GI Disorders - Hepatitis Flashcards
What is Hepatitis?
severe inflammation of the liver
Liver is the second _____ ___ of the body
largest, organ
What is the function of the liver? (11)
- process CHO, proteins, lipids after absorption and regulate levels in blood
- synthesize plasma proteins (eg clotting factors, albumin, complement proteins etc)
- largely involved in metabolism for own needs
- inactivates toxins, drugs, and converts ammonia to a less toxic urea
- produce and secrete bile
- stores CHO as glycogen and converts to glucose when needed by the body
- make metabolites for cells of the body for their own metabolism
- stores glycogen, fat, iron, vitamin, and lipid soluble toxins
- activates vit D
- excrete cholesterol and bilirubin
- kupffer cells remove pathogen and worn our RBC
Where is bile stored?
gallbladder
What is the flow of bile? from bile to duodenum (7)
bile –> bile cannaculi –> bile duct –> hepatic duct–> common hepatic duct–> common bile duct–> duodenum
What does bile contain and their function? (5)
NaHCO2 = neutralize chime
bile salts = breakdown fats
lecithin = transport fat
cholesterol = for excretion
bilirubin = waste product of heme breakdown –> excreted
Etiology of Hepatitis (4)
- viral infection
- infection in liver caused by microbe (bacteria, fungi, viruses, and protozoa) - drugs
- hepatotoxic drugs eg methotrexate and ethanol - autoimmunity
- secondary to systemic problem eg EBV
In viral hepatitis, what are most common?
most common is hepatitis A, B, and C
In viral hepatitis, what are less common?
Hepatitis D, E, F, and G
What causes Hepatitis A, B, C, D, E, F, and G?
Their own corresponding virus eg Hepatitis A is caused by Hepatitis A virus
What are the different in the type of hepatitis?
- virus
- transmission and incubation period
- different in viruses - severity
- all similar mnfst but differ in severity - carrier state = An individual harbours a virus and overcomes the disease but can transfer the virus to another host
Hepatitis A (5)
- mild and acute
- self-limiting
- least severe of Hep A, B, and C
- oro - fecal transmission: waterbourne, foodbourne, poor sanitation, oral-anal sex
- Anti-HAV antibodies: used for protection against HAV and for diagnostic purposes
Hepatitis B (6)
- more severe than Hep A
- mostly acute and some chronic
- ~10-15% chronic
- Blood, other body fluids, oral, sexual transmission
- Carrier State?/Cirrhosis?: mostly not present in all cases
- 3 anti-HB antibodies:
1. anti-HBs: antigens produced on SURFACE of the virus
2. anti-HBc: antigen produced on CORE of virus
3. anti-HBe: antigen produced on the ENVELOPE (core and precore) of the virus
Hepatitis C (8)
- ~80% chronic but curable
- most severe
- transmission: IV drug use and high risk sex practices (multiple sex partners or sex at a young age)
- infect blood
- Cirrhosis?/CA?: high potential
- carrier state
- anti-HCV antibodies: no beneficial effect and provide no protection–> used for diagnostic purposes
- PCR: polymerase chain reaction can make millions of copies of sections of DNA or RNA for analysis
Hepatitis D (6)
- can be acute or chronic
- occurs suddenly
- no cure/vaccine
- greater likelihood of cirrhosis/carrier state/chronic active hepatitis
- Blood, other body fluids, oral, sexual transmission
- requires HBV surface antigen for replication (cannot replicate without HBV t/f occurs in ppl w/ HBV)
Hepatitis E (5)
- mild, acute
- symptoms severe in preg women
- fecal-oral route
- person to person contact may be possible (low risk)
Patho of all Hepatitis (2 mechanisms)
- viral injury –> cell necrosis
2. immune response–> inflm–> damaged tissues–> necrosis
Explain the 2 mechanism by which virus cause tissue injury.
- virus invades the host cell, incorporate genetic DNA to replicate, and lyses the cell (cell necrosis) –> virus targets the hepatocytes compromising liver fxn
- inflammation induced by viral injury: hepatocytes and surrounding cells are affected –> vessels in liver (largely vascularized) gets damaged causing ischemia and further necrosis
Recovery on average take approx. ___ ______
4 months
What are the 3 phases of manifestations? How long does each phase last?
- prodromal phase: ranging form insidious to symptomatic
- clinical phase: post prodromal, 5-10 days later
- recovery phase: ~4 months
Explain the manifestations of the prodromal phase
SS = lethargy, myalgia, generalized weakness, anorexia, N/V, fever, and abdominal pain
Myalgia/lethargy = liver is unable to produce metabolites for other cells eg storing glycogen and converting it to glucose when needed for ATP synthesis = muscle weakness
N/V = liver is an accessory organ of GIT
Fever = d/t infection
abdominal pain = location of pain is in abdominal cavity where liver is
Anorexia = decrease appetite and desire to ingest food
Explain the manifestations of the clinical phase
- mnfst worsens
- liver is tender and swollen –> sore on palpation
- jaundice b/c liver is unable to process aged erythrocytes for excretion/recycling (bilirubin is a product); bilirubin gets into circulation and deposits thru various organs and tissues (eg skin and eye)
- pruritus d/t bile salt accumulation and deposition in skin
- hepatomegaly = enlargement of the liver w/ inflm and hyperemia
Explain the manifestations of the recovery phase
- acute mnfst subsides in ~3 weeks depending on type
- full recovery in ~ 4 months (or 16 weeks): liver enzymes are back to normal
Diagnosis of Hepatitis (3)
- basic labs
- serology
- identify virus eg PCR
Treatment of Hepatitis (8)
- bed rest: to decrease energy demand of body
- decrease hepatic workload: eg resting to decrease metabolic workload to ensure liver has the opportunity to heal
- diet restriction: smaller calorie-dense meals to decrease hepatic workload
- high calories w/ more proteins and less fat –> less fat decrease demand for bile to emulsify fat - no all alcohol (hepatotoxic)
- no hepatotoxic drugs eg methotrexate
- symptomatic management
- Antiviral (DAA) for Hep C: DAA = direct acting antiviral drugs to cure hep C (up to 95% efficacy) by targeting specific stage of the life cycle of HCV and req monitoring
- Vaccines (A & B): prophylactic drugs to prevent disease but not Hep C
