Chrionic Hepatitis Flashcards
Hepatitis in general
Hepatitis is an inflammation of the liver. It can be caused by a variety of factors, including viral infections, alcohol abuse, certain medications, and autoimmune diseases.
Types
Hepatitis A: This is a short-term infection caused by the hepatitis A virus (HAV). It’s usually spread through contaminated food or water, or through close contact with an infected person. Most people recover fully from hepatitis A without any lasting liver damage.
* Hepatitis B: This can be a short-term or long-term infection caused by the hepatitis B virus (HBV). It’s spread through contact with infected blood or body fluids, such as through sharing needles or having unprotected sex. Chronic hepatitis B can lead to serious liver problems, such as cirrhosis and liver cancer.
* Hepatitis C: This is a viral infection caused by the hepatitis C virus (HCV). It’s usually spread through contact with infected blood, such as through sharing needles. Most people who get hepatitis C develop a chronic infection, which can also lead to cirrhosis and liver cancer.
* Hepatitis D: This is a viral infection that can only occur in people who also have hepatitis B. It’s spread through contact with infected blood or body fluids.
* Hepatitis E: This is a short-term infection caused by the hepatitis E virus (HEV). It’s usually spread through contaminated food or water, or through eating undercooked pork.
Acute hepatitis
Acute hepatitis lasts less than 6 months.
Chronic hepatitis definition
– is a polietiologic diffuse
inflammatory disease of the liver which lasts for at
least 6 months.
Classification according to etiology
o Autoimmune
o Chronic viral B, C, D
o Chronic viral (non-identified)
o Idiopathic (nor viral and autoimmune)
o Chronic drug-induced
o Alcocholic
o Liver disease associated with α1-antitripsin
deficiency
o Wilson’ disease
Nonalcoholic fatty liver disease (NAFLD): This condition, often associated with obesity and diabetes, can progress to NASH and chronic hepatitis.
* Certain medications: Some medications can cause liver damage and lead to chronic hepatitis
Classification according to stages
By stages:
0 Absence of fibrosis
1 Mild fibrosis
2 Moderate fibrosis
3 Severe fibrosis
4 Liver cirrhosis
(periportal)
(porto-portal septs)
(porto-central septs
Classification according to activity
Mild Moderate Severe>10
ALT level (10-40 U/l)
< 3 ULN
3-10
Pathogensis
Clinical picture
o intoxication
o distension of liver capsule
o deterioration of pigment metabolism
o deterioration of protein formation in the liver
o deterioration of coagulion factors formation
o deterioration of carbohydrates metabolism
o deterioration of lipids metabolism
o deterioration of metabolism of vitamins
o deterioration of hormones metabolism
o cholestasis
o cytolysis
o damage of central nervous system
o hepatocellular insufficiency
Clinical symptoms
Intoxication causes
o fatigue
o poor work capacity
o excitation
o bad mood
o fever (subfebrile) …
Distension of liver capsule causes
o pain (discomfort, heaviness)
in the right hypochondrium,
worsening after meal
o hepatomegaly
Deterioration of pigment metabolism
Hyperbilirubinemia causes
- liver may be unable to conjugate or secrete
bilirubin appropriately. Can lead to:
• Icterus - yellow discoloration of the sclera
• Jaundice - yellow discoloration of the skin
• Bilirubinuria - golden-brown coloration of the
urine
deterioration of carbohydrates metabolism causes
o ↓ glycogen (latent)
o intolerance to glucose (secondary diabetes
mellitus)
deterioration of lipids metabolism causes
o xantomas (intradermal plaques)
deterioration of metabolism
of vitamins
o red smooth tongue with atrophy
of papillae (↓ Vit B12, folic acid)
deterioration of carbohydrates metabolism
o ↓ glycogen (latent)
o intolerance to glucose (secondary diabetes
mellitus)
deterioration of lipids metabolism
o xantomas (intradermal plaques)
deterioration of metabolism
of vitamins
o red smooth tongue with atrophy
of papillae (↓ Vit B12, folic acid)
Mechanisms of Action
- Inflammation: Chronic hepatitis involves ongoing inflammation of the liver tissue. This inflammation can be triggered by various factors, including viral infections (hepatitis B, C, D), autoimmune disorders, medications, alcohol abuse, or non-alcoholic fatty liver disease (NAFLD).
- Liver Cell Damage: The persistent inflammation leads to damage and destruction of liver cells (hepatocytes). This can disrupt liver function and lead to a range of complications.
- Fibrosis: As the liver tries to repair itself from the ongoing damage, it produces scar tissue called fibrosis. Over time, excessive fibrosis can lead to cirrhosis, a severe scarring of the liver that impairs its function.
- Cirrhosis: Cirrhosis is the end stage of chronic liver damage. The liver becomes severely scarred, and its structure is disrupted. This can lead to liver failure, portal hypertension (increased pressure in the blood vessels leading to the liver), and other serious complications.
- Liver Failure: In severe cases, chronic hepatitis can progress to liver failure, where the liver is no longer able to perform its essential functions. This can be life-threatening and may require a liver transplant.
Complications
Cirrhosis: This is a severe scarring of the liver that can lead to liver failure.
* Liver failure: This is a life-threatening condition where the liver is no longer able to function properly.
* Liver cancer: People with chronic hepatitis are at increased risk of developing liver cancer.
* Portal hypertension: This is an increase in the pressure in the blood vessels that lead to the liver. It can cause complications such as ascites (fluid buildup in the abdomen) and varices (enlarged veins in the esophagus or stomach that can bleed).
* Ascites: This is a buildup of fluid in the abdomen. It can be caused by portal hypertension or liver failure.
* Hepatic encephalopathy: This is a condition that can occur when the liver is not able to remove toxins from the blood. It can cause confusion, disorientation, and even coma.
* Variceal bleeding: This is bleeding from enlarged veins in the esophagus or stomach. It can be a life-threatening complication of portal hypertension.
Drug-induced hepatitis
Drug-induced hepatitis, or drug-induced liver injury, is a rare condition where liver inflammation and damage occur due to certain medications. Here’s how it happens:
* Liver Metabolism: The liver plays a crucial role in processing and breaking down medications. When a medication is ingested, the liver works to metabolize it, transforming it into substances that can be eliminated from the body.
* Toxic Byproducts: In some cases, the liver’s metabolic processes can create toxic byproducts that damage liver cells. These byproducts can trigger inflammation and disrupt liver function. Dose-Related vs. Idiosyncratic Reactions:
* Dose-related reactions occur when a medication’s dosage exceeds the liver’s capacity to process it safely. This can lead to a buildup of toxic substances and liver damage.
* Idiosyncratic reactions are unpredictable and can occur even at normal dosages. They may involve immune hypersensitivity or genetic predispositions that make certain individuals more susceptible to liver damage from specific medications.
* Inflammation and Damage: The liver’s response to toxic byproducts or immune reactions involves inflammation. This inflammation can damage liver cells, impair their function, and lead to various liver problems, including hepatitis.
* Chronic Hepatitis: In some cases, drug-induced hepatitis can become chronic, persisting for more than six months. This can happen if the medication is continued despite liver damage or if the initial injury triggers an ongoing inflammatory response.
Factors Increasing Risk:
* Dosage: Higher doses of medication increase the risk of liver damage.
* Duration: Taking a medication for an extended period can increase the risk of chronic hepatitis.
* Individual Susceptibility: People with pre-existing liver conditions, alcohol abuse, or certain genetic factors may be more susceptible to drug-induced hepatitis.
* Multiple Medications: Taking multiple medications simultaneously increases the risk of liver damage due to potential drug interactions.
Risk factors:
- Exposure to hepatitis B or C virus: This can occur through sharing needles, sexual contact, or from mother to child during birth.
- Autoimmune diseases: People with autoimmune diseases are at increased risk of developing autoimmune hepatitis.
- Excessive alcohol consumption: This is a major risk factor for alcoholic hepatitis.
- Obesity and diabetes: These conditions increase the risk of NAFLD and NASH.
- Family history: A family history of liver disease can increase the risk of chronic hepatitis.
Bilirubin
Bilirubin is a yellow pigment that is produced when red blood cells break down. It is normally processed by the liver and excreted in bile. However, when the liver is not functioning properly, bilirubin can build up in the blood, causing jaundice.
Direct and Indirect Bilirubin:
There are two types of bilirubin:
* Indirect bilirubin: This is the form of bilirubin that is produced when red blood cells break down. It is not water-soluble and must be converted to direct bilirubin by the liver.
* Direct bilirubin: This is the water-soluble form of bilirubin that is produced by the liver. It is excreted in bile.
Elevated bilirubin levels can be a sign of a number of different conditions, including:
Liver disease: Hepatitis, cirrhosis, and other liver diseases can impair the liver’s ability to process bilirubin, leading to elevated levels.
* Gallstones: Gallstones can block the flow of bile from the gallbladder, causing bilirubin to build up in the blood.
* Hemolytic anemia: This condition occurs when red blood cells are destroyed faster than they can be made. This can lead to an increase in indirect bilirubin levels.
* Gilbert’s syndrome: This is a mild genetic condition that can cause elevated levels of indirect bilirubin.
