Disorders of the Liver

Question 1

Functions of the Liver

Answer 1

1. Detoxifies
2. Storage
3. Activates vitamin D
4. Fetal RBC production
5. Phagocytosis
6. Metabolizes absorbed food molecules

Question 2

How does the liver detoxify for the body?

Answer 2

Detoxifies and removes alcohol and drugs

Question 3

What does the liver store in the body?

Answer 3

1. Glycogen
2. Vitamins A, D, E , and K
3. Fe and other minerals
4. Cholesterol

Question 4

What kind of food molecules does the liver metabolize?

Answer 4

1. Carbohydrates
2. Proteins
3. Lipids

Question 5

Types of Hepatitis

Answer 5

1. Alcoholic hepatitis
2. Autoimmune hepatitis
3. Drug-Induced Hepatitis
4. Hep A
5. Hep B
6. Hep C
7. Delta Agent (Hep D)

Question 6

Alcoholic Hepatitis: What is it?

Answer 6

Damage to the liver and its function due to alcohol abuse

Question 7

Autoimmune Hepatitis: What is it?

Answer 7

Occurs when immune cells mistake the liver’s normal cells for harmful invaders and attack them

Question 8

Hepatitis D (Delta Agent): What is it?

Answer 8

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.

Question 9

Drug-Induced Hepatitis: What is it?

Answer 9

Many different drugs can cause this

Question 10

Hepatitis A: What is it?

Answer 10

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

Question 11

Hepatitis B: What is it?

Answer 11

Spread through having contact with the blood, semen, vaginal fluids, and other body fluids of someone with hepatitis B infection

Question 12

Hepatitis C: What is it?

Answer 12

Has an acute and chronic form. Most people who are infected with the virus develop chronic hepatitis C.

Question 13

Hepatitis A: Assessment Findings

Answer 13

• Varies in severity from mild to severe
• Abrupt onset with fever, malaise, anorexia, nausea, abd discomfort, then jaundice

Question 14

Hepatitis A: Transmission

Answer 14

Fecal-Oral route from person to person

Question 15

Hepatitis B: Assessment Findings

Answer 15

Gradual onset with…
1. Anorexia
2. Vague abdominal discomfort
3. Nausea and vomiting
4. Rash
5. Then often progresses to jaundice

Question 16

Hepatitis B: Transmission

Answer 16

Found in all body secretions and excretions. Only blood, saliva, semen, and vaginal fluids have been known to be infectious

Question 17

Hepatitis C: Assessment Findings

Answer 17

Onset of anorexia, vague abdominal discomfort, N/V, progressing to jaundice less frequently than hepatitis B

Question 18

Hepatitis C: Transmission

Answer 18

By injecting contaminated blood and plasma derivatives

Question 19

Hepatitis D: Assessment Findings

Answer 19

Abrupt onset with signs and symptoms similar to hepatitis B
** Self-limiting but may progress to chronic

Question 20

Hepatitis D: Transmission

Answer 20

Similar to Hepatitis B
* Found in all body secretions and excretions. Only blood, saliva, semen, and vaginal fluids have been known to be infectious

Question 21

Hepatitis E: Assessment Findings

Answer 21

• Similar to Hepatitis A
• Abrupt onset with fever, malaise, anorexia, nausea, abd discomfort, then jaundice

Question 22

Hepatitis E: Transmission

Answer 22

1. Contaminated water
2. Probably person-to-person via fecal-oral route

Question 23

Hepatitis: Generalized Symptoms

Answer 23

1. 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
2. Abd pain or distention
3. Breast development in men
4. Dark urine and pale or clay-colored stools
5. Fatigue
6. Fever - usually low grade
7. General itching
8. Jaundice
9. Loss of appetite
10. Nausea and vomiting
11. 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.

Question 24

Nonalcoholic Fatty Liver Disease: What is it?

Answer 24

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.

Question 25

Nonalcoholic Fatty Liver Disease: Etiology

Answer 25

- 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)

Question 26

Nonalcoholic Fatty Liver Disease: Risk Factors

Answer 26

1. Insulin resistance 2. Metabolic syndrome 3. Obesity 4. Type 2 DM 5. Cardiovascular disease 6. HTN 7. Dyslipidemia, particularly high triglycerides, and/or low high-density lipoprotein levels 8. Male sex 9. Older age 10. Hispanic ethnicity 11. Genetic predisposition

Question 27

Nonalcoholic Fatty Liver Disease: Assessment Findings

Answer 27

1. Penetration of fat into liver cells (hepatic steatosis) that may result in inflammation and/or fibrosis of the liver, can progress to cirrhosis. 2. Most patients are asymptomatic 3. Mild abdominal pain, particularly in RUQ 4. Nausea 5. Fatigue 6. Dorsocervical lipohypertrophy 7. Elevated liver enzymes (particularly ALT > AST) 8. Jaundice 9. Pruritis 10. Hepatomegaly 11. Elevated alkaline phosphatase (2-3 times upper limit of normal) ** Include a thorough review of social history and past medical history

Question 28

Nonalcoholic Fatty Liver Disease: Non-Pharmacologic Management

Answer 28

1. Mainstay of treatment is lifestyle changes, including diet modifications and increased physical activity 2. Weight loss is recommended for overweight or obese patients (using lifestyle modifications or bariatric surgery), with goal of 1-2 lbs. per week 3. Dietary changes, including decreased caloric intake, adherence to low-fat, low-cholesterol diet, and avoidance of trans fats and high-fructose corn syrup 4. Avoid alcohol consumption to decrease further injury to the liver 5. Exercise (moderate physical activity 3-4 times per week) 6. > 3% weight loss can reduce hepatic steatosis 7. Support groups helpful with necessary lifestyle changes 8. Psychosocial therapy to help with weight loss

Question 29

Nonalcoholic Fatty Liver Disease: Pharmacologic Management

Answer 29

- No medication has an indication for the treatment of NASH or NAFLD - Proper management of cardiovascular disease and diabetes instrumental in treatment

Question 30

Nonalcoholic Fatty Liver Disease: Possible Complications

Answer 30

1. Hepatocellular carcinoma 2. Fibrosis 3. Cirrhosis 4. A high rate of fatal cardiovascular events occurs in patients who have NAFLD