chapter 31 Flashcards
bilirubin
organic yellow pigment formed in liver by breaking down hemoglobin and is excreted in bile
Conjugated bilirubin
Once in the liver, bilirubin becomes conjugated. This means it is water-soluble and can be excreted. Unconjugated bilirubin is toxic
Liver basics
- uses enzymes and O2 to burn toxins, especially fatty ones
- the toxins are combined w amino acids so they can be removed from the liver through the bile or urine
Hepatitis A Virus (HAV)
-Transmitted by the fecal-oral route
-Virus shed in feces
-Virus killed by thorough cooking
-Fever, abdominal pain, mild flu-like symptoms
-Vaccine available (Havrix)
-Endemic (routinely found) in Asia, Africa, Mexico, and -South America
-Treatment
-Supportive
Hepatitis B Virus (HBV)
-Transmitted by blood products, body fluids, or sexual contact
-Does not directly kill cells, but the host’s immune system destroys viral-infected cells
Hepatitis Signs and Symptoms (General)
-Fever
-Abdominal pain
-Flu-like symptoms
-Nausea and vomiting
-Fatigue
-Malaise
-Myalgias
-Arthralgias
-Mild headache
-Anorexia
-Loss of taste for food
-Smokers often lose their taste for tobacco
-Hepatomegaly
-Jaundice
-Stool that may have a pale appearance
-Dark urine
-Pruritus
Hepatitis B Virus Stage 1
-Incubation period
-No signs or symptoms, however, can infect others
-Duration of 2 to 4 weeks
Hepatitis B Virus Stage 2
-The inflammatory reaction of hepatocytes
-Flu-like symptoms and jaundice
-HBeAg, HBsAg, and HBV DNA can be detected in the bloodstream
-Liver enzymes begin to increase
-Duration 3 to 4 weeks
Hepatitis B Virus Stage 3
-Immune system reaction to HBV
-Viral replication slows
-HBV DNA levels are lower or undetectable
-Liver enzyme levels decrease to norma
Hepatitis B Virus Stage 4
The virus cannot be detected
Antibodies to HBsAg, HBcAg, and HBeAg
Antibodies against HBsAg confer long-term protective immunity
Anti-HBcAg only with infection, not vaccination
HBV Signs and Symptoms
-Anorexia
-Nausea and vomiting
-Fatigue
-Flu-like symptoms
-Fever, malaise, myalgias
-Jaundice
*Hepatomegaly
*Splenomegaly
*Lymphadenopathy
-Spider angioma
-Palmar erythema
-Jaundice can last for months
-Patients with severe cases of infection may show signs of hepatic encephalopathy—somnolence, confusion, stupor, or coma.
HBV Diagnosis
-Presence of HBsAg in the bloodstream
-Levels do not correlate with disease severity
-IgM-type anti-HBc antibodies
-Acute infection
-IgG-type anti-HBc antibodies
-Chronic infection
HBV Treatment
-Based on symptoms
-Supportive with rest
-Small, high-calorie, and high-protein meals
-Interferon alpha
-Prevention is key
HBV Extra Info
-Course is variable
-Most do not recover completely
-Chronic HBV
Can be healthy carriers without disease evidence
-Can lead to hepatocellular cancer
-Contacts can obtain HBIg (rapid, passive immunity)
Hepatitis C virus (HCV)
-Acute infection usually mild
-Most develop chronic hepatitis
Can remain dormant for years before symptoms
-Long incubation period
2 weeks to 8 months
-Patient is asymptomatic, can spread the virus
Transmitted via blood: IV drug use
-HCV-RNA
Detected weeks to months before antibody development
-Virus mutates rapidly
No vaccination
Hepatitis C Virus Treatment
Anti-viral drugs
Current drug therapy
Non-detectable levels of virus in 12 weeks
Protease inhibitor combinations
Paritaprevir-ritonavir-ombitasvir-based regimen
Nonalcoholic fatty liver disease (NAFLD)
-Most common cause of chronic liver disease in the United States
-Associated with metabolic syndrome, insulin resistance, and obesity
-Hepatocytes accumulate triglycerides
-Accumulation of fat disrupts cellular function
-Cells can rupture causing inflammatory response, damaging to liver
NAFLD steatosis
more than 5% of the liver contains fat
NAFLD etiology
unclear
Nonalcoholic steatohepatitis (NASH)
Extreme form of NAFLD in which scarring and inflammation of liver occurs
vegetarians and NAFLD
strict vegetarian diet lack of protein leads to a deficiency of amino acids that are needed by the liver for the conversion of fat to phospholipids, lipoproteins, and transportation of cholesterol from the cells. This can lead to accumulation of fat in the liver resulting in NAFL
NAFLD signs and symptoms
Mild cases: none, abnormal liver enzyme levels may be present
Nonalcoholic steatohepatitis (NASH):
-obvious signs of liver impairment
-Edema, jaundice, fatigue
-Can lead to hepatocellular carcinoma (HCC)
NAFLD diagnosing
-No specific biomarkers or blood tests
-Liver biopsy is key test
False negative: if sample not taken from high fat content area
-Patient who is obese, metabolic syndrome with elevated liver enzymes should be evaluated for NAFLD
-NAFLD fibrosis score
Age, hyperglycemia, body mass index (BMI), platelet count, albumin level, and ratio of AST to ALT
NAFLD treatment
-Weight loss and exercise
-Bariatric surgery
-Medication
Lipid-lowering agents (monitor for liver toxicity)
Insulin sensitivity medications
alcoholic liver disease types
alcoholic hepatitis and alcoholic liver disease
alcoholic liver disease
-AKA alcoholic cirrhosis
-Develops over a long period of time and is permanent
-Diagnosis
Liver biopsy
-Alcohol is a potent toxin to hepatocytes
-Hepatocytes can regenerate but are susceptible to repeated damage
-Steatosis
Initial cellular change
-Can progress to cirrhosis
-Common for patients to not provide accurate history of alcohol intake
Alcoholic Liver Disease Signs and Symptoms
-Hepatomegaly and splenomegaly
-Portal hypertension with esophageal varices
-Ascites
-Spider angioma
-Proximal muscle wasting
-Gynecomastia in males
-Withdrawal symptoms of restlessness, mood disturbance, tremors called delirium tremens, and, possibly, seizures
Acute Alcoholic Hepatitis
-RUQ pain and tenderness
-Nausea
-Malaise
-Low-grade fever
-Jaundice
-Darkened urine
-Hepatomegaly
Severe Alcoholic Hepatitis
-Hepatic encephalopathy
Confusion, disorientation, or stupor
-Coagulation dysfunction
-Spontaneous bruising and bleeding
-Hyperbilirubinemia
-Jaundice
-Hematemesis
diagnosis of alcoholic liver disease
-AST and ALT elevation
-Hypertriglyceridemia and hypercholesterolemia
-Hyperbilirubinemia and hypoalbuminemia
-Coagulation disturbances
-Liver biopsy to confirm changes
Treatment of Alcoholic Liver Disease
-Cessation of alcohol
-Proper nutrition
-High-protein diet (unless hepatic encephalopathy present)
-Improvement of liver function if there is 6 months of abstinence from alcohol
