Hepatitis Flashcards
What is hepatitis?
What are the common etiologies?
inflm of the liver
- Microbes
- Drugs (hepato toxic drugs)
- Autoimmunity
What microbes can cause hepatitis?
What is the most common?
Could be bact, viral, parasite, fungal
• Most d/t viral infection
What viruses might cause Hepatitis?
• Hepatitis A, B, C, D, E
o F and G exist but are not currently a concern
o Other viruses may cause hepatitis
(EX. Epstein Barr)
NOTE D (like Bad B), E (like bad A in pregnant women)
What virus causes hepatitis A
Hepatitis A
Virus is named same as the disease
What characteristics differentiate the hepatitis viruses? (3)
o Virus and transmission
o Incubation period
o Severity
(EX. Hep C serious, Hep A mild)
*NOTE* • Refer to DAY 1214 Table 40-4 for comparison FOCUS ON: o Incubation period (chronic vs acute) o Mode of transmission o Carrier state
Hep A in Brief
- Mild, Acute w/ recovery, No carrier state, no inc in liver risk (cirrhosis, cancer, failure)
- Transmission- oral/fecal route, poor sanitation, water/food borne
- Incubation- ~15-50 days. Largely self limiting, considered an acute form
SandS- flu like (headache, malaise, fever,) Icteric phase- dark urine, jaundice
Hep B in Brief
- Can be severe, 10% -15% are chronic, includes a carrier state, inc risk to liver
- Transmission- Parenterally, saliva and serum
Incubation- 28-160 days
SandS- may be w/o symptoms, rash and arthralgias
Hep C in Brief
- 80% are chronic, high inc liver risk, includes a carrier state, remissions and exacerbations common, often leads to cirrhosis
- Transmission- through blood and blood products, sex
Incubation- 15-160days
Outcomes- frequent chronic liver disease
Is the pathology the same for all viral hepatitis
Basically Yes
What are the two mechanisms of injury in hepatitis?
o IR -> inflm and necrosis
o Viral injury -> necrosis
What is targeted, what is damaged?
viruses target hepatic cells specifically but inflm can damage vessels as well.
Vascular damage common
What is a simple measure of hepatocyte necrosis?
serum markers for liver damage- AST and ALT are released with hepatocyte necrosis
What is the central MFNTS and how long will until healing can occur?
Decrease in Liver Function
Healing in 4 months
3 stages to MNFTS of Hepatitis
Prodromal, Clinical, Recovery
Discuss MNFTS of the Prodromal Phase
• lethargy, myalgia
• fever and abd pain
Pain r/t liver enlargement and stretching liver capsule
• Anorexia, nausea, vomiting (r/t to GI impacts)
Discuss MNFTS of CLINICAL Phase
Appear 5-10 days later
- Mnfts worsen
- Jaundice (bilirubin is normally processed by liver, heme break down, inc bilirubin in blood and gets deposited)
- Pruritus (caused by bile salts deposition in the skin)
- Enlarged liver (hepatomegely)
What is Jaundice
Bilirubin, formed from the break down of heme, is normally processed by liver, Dec liver Fx ->, inc bilirubin in blood and gets deposited in tissue
Oh ya… it’s yellow
How do MNFTS regress in Recovery phase
QUICKLY
• Acute MNFTS subside ~3weeks
• Full recovery within ~16weeks
Tx- Why is rest important?
Decrease workload of liver
To allow recovery you want to Dec Energy requirement of body. (Liver will have to process less)
Tx what sort of Diet would you encourage
Small meals, High in calorie (like Carbs) but…. Reduced fat content, as liver needs to produce bile to break down fats
Tx- What offending agents to you want to completely remove
No alcohol and all other hepatotoxic drugs or chemicals
Other basic hepatitis symptom tx
• Symptomatic relief (pain, relief from pruritus)
• Post exposure prophylaxis
o Improve hygiene
Pharmacologically what is the difference in tx between Hep A, B and C
- Hep A +B – vaccine and gamma globulins available
* Hep C- No vaccine, antiviral drugs may be used
Is autoimmune hepatitis a chronic or Acute Disease?
There is both severe and chronic form
Etiology of Autoimmune Hepatitis
o Idiopathic (but not really)
o Complex trait
• HLA genes on Chr 6
• + Enviro factor (virus or chemical agents)
Discuss Type One autoimmune Hepatitis
o More common
o 30% of Auto Hepatitis is in women under 40yrs
o The associated Antibodies in immune response
ANA’s (anti-nuclear antibodies) AND
Anti-smooth muscle Abs (smooth muscle in walls of vessels)
Discuss Type Two autoimmune hepatitis
o 2-14yrs
o Abs target cytosol (is the cytoplasm less the organelles) and microsomes (vesicles from endoplasmic Reticulum)
Range of MNFTS of Autoimmune Hepatitis
•Range from asymptomatic to MNFTS of liver failure (leans to severe)
Dx of Autoimmune Hepatitis
• By Exclusion
o Viral hepatitis
o Other liver diseases\
• You can measure Increase in gamma globulins (Abs)
Tx for autoimmune hepatitis
- Immunosuppressant drugs
* Liver transplant? (chronic and serious disease)
