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The liver in systemic disease 

The liver in systemic disease
The liver in systemic disease

James Neuberger

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date: 25 February 2021

The liver is affected in many systemic diseases, with important examples being cardiovascular diseases—raised venous pressure can lead to hepatic congestion. 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, autoimmune hepatitis, cirrhosis, and (rarely) 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. Obesity, especially in association with the metabolic syndrome, may be associated with nonalcoholic hepatitis and steatohepatitis. Endocrine diseases—autoimmune hepatitis and primary biliary cholangitis 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 haemoglobinuria, 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 elsewhere although many systemic infections also infect the liver. 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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