Exam 2: Hepatitis And Acute Liver Failure Flashcards
Hepatitis
Inflammation of liver that can result in cell damage and liver dysfunction
Hepatitis can be caused by
Alcohol abuse
Medications
Viruses
Hepatitis can be
Acute or chronic
Viral Hepatitis
Relatively common
Primarily affects liver
Different strains of viruses cause different types of hepatitis (A-E+)
Hepatitis: Pathologic Lesions include
Hepatic cell necrosis
Scarring (with chronic disease)
Kupffer cell hyperplasia
Hepatitis A (HAV) injury to hepatocyte is cause by
Host cell’s immune response
Hepatitis B
Milder than Hep C, but can lead to chronic hepatitis or liver failure and death
Transmission of Hepatitis B occurs through
blood and body fluid exposure, maternal-baby exchange.
Antiviral drugs therapy for hepatitis B include but are not limited to
Telbivudine (Tyzeka)
Telbivudine (Tyzeka)
Nucleoside analogue reverse transcriptase inhibitor
Treatment of Hepatitis B
Telbivudine (Tyzeka): Adverse Effects
fatigue, headache, diarrhea, nausea, pain in joint and muscles
Telbivudine (Tyzeka): Interactions
alpha-interferons (cause severe peripheral neuropathy)
Caution: Nephrotoxic drugs
Dosage adjustments of Telbivudine (Tyzeka) is need in patients with
Renal insufficiency
Hepatitis C
Leading cause of liver failure leading to liver transplantation
Symptoms initially mild, but lead to chronic
Hepatitis C: Transmission
Infected blood and sexual contact.
Alcoholic disease can lead to development of hepatitis C.
Hepatitis C: Treatment
- interferon (family of naturally-occurring proteins that are made and secreted by cells of the immune system; modulate the response of the immune system to viruses and cancer)
- ribavirin (Virazole)
- simeprevir (Olysio)
- sofosbuvir (Solvaldi)
Ribavarin (Virazole)
Given orally, or by oral or nasal inhalation
Inhalation form (Virazole) used for hospitalized infants with respiratory syncytial virus (RSV) infections
Pregnancy X drug, inhalation form can’t be given by pregnant healthcare provider.
Ribavarin (Virazole): MOA
Synthetic nucleoside analog
Works with RNA and DNA synthesis
Inhibits protein synthesis AND viral replication
Sofosbuvir (Solvaldi)
First-in-class RNA polymerase inhibitor for the treatment of chronic hepatitis C Sofosbuvir is considered “break-through” therapy. First drug treatment for hepatitis C that can be given without interferon
Sofosbuvir (Solvaldi): Side Effects
Few side effects (fatigue, headache, nausea, difficulty sleeping).
When taken with amiodarone (Cordarone or Pacerone) may cause slow heart rate which can lead to death.
Sofosbuvir (Solvaldi) used in
Combination with ribavarin (Varizole).
Not to be used as mono therapy.
Simeprevir (Olysio)
Protease inhibitor (PI)
Chronic hepatitis C
Approved in 2013
Pregnancy C, but when combined with interferon and ribavirin (Virazole) = Cat X
Simeprevir (Olysio): Used in
Conjunction with standard hepatitis C treatments: interferon and ribavirin (Virazole).
Not to be used as monotherapy.
Simeprevir (Olysio): Adverse Effects
Photosensitivity
Rash
Nausea
Pruritus
Acute Liver Failure
Severe impairment or necrosis of liver cells without preexisting liver disease or cirrhosis.
Rare
Acute Liver Failure: Causes
Acetaminophen overdose (most common) Viral hepatitis (particularly Hepatitis B) Compound infection of delta virus Metabolic liver disorder
Acute Liver Failure Pathophysiology
Edematous hepatocytes + patchy areas of necrosis + inflammatory cell infiltrates = disruption of the functional tissue of the liver (parenchyma)
Acute Liver Failure usually develops
6-8 weeks after the initial symptoms of viral hepatitis or metabolic liver disorder.
5 days-8 weeks after acetaminophen overdose.
Acute Liver Failure Symptoms
Anorexia
Vomiting
Abdominal pain
Progressive jaundice
Acute Liver Failure can lead to
Leads to ascites, GI bleeding -> which can lead to hepatic encephalopathy (lethargy, altered motor function) -> Coma (cerebral edema, ischemia, and brainstem herniation)
Renal failure and pulmonary distress can occur
Acute Liver Failure Lab Findings
Increased direct and indirect serum bilirubin
Increased serum transaminases
Increased blood ammonia
Increased prothrombin time
Acute Liver Failure Treatment
- Irreversible (60-90% of children die)
- Rapid evaluation and critical care and support: airway, circulation, hemodynamics; infection control; acetylcysteine for acetaminophen overdose; monitor labs and assess for GI bleeding; nutrition (patient should be NPO)
- Liver Transplant
