ACOG
Close Search
Menu
Home Search

Liver Disease: General Pathophysiology, Diagnosis, and Management

  • Clinical Updates in Women's Health Care CU
  • November 2016

ABSTRACT: Approximately one third of American adults have a chronic hepatobiliary disease 1. The multiple etiologies include alcoholic liver disease, nonalcoholic fatty liver disease, viral hepatitis, autoimmune liver diseases, drug-induced liver injury, and genetic or metabolic diseases. Most patients have few or no symptoms, but many have abnormal liver test results or serum bilirubin levels. Cirrhosis, regardless of the etiology of the underlying liver disease, is a risk factor for hepatocellular carcinoma. Because obstetrician–gynecologists provide both general and specialized care to adolescents and adult women, it is important that they understand the basics of liver anatomy and physiology, significance of abnormal liver test results and abnormal levels of serum bilirubin, and strategies for additional testing and imaging required for diagnosis. Several hepatobiliary diseases occur with greater frequency in women than in men, whereas others affect women differently from men. Early diagnosis and therapy offer the best hope for preventing the progression of hepatobiliary diseases to cirrhosis, liver failure, and the need for liver transplantation. Obstetrician–gynecologists should develop strong working relationships with consultants in hepatology and liver transplantation to promote the best outcomes for their patients.

Log in to read more

This content is only available to members and subscribers.

Log In

Nonmembers: Subscribe now to access exclusive ACOG Clinical content, including:

ACOG Clinical is designed for easy and convenient access to the latest clinical guidance for patient care. Developed with members’, physicians’, and women’s health care professionals’ needs in mind, user-friendly features include:

  • Easy, advanced search function to find the most relevant guidance
  • Enhanced document presentation
  • Advanced features and functionality

You’ll find clinical content written and peer reviewed by experts and valuable information that spans guidance on the diagnosis and management of the full spectrum of obstetric and gynecological conditions and clinical management issues.

Note for Life Fellows: Annual membership dues are waived but there is a discounted annual subscription fee of $95 for access to publications such as the Green Journal, Practice Bulletins, and Committee Opinions. Individual subscriptions include print and online access. Subscribe today.

Subscribe
Download PDF Figures & Tables Earn CME Credits
Related

Figures & Tables

Fig. 1. The gross anatomy of the liver with biliary tract, gallbladder, and vascular supply by the portal vein and hepatic artery. The branches of the hepatic artery and portal vein accompany each other, and the calibers of the hepatic artery branches and accompanying bile ducts are similar.

Fig. 1. The gross anatomy of the liver with biliary tract, gallbladder, and vascular supply by the portal vein and hepatic artery. The branches of the hepatic artery and portal vein accompany each other, and the calibers of the hepatic artery branches and accompanying bile ducts are similar.

request permissions

Fig. 2. A bile duct unit is composed of a bile duct, a branch of the hepatic artery with a peribiliary capillary plexus surrounding the bile duct, and peribiliary lymphatics that drain bile formed in hepatic lobules.

Fig. 2. A bile duct unit is composed of a bile duct, a branch of the hepatic artery with a peribiliary capillary plexus surrounding the bile duct, and peribiliary lymphatics that drain bile formed in hepatic lobules.

request permissions

Fig. 3. Hepatic acinus. Each acinus receives its blood supply from several portal tracts contributing both portal venous and hepatic arterial blood that flows in the sinusoidal spaces between cords of hepatocytes to the central vein.

Fig. 3. Hepatic acinus. Each acinus receives its blood supply from several portal tracts contributing both portal venous and hepatic arterial blood that flows in the sinusoidal spaces between cords of hepatocytes to the central vein.

request permissions

Fig. 4. Hepatic zones. Hepatic zones within each hepatic acinus are populated by hepatocytes exposed to different gradients of oxygen and nutrients as blood flows from the portal tracts to central veins. These zones are designated as 1) periportal, 2) midlobular, and 3) central venous.

Fig. 4. Hepatic zones. Hepatic zones within each hepatic acinus are populated by hepatocytes exposed to different gradients of oxygen and nutrients as blood flows from the portal tracts to central veins. These zones are designated as 1) periportal, 2) midlobular, and 3) central venous.

request permissions

Fig. 5. Differential functions of hepatocytes in zone 1 compared with those in zone 3 illustrated for NH 3 metabolism. The gradient of oxygen and nutrients flowing from zone 1 to zone 3 is associated with differential functions of hepatocytes populating these microenvironments. Abbreviations: HCO 3 – indicates hydrogen carbonate; NH 4 + , ammonium.

Fig. 5. Differential functions of hepatocytes in zone 1 compared with those in zone 3 illustrated for NH 3 metabolism. The gradient of oxygen and nutrients flowing from zone 1 to zone 3 is associated with differential functions of hepatocytes populating these microenvironments. Abbreviations: HCO 3 – indicates hydrogen carbonate; NH 4 + , ammonium.

request permissions

Fig. 6. Algorithm for diagnostic testing in a patient with abnormal liver enzyme test results. *The asterisk indicates that diagnostic liver biopsy is required. Abbreviations: ALP indicates alkaline phosphatase; ALT, alanine aminotransferase; AST aspartate aminotransferase; PCR, polymerase chain reaction; RNA ribonucleic acid.

Fig. 6. Algorithm for diagnostic testing in a patient with abnormal liver enzyme test results. *The asterisk indicates that diagnostic liver biopsy is required. Abbreviations: ALP indicates alkaline phosphatase; ALT, alanine aminotransferase; AST aspartate aminotransferase; PCR, polymerase chain reaction; RNA ribonucleic acid.

request permissions

Fig. 7. Algorithm for diagnostic testing in a patient with hyperbilirubinemia.

Fig. 7. Algorithm for diagnostic testing in a patient with hyperbilirubinemia.

request permissions

Table 1. Differential Diagnosis of Hepatocellular, Cholestatic, and Mixed Patterns of Abnormal Liver Enzymes

Table 1. Differential Diagnosis of Hepatocellular, Cholestatic, and Mixed Patterns of Abnormal Liver Enzymes

request permissions

Table 2. Modified West Haven Classification of Stages of Hepatic Encephalopathy

Table 2. Modified West Haven Classification of Stages of Hepatic Encephalopathy

request permissions

Table 3. Model of End-Stage Liver Disease Scores and Estimated 90-Day Mortality (95% Confidence Intervals) With Medical Management

Table 3. Model of End-Stage Liver Disease Scores and Estimated 90-Day Mortality (95% Confidence Intervals) With Medical Management

request permissions

Table 4. Child–Turcotte–Pugh Scoring System and Child–Pugh Class

Table 4. Child–Turcotte–Pugh Scoring System and Child–Pugh Class

request permissions

Table 5. Serologic and Molecular Diagnostic Test Results in Patients With Acute and Chronic Viral Hepatitis, in the Convalescent Period, and After Immunization for Hepatitis A Virus or Hepatitis B Virus

Table 5. Serologic and Molecular Diagnostic Test Results in Patients With Acute and Chronic Viral Hepatitis, in the Convalescent Period, and After Immunization for Hepatitis A Virus or Hepatitis B Virus

request permissions

Table 6. Treatment Guidelines for Patients With HBeAg-Positive and HBeAg-Negative Chronic Hepatitis B from the American Association for the Study of Liver Diseases, the European Association for the Study of the Liver, and the Asian Pacific Association for the Study of the Liver

Table 6. Treatment Guidelines for Patients With HBeAg-Positive and HBeAg-Negative Chronic Hepatitis B from the American Association for the Study of Liver Diseases, the European Association for the Study of the Liver, and the Asian Pacific Association for the Study of the Liver

request permissions

Table 7. Comparison of the Incidences of Selected Hepatobiliary Diseases and Neoplasms in Women and Men

Table 7. Comparison of the Incidences of Selected Hepatobiliary Diseases and Neoplasms in Women and Men

request permissions

Table 8. CAGE Questionnaire for Detection of Alcoholism

Table 8. CAGE Questionnaire for Detection of Alcoholism

request permissions

Table 9. Causes of Nonalcoholic Steatohepatitis Other Than Metabolic Syndrome

Table 9. Causes of Nonalcoholic Steatohepatitis Other Than Metabolic Syndrome

request permissions