Chapter 9: Hepatic Digestic Pathology

Question 1

Most frequent symptoms of oesophageal disorders?

Answer 1

Dysphagia, regurgitations, halitosis, sialorrhea

Question 2

Management of the patient with oesophageal alterations:

Answer 2

Prescription of small capsule meds or envelopes
Avoid anaesthetic intake to avoid feeling of not being able to swallow

Question 3

Management of the patient with stomach and intestine disorders:

Answer 3

• Avoid intake of aspirin and anti-inflammatory drugs (steroids). If necessary with food and stomach protector such as omeprazole. 1 pill every 24 hours.
• Avoid prolonged treatments with antibiotics because of the drop of intestinal flora. NB: nowadays we add probiotics with ATB.

Question 4

Hepatitis A:

Answer 4

• Incubation period: 2-6 weeks (15-45 days).
  Transmission: HA in infected excreta. Oral-fecal transmission. Healing in 2-3-6 months.
  Fulminant hepatitis (1-5%) liver transplantation.
  Symptoms and signs (> adult frequency):
  • Asymptomatic.
  • Hepatomegaly.
  • Tiredness, nausea, fever, anorexia, abdominal pain, diarrhoea, jaundice, choluria, acholia.
  Diagnosis of hepatitis A:
  • Clinical history.
  • Antibodies anti VHA (IgM- IgG).
  IgM persists for 2-4 months.
  IgG persists as an indicator for years. Prevention:
  • Vaccination.
  • Personal and environmental hygiene.

Question 5

Hepatitis B:

Answer 5

• Incubation period: 6 weeks - 6 months.
• Transmission mechanisms:
  • Parenteral: through syringes and infected blood products.
  • Sexual.
  • Perinatal or vertical: from mother to child at birth.
  • Horizontal: through contact with infected people. The virus can remain stable for up to 7 days
  on different surfaces of the environment.
  Transmission through contaminated objects (toothbrushes, bottles, toys, cutlery, or sanitary equipment), by contact with membranes, mucous membranes, or open wounds.

Question 6

Hepatitis C:

Answer 6

• Incubation period: 2-12 months. (Longest incubation period).
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• -
  Acute hepatitis: 3-6 months to a year, most frequently asymptomatic. • At times: fatigue myalgias, nausea, vomiting, infrequent jaundice.
  • Spontaneous healing (approx: 20%).
  Chronic hepatitis: 50-80%,can be extended 10, 20, 30 years with no more symptoms than the
  alteration of some liver markers. • Evolution:
  Fibrosis.
  Cirrhosis.
  Hepatocellular carcinoma.
  Ways of transmission:
  • Intravenous drugs (40%).
  • Inhalation cocaine/heroin.
  • Tattoos, piercings.
  • No apparent cause (40%). • Sexual contact (6%).
  • Family contact (3%).
  • Occupational contact (2%).
  VHC can be detected in a contaminated gauze by the infected patient’s blood for up to 24 hours!!!!

Question 7

Management of patient with hepatitis:

Answer 7

Avoid potential transmission of the infections agent (barrier, sterilisation, and disinfection methods).
• Preventing the risk of bleeding: coagulation tests.
• Prescription medication:
Avoid drugs of hepatic metabolism. Adjust dose.
Alcoholics (non-alcoholic drugs and avoid interactions).
• In the acute phase, only EMERGENCY treatments.
• In chronic patients, investigate associated
pathologies.
• Prevention of hemorrhage.
• Control measures: universal or standard
precautions;
Vaccination: all healthcare personnel should be vaccinated against HB as an effective measure to prevent the transmission of the disease.
In the market we have 2 vaccines (Engerix B and Recombivax HB): MI in deltoids (first dose , one month and six months after).
• One month after completing all 3 doses, a check will be made to check to see if the antibody has reached its correct level (> 10 IU/ML- ELISA).