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