results were analytic by help of spss from which frequecies of each group were describer as follw:
Mean of reseach found in graphs
Summary of study and corelation of each group were analised very well.
BIOSTATISTICS ANALYSIS:
Frequencies:
Correlation
Descriptive Statistics
Mean
Std. Deviation
N
Total number of patients
41.1100
12.10467
100
Total number of liver cirrhotic patients
40.6000
11.50499
35
Total male patients
29.8000
5.62139
15
Total female patients
48.7000
7.24097
20
Correlation
Total number of patients
Total number of liver cirrhotic patients
Total male patients
Total female patients
Total number of patients
Pearson Correlation
1
1.000(**)
.998(**)
.526(*)
Sig. (2-tailed)
.
.000
.000
.017
N
100
35
15
20
Total number of liver cirrhotic patients
Pearson Correlation
1.000(**)
1
1.000(**)
.525(*)
Sig. (2-tailed)
.000
.
.
.018
N
35
35
15
20
Total male patients
Pearson Correlation
.998(**)
1.000(**)
1
.883(**)
Sig. (2-tailed)
.000
.
.
.000
N
15
15
15
15
Total female patients
Pearson Correlation
.526(*)
.525(*)
.883(**)
1
Sig. (2-tailed)
.017
.018
.000
.
N
20
20
15
20
** Correlation is significant at the 0.01 level (2-tailed).
* Correlation is significant at the 0.05 level (2-tailed).
DISCUSSION:
In this prospective study, there were certain points for consideration that what causes of females affected more by liver disease as compared male.This study showed females were more,interpreted by graphs and charts.
Chronic liver disease is marked by gradual destruction of liver tissue overtime.It is seventh leading cause of death in United States, according to National Institute of Diabetes and Digestive and Kidneys disease becaudse of chronic damage to the liver, scar tissue slowly replaces normal functioning liver tissue, as the normal liver is lost, nutrients, hormones, drugs, and poisons,are not processed effectively by the liver. In addition, protein production and other substances produced by the liver are inhibited.
“obesity is not associated with nonalcohlic fatty liver disease but it also adversely affects the progression of other liver disease.Specific directly interventions should focus on decreasing intake of low-nutrient and high sodium food, as wellas high fat sources of meat/ protein”(kimech et al 2008)
“our study match with the study of the klad chareon et al(2004) in which they aimed to determine the prevalences on non alcohalic steatohepatitis in thai patients with non HBV,HCV,chronic hepatitis. Forty six patients with negative markers of viral hepatitis B and viral hepatitis C and non alcohalic consumption were enrolled.just in our study we enrolled 100liver cirrhotic patients from which we selected non alcohalic and non HBV,HCV.They informed consent for liver biopsy and blood collecting to identify the etiological of chronic hepatitis was performed.Thai patients wth non alcolic,non HBV,HCV,chronic hepatitis with obesity,diabetes mellitus and dyslipidemia”(kladchareonN,et al 2004)
“This study match with the study of the Omagrik et al 1996 ,They discovered of hepatitis c virus (HCV) has enabled the diagnosis of type c chronic liver disease, which had the past been diagnosed as part of non-A,non-B,chronic liver disease. Although most cases with chronic liver were by hepatitis B,C there are stillcases of non B,C,chronic liver disease.Forty two patients with chronic liver disease who were seronegative hepatitis B,Cwere followed in the study for treatment.The yearly incidence hepatocellular carcinoma 9.3% with liver cirrohosis and 3.9% of chronic hepatitis.This suggested that their population sample contained a number of patients with type B,typeC or other etiological agents.Our study suggested that more detialed and accurate tests of detecting HBV andHCV should be considered before maing diagnosis o non B,nonC chronic liver disease that there was need to revial unknown etiological agents.
REFERENCES:
Omagarik,komatsuk,katoy,1996 “clinical manifestation of non HBV,HCV chronic liver disease” Internal medicine 1996,vol35,600-604.
Kladchareon N, Treepraserkstut,Mahachai 2004,prevalences of nonalcolic steatohepatitis in Thai patients with non HBV,HCV chronic hepatitis”Jmed Assoc Thai2004 sep87 suppl 2:s29-34.
Kimch, kallman, Baiec et al 2008 “nutritional assessments of patients with non alcolic fatty liver disease” obes, surg jun 17.
Liver foundation trust 2002-liver is a vital organ of body,www.liver foundation.org.html.
Kumar,abbas, fausto”the liver”basis pathology of disease 7th edition 2004.
Howard. J.Warman 1998 ‘common labortary test in liver disease.
Dr vivaRolf 2004 “anatomy of liver” school of nursing and accademic division of midwifery university of Nottingham.
Tzankakis et al “liver assist-device” annual review medical engineering 2000-607-632.
Spiritus 2005 function of liver;spiritus-temporis.com.
Haslett,chilver, collenge hunter Davidson’s “princal and practic of medicine’the liver” 2004 19th edition churchil living stone,edinberg.
working>as>assitant>professor>inmmc>mirpurkhas>sindh