Disorders of the Liver Flashcards
Functions of the Liver
- Detoxifies
- Storage
- Activates vitamin D
- Fetal RBC production
- Phagocytosis
- Metabolizes absorbed food molecules
How does the liver detoxify for the body?
Detoxifies and removes alcohol and drugs
What does the liver store in the body?
- Glycogen
- Vitamins A, D, E , and K
- Fe and other minerals
- Cholesterol
What kind of food molecules does the liver metabolize?
- Carbohydrates
- Proteins
- Lipids
Types of Hepatitis
- Alcoholic hepatitis
- Autoimmune hepatitis
- Drug-Induced Hepatitis
- Hep A
- Hep B
- Hep C
- Delta Agent (Hep D)
Alcoholic Hepatitis: What is it?
Damage to the liver and its function due to alcohol abuse
Autoimmune Hepatitis: What is it?
Occurs when immune cells mistake the liver’s normal cells for harmful invaders and attack them
Hepatitis D (Delta Agent): What is it?
Is only found in people who carry the hepatitis B virus. HDV may make a recent (acute) hepatitis B infection or an existing long-term (chronic) hepatitis B liver disease worse. It can even cause symptoms in people who carry hepatitis B virus but who never had symptoms.
Drug-Induced Hepatitis: What is it?
Many different drugs can cause this
Hepatitis A: What is it?
Virus is found mostly in the stools and blood of an infected person about 15-45 days before symptoms occur and during the first week of illness
Hepatitis B: What is it?
Spread through having contact with the blood, semen, vaginal fluids, and other body fluids of someone with hepatitis B infection
Hepatitis C: What is it?
Has an acute and chronic form. Most people who are infected with the virus develop chronic hepatitis C.
Hepatitis A: Assessment Findings
- Varies in severity from mild to severe
- Abrupt onset with fever, malaise, anorexia, nausea, abd discomfort, then jaundice
Hepatitis A: Transmission
Fecal-Oral route from person to person
Hepatitis B: Assessment Findings
Gradual onset with…
1. Anorexia
2. Vague abdominal discomfort
3. Nausea and vomiting
4. Rash
5. Then often progresses to jaundice
Hepatitis B: Transmission
Found in all body secretions and excretions. Only blood, saliva, semen, and vaginal fluids have been known to be infectious
Hepatitis C: Assessment Findings
Onset of anorexia, vague abdominal discomfort, N/V, progressing to jaundice less frequently than hepatitis B
Hepatitis C: Transmission
By injecting contaminated blood and plasma derivatives
Hepatitis D: Assessment Findings
Abrupt onset with signs and symptoms similar to hepatitis B
** Self-limiting but may progress to chronic
Hepatitis D: Transmission
Similar to Hepatitis B
* Found in all body secretions and excretions. Only blood, saliva, semen, and vaginal fluids have been known to be infectious
Hepatitis E: Assessment Findings
- Similar to Hepatitis A
- Abrupt onset with fever, malaise, anorexia, nausea, abd discomfort, then jaundice
Hepatitis E: Transmission
- Contaminated water
- Probably person-to-person via fecal-oral route
Hepatitis: Generalized Symptoms
- May start and get better quickly (acute), or cause long-term disease (chronic). In some instances, it may lead to liver damage, liver failure, or even liver cancer
- Abd pain or distention
- Breast development in men
- Dark urine and pale or clay-colored stools
- Fatigue
- Fever - usually low grade
- General itching
- Jaundice
- Loss of appetite
- Nausea and vomiting
- Weight loss
** Many people with hepatitis B or C do not have symptoms when they are first infected. They can still develop liver failure later.
Nonalcoholic Fatty Liver Disease: What is it?
An accumulation of fat in the liver that is unrelated to alcohol use. It may cause fatigue and RUQ pain, or it may produce no symptoms at all. A diagnosis of NAFLD can be made when other causes of liver disease have been excluded by imaging or biopsy. NAFLD can progress to inflammation, cirrhosis, and hepatocellular carcinoma.
Nonalcoholic Fatty Liver Disease: Etiology
- Thought to be related to the “two-hit hypothesis”. First hit is hepatic triglyceride accumulation (steatosis) that increases the liver’s susceptibility to injury. Second hit is inflammatory cytokines/adipokinins, mitochondrial dysfunction, or oxidative stress that lead to steatohepatitis and/or fibrosis
- Poor dietary choices (high-cholesterol foods, sugary foods, especially fructose) can influence progression
- Inflammation causes more liver injury, which can result in fibrosis and later cirrhosis and/or hepatocellular carcinoma
- Three genes have polymorphisms that contribute to the development of non-alcoholic steatohepatitis (NASH)
Nonalcoholic Fatty Liver Disease: Risk Factors
- Insulin resistance
- Metabolic syndrome
- Obesity
- Type 2 DM
- Cardiovascular disease
- HTN
- Dyslipidemia, particularly high triglycerides, and/or low high-density lipoprotein levels
- Male sex
- Older age
- Hispanic ethnicity
- Genetic predisposition
Nonalcoholic Fatty Liver Disease: Assessment Findings
- Penetration of fat into liver cells (hepatic steatosis) that may result in inflammation and/or fibrosis of the liver, can progress to cirrhosis.
- Most patients are asymptomatic
- Mild abdominal pain, particularly in RUQ
- Nausea
- Fatigue
- Dorsocervical lipohypertrophy
- Elevated liver enzymes (particularly ALT > AST)
- Jaundice
- Pruritis
- Hepatomegaly
- Elevated alkaline phosphatase (2-3 times upper limit of normal)
** Include a thorough review of social history and past medical history
Nonalcoholic Fatty Liver Disease: Non-Pharmacologic Management
- Mainstay of treatment is lifestyle changes, including diet modifications and increased physical activity
- Weight loss is recommended for overweight or obese patients (using lifestyle modifications or bariatric surgery), with goal of 1-2 lbs. per week
- Dietary changes, including decreased caloric intake, adherence to low-fat, low-cholesterol diet, and avoidance of trans fats and high-fructose corn syrup
- Avoid alcohol consumption to decrease further injury to the liver
- Exercise (moderate physical activity 3-4 times per week)
- > 3% weight loss can reduce hepatic steatosis
- Support groups helpful with necessary lifestyle changes
- Psychosocial therapy to help with weight loss
Nonalcoholic Fatty Liver Disease: Pharmacologic Management
- No medication has an indication for the treatment of NASH or NAFLD
- Proper management of cardiovascular disease and diabetes instrumental in treatment
Nonalcoholic Fatty Liver Disease: Possible Complications
- Hepatocellular carcinoma
- Fibrosis
- Cirrhosis
- A high rate of fatal cardiovascular events occurs in patients who have NAFLD
