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The liver in systemic disease 

The liver in systemic disease

The liver in systemic disease

J. Neuberger



Chapter reviewed in July 2012—minor updates made, in particular relating to liver involvement in leukaemias, myelofibrosis, and myelodysplasia.

Updated on 28 Nov 2012. The previous version of this content can be found here.
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date: 28 April 2017

The liver is affected in many systemic diseases, with important examples being:

Cardiovascular diseases—raised venous pressure, e.g. cardiac failure, constrictive pericarditis, can lead to hepatic congestion, which sometimes causes nausea, vomiting, and right upper quadrant pain. Hepatomegaly is frequent in moderately severe heart failure. Cardiac cirrhosis is a rare complication.

Pulmonary diseases—conditions that involve the liver as well as the lungs include cystic fibrosis, sarcoidosis, and α‎1-antitrypsin deficiency.

Gastrointestinal diseases—inflammatory bowel disease is associated with a range of hepatic pathology including fatty change, pericholangitis, sclerosing cholangitis, chronic active hepatitis, cirrhosis, and amyloidosis. Hepatobiliary disease associated with total parenteral nutrition varies from a mild, asymptomatic disease to jaundice, cirrhosis, and liver failure. Coeliac disease may rarely present with abnormal liver tests.

Endocrine diseases—autoimmune hepatitis may be associated with autoimmune endocrine disorders. Both hypothyroidism and hyperthyroidism can cause abnormalities of liver function, which are usually mild.

Haematological diseases—conditions associated with abnormal blood clotting, such as protein C or S deficiency and paroxysmal nocturnal haemoglobulinuria, may lead to Budd–Chiari syndrome (hepatic vein thrombosis). The liver may be involved in both non-Hodgkin’s lymphoma and leukaemia.

Infectious diseases—agents that particularly affect the liver, e.g. viral hepatitis, are discussed in other chapters. Abnormal liver function may occur during many systemic infections, but it is rare for patients with sepsis to present primarily with liver symptoms, although jaundice, abnormal liver function tests or (very rarely) fulminant hepatic failure may be the principal presenting feature.

Rheumatological diseases—hepatic disease may either be a consequence of treatment or occur in association with other autoimmune diseases.

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