Hepatitis causes, presentation, and labs Flashcards
What are the causes of hepatitis
- Viruses
- Alcohol
- Drugs
- poisons
- idiopathic
6 autoimmune related
Viruses that cause hepatitis
- hepatitis A, B, D, C, E, G
- Epstein-barr
- cytomegalovirus
- rubella
- Herpes simplex
Drugs that are potential causes of hepatitis
- some OTCs
- prescription medications
- steroids
- anesthetics
Autoimmune issues that are potential causes of hepatitis
- common in lupus patients
2. more common in women than men
Natural history of acute viral hepatitis that leads to recovery
- acute illness leading to recovery
- can be clinical or subclinical
- recovery and immunity
Natural history of acute viral hepatitis that leads to chronic infection
- no recovery
- clinical or subclinical illness
- continued viral activity and related complications
HPI for acute viral hepatitis: general symptoms
- Fatigue
- fever
- arthralgia
- myalgia
HPI for acute viral hepatitis: skin symptoms
- rash
2. pruritis
HPI for acute viral hepatitis: HEENT
jaundice
HPI for acute viral hepatitis: GI
- abdominal pain
- anorexia
- Nausea/vomiting
Past medical history for acute viral hepatitis
- medications
- alcohol/tobacco use
- occupational risks
- high-risk sexual activity
- sick contacts
- travel
- Poisoning
Focused PE for acute viral hepatitis
- Vital signs
- skin
- HEENT
- Cardiac/respiratory
- abdomen
- Neuro
HPI for chronic hepatitis infection
asymptomatic until advanced disease or other events such as coinfections trigger consideration of viral hepatitis;
highly variable course
Past medical history for chronic hepatitis infection
- same as acute with high risk sexual activity, sick household contacts, etc.
- injection-drug use;
- tattooing
- immigration
- incarceration/group home placement
- day care
- piercing
focused PE for chronic hepatitis infection
- Vital signs
- skin
- HEENT
- cardiac/respiratory
- abdomen
- neuro
ALT {SGPT} transaminases
- leaked into serum via damage to ALT-rich tissues or changes in cell membrane permeability
ALT {SGPT} transaminase is most sensitive and specific marker for
viral liver infections;
it “tells all”
AST {SGOT}
- found in highly metabolic tissue such as heart, liver;
2. elevated in hepatitis
Elevated ALT {SGPT} differentials
- fatty liver
- alcoholic liver
- drug/chemical toxicity
- hemachromatosis
Elevated AST {SGOT} differentials
- MI
- acute pancreatitis
- musculoskeletal trauma
- acute hemolytic anemia
- severe burns
What is the characteristic transaminase pattern in viral hepatitis
ALT and AST 5-8 times the upper lift of normal
AST 2 times ALT can indicate what
- alcoholic hepatitis
- alcoholic cirrhosis
- liver congestion
- liver mets
what is alkaline phosphatase
enzyme in cells lining liver, biliary tract, and bone
differential diagnosis for elevated alkaline phosphatas
- vitamin D deficiency
- mets/neoplastic disease
- cholestasis
- infiltrative liver disease {tumors. abscesses}
- granuloma
How do you determine if elevated alkaline phosphatase is because bone or liver
isoenzymes
Bilirubin
by-product of RBC recycling
Bilirubin is produced by
- liver
- spleen
- bone marrow
indirect bilirubin
unconjugated in the spleen
direct bilirubin
conjugated in the liver, travels to bowel through the bile ducts
elevated indirect {unconjugated} bilirubin
hemolysis
elevated direct {conjugated} bilirubin
- hepatic dysfunction
- viral hepatitis
- obstruction of bile flow by stones, tumors, etc.
lactic dehydrogenase {LDH} is found in
- liver
- heart
- kidney
- muscle
lactic dehydrogenase {LDH} source is differentiated by
isoenzymes
lactic dehydrogenase {LDH} elevation differentials
- MI
- hemolytic anemias
- tumors
LFTs with acute viral hepatitis
- AST: prejaundice increase up to several thousand units not prognostic
- ALT: later increase up to several thousand units; not prognostic;
- ALP, LDH elevated but specifics require isoenzymes
Bilirubin with acute viral hepatitis
increased
CBC with acute viral hepatitis
- low total WBC, leukopenia;
- low polys, bands: bandemia
- high lymps: lymphocytosis
H/H with acute viral hepatitis
mild anemia
Albumin with acute viral hepatitis
high or low
Prothrombin time with acute viral hepatitis
high or low;
prolonged duration indicates impending liver failure;
need to test for specific viral markers
IgD results from and relates to
B lymphocyte differentiation and relates to antigen receptors
IgM aids
early immune response and activates complement
IgG acts as
primary, long-term antibody against viruses/bacteria, fixes complement