liver disease is a common presentation to the ED whether it be an acute hepatitis, a complication of chronic hepatitis / cirrhosis such as portal hypertension, or incidental liver disease findings
the liver is a common site for metastatic deposits from other organ cancers
the dual blood supply means that liver infarcts are rare but localised infarcts can occur if a intrahepatic branch of the hepatic artery is compromised
an exception is when thrombosis of the hepatic artery in a transplanted liver occurs, this results in infarction and loss of the transplanted liver
a variety of genetic disorders can also cause hepatic dysfunction:
alpha-1 antitrypsin deficiency
often Dx in children or adolescents but may be silent until cirrhosis develops in middle age onwards
resolution (far majority of HAV, 90% of hepatitis B virus, most HEV if not pregnant)
acute fulminant hepatitis
12% due to viral infections: < 0.5% of hepatitis B virus, 0.1% fatal acute fulminant hepatitis with hepatitis A, 20% mortality rate with HEV in pregnant women, dengue fever, herpes virus
acute fatty liver of pregnancy (AFLP) - rare condition of 3rd trimester, may be cause hepatic failure - 20-40% have concurrent pre-eclampsia and eclampsia
NB. hepatitis may appear normal on USS or it may have a “starry sky” texture due to oedematous parenchyma allowing the portal triads to stand out brightly
NB. hepatitis may cause GB wall thickening
cirrhosis
develops into nodular and atrophic appearance (esp. R hepatic lobe)
on USS:
texture becomes heterogeneous and coarse, there may be nodules on the liver surface
on contrast CT:
nodules may be variable but usually do not significantly enhance with contrast
may also have ascites, varices, splenomegaly, carcinoma