Hepatitis Flashcards
The liver is unusual in that it
has a double blood supply; the right and left hepatic arteries carry oxygenated blood to the liver, and the portal vein carries venous blood from the GI tract to the liver
Functions of the liver
- Bile synthesis
- Metabolic: CHO, protein fat, detoxification, steroid metabolism
- Storage: Glucose as glycogen, Vitamins, fatty acids, minerals, amino acids
- Mononuclear Phagocyte System:Kupffer cells
Bile synthesis in the liver
- Bilirubin is a byproduct of RBC breakdown
- Released bilirubin is not water soluble (unconjugated). Binds to albumin
- Liver extracts the unconjugated bilirubin from the blood and makes it water soluble (conjugated)
- Excreted in bile
- Reduced bile to urobilinogen by intestinal bacteria
- Most recycled back through the blood stream. Some excreted in stool (brown color). Very small amount excreted in urine
Metabolic functions of the liver: CHO
*glucose to glycogen to glucose
Metabolic functions of the liver: Protein
*synthesis of nonessential amino acids, clotting factors, urea formation from ammonia
Metabolic function of the liver: Fat
*lipoproteins, triglyceride breakdown, synthesis of fatty acids, cholesterol synthesis and breakdown
Metabolic functions of the liver: Detoxification
*inactive drugs and harmful substances. Excretion of their breakdown products
Metabolic functions of the liver: Steroid metabolism
*gonadal and adrenal corticosteroid hormones
Storage in the liver
- glucose as glycogen
- Vitamins: Fat soluble: A,D,E,K Water soluble: B1, B2, cobalamin, folic acid
- Minerals: copper, iron
- Amino acids
Mononuclear Phagocyte System: Kupffer cells
- Breakdown of old RBC’s, WBC’s, bacteria
* Breakdown of hemoglobin to bilirubin
Hepatitis
- Inflammatory of the liver
- Immunologic Damage
- Infections: viruses, bacteria, fungi, protozoa
- Toxic Damage: alcohol, drugs, poisons/chemicals
Etiology of hepatitis:
- Viral: A, B, C, D, E, G cytomegalovirus, herpes virus
- Drugs: alcohol, acetaminophen, isoniazid, statins, sulfonamides, thiazide diuretics etc.
- Autoimmune
Hepatitis A
- Fecal- oral transmission. Hep A rap
- Occurs in small outbreaks
- Contamination of food or water
- virus in feces during 2 week incubation period
- Prevention: Hep A vaccine for pre-exposure
- Hep A immune globulin before or after exposure
Hepatitis B/C
- Perinatal, percutaneoulsy, sexual contact
- Hep B prevention: vaccine 3 IM injections: Titer, post-op exposure vaccine and immune globulin
- Hep C: Nothing
Vaccine that protects against Hep A and B
Twinrix: hepatitis A and B combination vaccine manufactured by GlaxoSmithKline, was licensed for use in the US in 2001 for people 18 years of age and older.
**Three doses of Twinrix are necessary for full protection against both hep A and B
Signs and Symptoms of Viral Hepatitis:
- Dark urine
- Loss of appetite
- Fatigue
- Abdominal distention
- Generalized itching
- Jaundice
- Nausea/vomiting
- Low grade fever
- Pale or clay color stools
- Hepatic tenderness
- Hepatomegaly
- Splenomegaly
- 30% with acute B- no symptoms
- 80% with acute C- no symptoms
Complications of Hepatitis
- Can recover completely with no complications
- Fulminant hepatic failure
- Chronic hepatitis (B,C)
- Cirrhosis of the liver
- Hepatocellular carcinoma
Diagnostic tests for Hepatitis
- Hepatitis antibodies, antigens
- AST, ALT, GGT increased
- Alkaline phosphates increased
- Serum protein varies
- Total bilirubin increased
- Urinary bilirubin increased
- Urinary urobilinogen increased
- Prothrombin time prolonged
Three phases of Hepatitis: lasts 1-4 months
- Incubation period
- Icteric phase
- Convalescent phase
Incubation period
- Non-specific complaintsof fatigue, anorexia, nausea, cough, joint pain, loss of appetite
- **Labs increase with ALT & AST, urine bilirubin levels, presence of viral antibodies, antigens, or virus particles
Icteric Phase:
- Appearance of jaundice, dark urine, stools clay colored due to decreased urobilinogen.
- Right upper quadrant pain and increasing pruitus
- Labs: elevated direct bilirubin levels
- Anicteric hapatitis :no symptoms
Post Icteric
- Malaise
- Fatigue
- Jaundice fades
- Lasts 2-4 months
Collaborative Care:Acute Hepatitis
- Tx at home usually
- Decreased transmission
- Medications: Antihistamines given for pruritus and jaundice, antiemetics for nausea. Must eval. hepatic drug clearance
- Diet- well balanced- no ETOH, small meals 6X a day
- Activity- rest
- Bedrest if symptoms are severe
Collaborative Care: Chronic Hepatitis B and C
- Interferon: effect viral replication
* Nucleoside analogs: suppress viral replication
