Gluconeogenesis : The formation of glucose
(blood sugar) from certain amino acids, lactate or
glycerol; that is necessary to support the stable
concentration of glucose in the blood.
Glycogenolysis : The formation of glucose
from glycogen - to mobilize glucose for the body
from intrahepatic resource.
Glycogenesis: The formation of glycogen from
glucose - to make resource of glucose for future
Hepatitis means inflammation of the liver.
The disease can be caused by:
► Infections from
viruses (such as
hepatitis B, or hepatitis C) or parasites,
► Excess accumulation of
fat (triglycerides) in liver cells - Non Alcoholic
Fatty Liver Disease (NAFLD) - caused by obesity and
abnormal lipid metabolism, may result in
► Liver damage from
alcohol, drugs, or poisonous mushrooms
► Immune cells in the
body may attack the liver and cause autoimmune
► Some inherited genetic
liver disorders result in hepatitis
► An overdose of
acetaminophen, which is rare but mortal. Besides
acetaminophen (other names: Tylenol, paracetamol)
some other medications can cause damage and
inflammation of the liver.
Hepatitis may start and resolve quickly (acute
hepatitis), or cause long-term disease for decades
(chronic hepatitis). In some instances, progressive
liver damage, liver failure, or even liver cancer
may (hepatocellular carcinoma) result.
severity of hepatitis depends on many factors,
including the cause of the liver damage and any
underlying illnesses you have. Hepatitis A, for
example, is generally transient, not leading to
chronic liver problems.
The symptoms of hepatitis may include some or
all of the following (depends on a stage of
► Early menopause
► Loss of appetite
► Jaundice (yellowing of
the skin or eyes)
► Abdominal pain or
► Weight loss
► General itching
► Chronic fatigue
► Low grade fever
► Breast development in
► Nausea and vomiting
► Dark urine and pale or
Many people with hepatitis B or C do not have
symptoms when first infected and can still develop
liver failure later (sometimes decades later).
Chronic hepatitis very often results in liver
failure (cirrhosis) or liver cancer.
"Fibrosis is a scarring process of body organs and
hepatic fibrosis is scarring of the liver."
"Fibrosis is the excessive accumulation of
extracellular matrix proteins including collagen
proteins in abnormal ratio."
In other words" liver fibrosis is associated with
major alterations in both the quantity and
composition of extracellular matrix proteins."
In advanced stages, the liver contains
approximately 6 times more extracellular matrix
proteins than normal and its end-stage disease
cirrhosis are major world health problems arising
from chronic injury of the liver by a variety of
factors including viruses, the metabolic syndrome,
autoimmune disease, alcohol and drug abuse, and
inherited (genetic) disorders of metabolism.
Cirrhosis is the final common pathway through
which nearly all chronic diseases of the liver
produce morbidity and mortality.
► Fibrosis process
occurs in most types of chronic liver diseases.
► It is the consequence
of chronic liver injury of any etiology.
► Hepatic fibrosis is
the result of the wound-healing response of the
liver to repeated injury.
The liver has an incredible ability to heal itself,
but it can only heal itself if nothing is damaging
it time and again. After an acute liver injury
(e.g., acute viral hepatitis), liver cells
regenerate and replace the damaged and dead cells.
This process is associated with an inflammatory
response and a limited deposition of extracellular
matrix proteins. If the hepatic injury persists,
then eventually the liver regeneration response
becomes wrong, pathologically activated hepatic
stellate cells-cells that encircle the sinusoids and
in healthy condition are quiescent and store
vitamin A- become the main source of scar-like
matrix composed of cross-linked collagen. As
fibrotic liver diseases advance, disease progression
from collagen bands to bridging fibrosis and frank
The onset of liver fibrosis is usually insidious and
inconspicuous, and most of the related morbidity and
mortality occur after the development of advanced
liver fibrosis, i.e. cirrhosis. In the majority of
patients, progression to cirrhosis occurs after an
interval of 10 to 20 years. Major clinical
complications of cirrhosis include
ascites, renal failure,
hepatic encephalopathy, and
Historically, treatments for hepatic fibrosis
have been directed against specific causes of
chronic liver injury, and include for example:
► Corticosteroids for
► Interferon for
hepatitis B and C
► Once treatments become
ineffective, a liver transplant has been considered
until the present.
► Transplantation of
cultured liver cells: In most circumstances, liver
cell infusion along with a proper adjuvant therapy
(according to individual characteristics of
patient's clinical course) reduces and reverse the
harmful affects of advanced liver fibrosis and
cirrhosis, and can prevent the need for a liver
transplant. Transplanted cells stop activated
hepatic stellate cells, stop their injurious
fibrotic activity and reverse them into quiescent
Hepatocellular carcinoma (HCC, also called
malignant hepatoma) is a primary malignancy (cancer)
liver. Most cases of HCC are secondary to either
a viral hepatitide infection (Hepatitis
B or C) or
cirrhosis (alcoholism being the most common
cause of hepatic cirrhosis).
In countries where hepatitis is not endemic, most
malignant cancers in the liver are not primary HCC
but metastasis (spread) of cancer from elsewhere in
the body, e.g., the colon.
Treatment options of HCC and prognosis are dependent
on many factors but especially on tumor size and
Tumor grade is also important. High-grade tumors
will have a poor prognosis, while low-grade tumors
may go unnoticed for many years, as is the case in
many other organs, such as the breast, where a
ductal carcinoma in situ (or a lobular carcinoma in
situ) may be present without any clinical signs and
without correlate on routine imaging tests, although
in some occasions it may be detected on more
specialized imaging studies like MR mammography.
The usual outcome is poor, because only 10 - 20% of
hepatocellular carcinomas can be removed completely
using surgery. If the cancer cannot be completely
removed, the disease is usually deadly within 3 to 6
months. This is partially due to late presentation
with large tumours, but also the lack of medical
expertise and facilities.
A new receptor tyrosine kinase inhibitor, sorafenib
has been shown in a Spanish phase III clinical trial
to add two months to the lifespan of late stage HCC
patients with well preserved liver function.
Signs and symptoms
HCC may present with jaundice,
bloating from ascites, easy bruising from blood
clotting abnormalities or as loss
of appetite, unintentional weight loss, abdominal
pain, nausea, emesis, or fatigue.
Fever ,Enlarged spleen ,Gastrointestinal bleeding
Asymptomatic in early stages ,Right upper abdominal
pain ,Right upper abdominal tenderness ,Right upper
abdominal lump,Ascites,Muscle wasting,Enlarged
liver,Tiredness,Impaired liver functionIncreased
blood alkaline phosphatase level,Increased blood
bleeding,Cachexia,Increasing abdominal girth (portal
vein occlusion by thrombus with rapid development of
ascites),Hepatic encephalopathy,Right upper quadrant