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Jaundice is an important clinical sign reflecting the accumulation of bilirubin in blood. It is frequently associated with significant underlying disease. It can result from increased bilirubin production (due to haemolysis); inability of the liver to take up and/or conjugate bilirubin (in Gilbert’s syndrome or parenchymal liver disease); or failure to excrete bilirubin into biliary canaliculi and/or...
Numerous viruses can infect the liver and the incidence of hepatitis caused by such hepatotropic viruses is increasing in the UK, perhaps related to increased travel worldwide. This article will outline the epidemiology, presentation and management of hepatitis A and E viruses, Epstein–Barr virus, cytomegalovirus, and herpes simplex virus. In certain groups such as pregnant women, and patients in...
Chronic liver disease is increasingly common in the UK, and now causes in excess of 5000 deaths per year. The natural history of liver injury is of increasing fibrosis in response to hepatocellular injury, which is usually asymptomatic until decompensation occurs. Up until this point, elevated liver enzyme concentrations are the only indicators of disease. Thorough investigation of abnormal liver...
The liver is frequently involved in infections that are prevalent in different regions of the tropics, and chronic liver disease, sometimes of multiple aetiologies, is an important cause of early morbidity and mortality. This article describes some hepatic and biliary problems that are seen in the tropics, or which may be imported from resource-poor settings. The epidemiology of hepatitis A is changing...
Acute liver disease or failure in children is most often due to viral hepatitis (A, B, E or sero-negative), paracetamol overdose or inherited metabolic liver disease. The clinical presentation includes jaundice, coagulopathy and encephalopathy. Uncomplicated acute hepatitis resolves spontaneously, but progressive acute liver failure is fatal in 70% of cases and requires referral to specialized units...
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