Hepatic and Biliary Flashcards
Where does the liver refer to?
- Thoracic spine (7-10) midline - to the right
- Right upper trap and shoulder
Where does the gallbladder refer to?
- Right upper trap and shoulder
- Right interscapular area (T4-8)
- Right subscapular area
When working with patients with liver disease, what is an important consideration to keep in mind regaurding their bones?
Increased risk for hepatic osteodystrophy and osteoporosis
Hepatic osteodystrophy
abnormal development of bone
Neurological symptoms associated with liver disease
- Confusion
- Sleep disturbances
- Muscle tremors
- Hyperreactive tremors
- Asterixis
- Peripheral n. dysfunction (bilateral carpal tunnel or tarsal tunnel syndrome)
- Poor concentration
- Fatigue
- S&S of encephalopathy
Route of transmission for Hep A, B, and C
Hep A: fecal-oral
Hep B + C: percutaneous w/bodily fluid + mucosal
Which acute hepatitis presents with diarrhea?
Hep A
What is the potential for chronic infection of Hep A?
NONE
What is the potential for chronic infection of Hep B?
Infants: 90% after acute infection at birth
Children: 25-50% newly infected at 1-5Y
Adults: 5%
What is the potential for chronic infection of Hep C?
> 50% of newly infected people
Long-term Effects of Hep A
Most people recover with no lasting liver damage.
Long-term Effect of Hep B
- Most recover with no lasting liver damage.
- 15-25% will develop chronic liver infection
Long Term Effects of Hep C
5-25% of people develop cirrhosis/10-20Y
Hep C + cirrhosis = 1-4% annual risk for hepatocellular carcinoma
Treatment for Hep A
Supportive treatment only
Treatment for Hep B
Acute: supportive treatment
Chronic: regular monitoring for signs of liver disease progression; antiviral drugs available
Treatment for Hep C
Acute: immediate treatment
Chronic: Over 90% of people can be cured w/8-12 weeks of oral therapy
Vaccination Hep A
- Single antigen hepatitis vaccine: 2 doses, 6-18M apart
- Combo HepA/B vaccine: 3 doses/6M
Vaccination Hep B
Infant and children: 3-4 doses over 6-18M
Adult: 2 does 1M apart or 3 doses over 6M
Combo HepA/B vaccine: 3 doses/6M
Vaccination Hep C
No vaccine available
Hep A Risk Factors
- Household/sexual contact
- Homosexual Men
- Drug users
- Environmental
- Blood clotting factor recevied pre-1987
Hep B Risk Factors
- Drug user
- Sexual contact
- Jail
- Environmental
- Occupaitonal
- Infants born to HBV mom
- Liver transplant recipient, blood products pre 7/1992
- Sharing items
Risk Factor Hep C
- Sharing drug equipment
- Blood transfusion/organ transplant or blood clotting products pre-1987
- HIV
- Occupational (Dialysis pt and staff)
- ## Infants born to HCV mom
General Hepatitis Risk Factors
- Injection drug user
- Acupunture
- Tattoo removal or inscription
- Ear or body piercing
- Recent operation
- Liver transplant recipient
- Blood or plasma transfusion pre-1992
- Hemodialysis
- Healthcare worker exposed to blood products or bodily fluids
- Exposure to certain chemicals or meds
- Unprotected sex
- Travel to high-risk areas
- Consumption of raw shellfish
