Chapter 17: Liver Disorders and Gallstones

Liver Disorders and Gallstones clinical exploration delves into the pathophysiology of hepatobiliary disorders, framing the liver as a vital metabolic factory responsible for essential synthetic, excretory, and detoxification processes. It details the organ's role in maintaining systemic glucose levels via gluconeogenesis and glycogenolysis, synthesizing crucial plasma proteins and vitamin K-dependent coagulation factors, and processing lipids into lipoproteins. A primary focus is placed on the complex pathway of bilirubin metabolism—from heme degradation to its conjugation in hepatocytes and eventual excretion into the intestinal tract—highlighting how disruptions at different stages manifest as pre-hepatic, hepatic, or post-hepatic jaundice. The text provides a rigorous framework for interpreting liver function tests (LFTs), distinguishing between markers of acute hepatocellular damage like alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and indicators of cholestasis such as alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT). Furthermore, it addresses chronic conditions including various forms of viral hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease (NAFLD), and the progression toward cirrhosis, portal hypertension, and hepatic encephalopathy. The discussion extends to rare inherited metabolic conditions such as Wilson’s disease, haemochromatosis, and Gilbert’s syndrome, alongside a detailed analysis of gallbladder pathology, focusing on the formation of cholesterol and pigment gallstones and their subsequent clinical complications like cholecystitis. Practical diagnostic algorithms are presented to guide the clinical investigation of jaundice and abnormal enzyme profiles through a combination of biochemical assays, serology, and imaging modalities such as ultrasound and cholangiography.