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Advanced pathophysiology > Liver Disorders > Flashcards

Liver Disorders Flashcards

1
Q

Describe the general signs and symptoms of acute viral hepatitis

A
  • Abnormal liver function tests
    • AST/ALT usually elevated >500 in acute infection
  • S/S’s
    • Jaundice
    • Dark urine
    • Fever
    • Malaise
    • Nausea
    • Sometimes it is asymptomatic with elevated liver enzymes
  • Symptoms last <6 months
  • Characterized by inflammation of the liver parenchyma d/t hepatitis virus
  • May sometimes progress to chronic hepatitis
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2
Q

What is the mode of transmission for hepatitis A?

A
  • Fecal-oral route (contaminated food or water)
  • Parenteral
  • Sexual
  • Crowded/unsanitary conditions increases risk
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3
Q

What is the incubation period for hepatitis A?

A
  • Incubation is 28 days (15-50 is the range)
  • 4-6 weeks long (time between exposure and onset of symptoms)
  • HAV bile excretion with shedding in stool occurs 2 weeks prior to and 1 week after onset of symptoms
  • 3-4 week period on infectivity
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4
Q

List the clinical manifestations of hepatitis A

A
  • Flu-like symptoms!
  • Fever
  • Painful/enlarged liver
  • Fatigue
  • Loss of appetite
  • Nausea/vomiting
  • Abdominal pain
  • Dark urine
  • Diarrhea
  • Joint pain
  • Jaundice
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5
Q

What are the preventative measures against hepatitis A?

A
  • Administration of immunoglobulin before exposure or early in the incubation period can prevent it
    • Can give prophylaxis <2 weeks before a trip or <2 years of age
    • Can give post-exposure up to 2 weeks
  • HAV vaccine and combined HAV and HBV vaccines confer long-term immunity
  • Hygiene
    • Handwashing and glove use when disposing of fecal matter
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6
Q

What are the serologic markers for hepatitis A?

A
  • HAVV Ab IgM = Acute/active disease if +
    • Increases initially
  • HAV Ab IgG= Chronic marker; Exposed to the disease at some point or vaccinated previously; not active, immune to disease
    • Elevated for several years
  • AST/ALT usually elevated >500 in acute infection
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7
Q

Pathophysiology and complications of hepatitis A

A
  • Hep A is ONLY ACUTE!!!
  • Hepatocellular injury caused by the virus
  • Viral replication takes place in hepatocytes leading to diffuse liver necrosis
  • It can lead to…
    • Diffuse liver necrosis
    • Prominent centrilobular damage
    • Increased portal cellularity
    • Regional lymph node enlargement
  • If hepatocellular injury progresses, it can lead to…
    • Jaundice
    • Hyperbilirubinemia
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8
Q

What questions would you want to ask your patients regarding their history that are important in diagnosing hepatitis A?

A
  • International travel
  • Military personnel
  • Illicit drug users
  • Male homosexuals
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9
Q

What is the mode of transmission for hepatitis B?

A
  • Parenteral
  • Sexual –> Mucousal contact with infected blood or body fluid
    • Seman/saliva
    • Blood exchanged during sex**
  • Mother-to-infant transmission
    • Occurs if mom becomes infected during the third trimester
    • Screening should occur for all pregnant women
    • Infants born to positive mothers should receive HBV vaccine and HBV immunoglobulin within 12 hours after birth
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10
Q

What is the incubation period for hepatitis B?

A

60-180 days

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11
Q

What information regarding your patient’s history would you want to obtain to help diagnose hepatitis B?

A
  • Current/hx of hemodialysis
  • Hx blood transfusions in other countries
  • Family hx of hep B and/or liver cancer
  • IV drug use/share needles
  • Etoh use
  • Multiple sex partners
  • Taking immunosuppressive drugs and/or immunocompromised
  • Other infections such as HCV, HDV, and HIV
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12
Q

What are the clinical manifestations of acute hepatitis B?

A
  • Hx: Exposure with infected fluids/blood within the past few months
  • S/S’s:
    • Flu-like
    • Loss of appetite
    • Body aches
    • Mild fever
    • Dark urine
    • Jaundice
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13
Q

What are the clinical manifestations of chronic Hep B?

A
  • Hx: Serological testing + for 6 months
  • S/S’s:
    • Might be asymptomatic
    • Nephritis
    • Abdominal pain
    • Hepatomegaly /hepatosplenomegaly
    • Spider telangiectasis
    • Ascites
    • Jaundice
    • Peripheral edema
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14
Q

What are the serologic markers and abnormal liver enzymes for hepatitis B?

A
  • HBsAg= Marker of active disease
    • Diagnostic test
      • Marker of acute OR chronic disease
      • Shows surface antigen
      • Marker for active disease/infection if +
  • IgM anti-HBc= Indicator or recent infection (< 6 months); acute marker
  • HBcAB Total= Will be + for life with hx of past infection or current
  • HBsAB (Anti-BBs)= Marker of immunity; will be + if immune, may be - during window period
  • HBeAg= Marker of active viral replication
    • Secreted by the nucleocapsid gene of HBV that is associated w/chronic hep B
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15
Q

What are some complications associated with hepatitis B?

A
  • Acute hep B can become chronic
    • Acute hep B cannot be treated-usually body heals itself
  • Can develop an immune tolerance
  • Once hep B becomes chronic…
    • Persistent liver cell injury
    • Increased r/o cirrhosis
    • Increased risk for hepatocellular carcinoma
      • Greater risk if there is also HBV and HCV coinfection
    • Liver failure
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16
Q

What are the preventative measure for hepatitis B?

A
  • Vaccine prevents hep B in both acute and chronic
    • Vaccinate high-risk individuals, including those w/family members w/chronic hep B
  • Combined HAV and HBV vaccine provides protective immunity
  • Hep B immunoglobulin provides postexposure prophylaxis against HBV after contact with blood/body fluids of those infected
    • Health-care workers
    • Liver transplant recipients
17
Q

Why is hepatitis B considered a sexually transmitted disease?

A
  • Because it is spread blood to blood, if blood is exchanged during sex, it can be spread
  • Also watch with pts who have multiple sex partners
18
Q

What is the route of transmission for hepatitis C?

A
  • Parenteral
    • Associated with IV drug use
19
Q

What information regarding a patient’s history would you want to ask regarding a hepatitis C diagnosis?

A
  • IV drug use
  • Hx hep B
    • Increases risk for Hep c
  • Hx of blood transfusions prior to 1992
  • Occupational ⇒ Healthcare worker
  • High-risk sexual behaviors ⇒ Multiple sex partners
  • Organ transplant recipients
  • Determine age (baby boomers more at risk)
    • ​One-time screening for HCV in birth cohort of 1945-1965
  • A hx helps determine a timeframe for disease
  • Nasal cocaine use
  • Unregulated tattoos
  • Prison hx
  • Long-term hemodialysis
  • Being born to an HCV-infected mother
  • HIV positive
  • Persistently abnormal ALT
20
Q

What are the clinical manifestations of hepatitis C?

A
  • Can be acute (small %) or chronic (more common)
  • Acute ♦
    • Most patients are asymptomatic until irreversible liver damage occurs
    • Malaise
    • Weakness
    • Jaundice
    • ALT elevation
    • HCV-RNA can be detected in within 1-2 weeks of exposure
      • Rapid elevation at first
  • Chronic ♦
    • ​Persistent HCV RNA in the blood after 6 months of acute infection onset
  • Leads to…
    • Fibrosis
    • Cirrhosis over time (20-30 years)
      • Can progress to decompensated cirrhosis or hepatocellular carcinoma
    • Peripheral neuropathy
    • Insulin resistance
  • Presents initially with chronic fatigue
  • Variceal bleed!
  • Can worsen other diseases…
    • Depression
    • Type 2 DM
    • HTN
    • CHF
21
Q

Identify the factors that promote the progression and severity of hepatitis C?

A
  • Age at time of infection >25
  • Gender ⇒ Male
  • Ethnicity ⇒ AA
  • Development of jaundice during acute infection
    • Chronicity of hep C is lower in those who developed jaundice
  • HIV
    • Increases rate of chronic hep C
  • Immunosuppression
  • Cirrhosis
    • Increased by chronic EtOH use
      • Major risk factor for the development of hep C to cirrhosis and hepatocellular carcinoma
      • Male gender
      • Older age at time of infection
      • Hep B
      • Degree of inflammation and fibrosis
      • HIv
22
Q

What are the complications of hepatitis C?

A
  • Acute hep C can lead to chronic
  • Chronic hep C can lead to…
    • Cirrhosis
    • Liver failure
    • Hepatocellular cancer
23
Q

What are some extrahepatic manifestations that can develop with hep C?

A
  • Cryoglobulinemia vasculitis
  • Lymphoproliferative disorders
24
Q

What is the incubation period for hepatitis C?

A
  • 35 to 72 days
25
Q

What serologic markers and liver enzymes would you see in hepatitis C?

A
  • HCV RNA► Confirms diagnosis
    • Positive 1-2 weeks after infection
    • Decreased RNA levels indicate recovery
    • Persistently elevated indicates chronic disease
  • Hepatitis C virus antibody ► Cannot tell you if pt has active disease
    • Only tests for exposure
    • Can take up to 6 months to show +, so may need to retest if too early
  • Elevated aminotransferase levels (ALT)
    • Seen with chronic hep C
  • HCV genotype ► Ordered when pt is + for hep C to further categorize type
26
Q

What are the preventative measures for hepatitis C?q

A
  • No vaccine is available
  • Can be cured but doe not mean immunity
    • Will be antibody + for life though if you’ve had it
  • Use latex condoms if multiple partners
  • Avoid sharing toothbrushes, razors, combs (i.e., where blood can be kept)
  • Cover open wounds
  • Blood screening
  • Hygiene
27
Q

What are the questions you would ask a patient regarding history to obtain a diagnosis of Hep D?

A
  • Hx.current hep B infection
    • Hep D CANNOT occur without hep B!!
  • IV drug use
28
Q

What are the twp types of Hep D?

A
  • Co-Infection
    • Simultaneous infection of Hep B and D at the same time (both acute)
  • Suprainfection
    • Acute hep D infection of someone who already has chronic Hep B
    • Can often progress to cirrhosis
29
Q

What is the incubation period for Hep D?

A
  • 3 to 7 weeks
30
Q

What are the clinical manifestations of acute Hep D?

A
  • Pre-icteric: Lasts 3-7 days
    • Fatigue
    • Lethargy
    • Anorexia
    • Nausea
    • AST/ALT abnormal
    • Jaundice
    • Clay-colored stools
    • Dark urine
    • Tbili abnormal
31
Q

What are the clinical manifestations of superinfection Hep D?

A
  • Short acute hepatitis with short incubation period
  • Leads to chronic HDV is 80% cases
  • HbsAg and HBV DNA are inhibited until cleared
  • Hepatic encephalopathy can occur
32
Q

What are the preventative measures against Hep D?

A
  • Vaccination for Hep B
  • Hygiene
33
Q

What are the modes of transmission for Hep D?

A
  • Parenteral
  • Facal-oral
  • Sexual
34
Q

Identify the established and emerging risk factors associated with NAFLD

A
  • Overweight/obese
  • Have insulin resistance
  • Have high triglycerides
  • High total cholesterol and high LDL
  • Low HDL
  • Metabolic syndrome or one or more traits of metabolic syndrome
    • Large weight size
    • High BP
    • Elevated blood glucose
    • High triglycerides and/or low HDL
  • type 2 DM
  • Certain genes*
35
Q

What are some causes of NAFLD?

A
  • Rapid weight loss
  • Hepatitis C
  • Certain medications
    • amiodarone
    • Diltiazem
    • Glucocorticoids
    • Highly active antiretroviral therapy
    • Methotrexate
    • Synthetic estrogens
    • Tamoxifen
    • Valproic acid
  • Hx gallbladder removal
36
Q

What is NAFLD and what are the two types?

A
  • Caused by excess fat stored in the liver
  • The two types:
    • Simple fatty liver ► Fat is present in the liver but little or no inflammation or liver cell damage
    • Nonalcoholic steatohepatitis (NASH) ► Hepatitis is present with inflammation of the liver and liver cell damage, in addition to fat accumulation

Advanced pathophysiology (3 decks)

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