Liver Disorders Flashcards
Describe the general signs and symptoms of acute viral hepatitis
- 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
What is the mode of transmission for hepatitis A?
- Fecal-oral route (contaminated food or water)
- Parenteral
- Sexual
- Crowded/unsanitary conditions increases risk
What is the incubation period for hepatitis 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
List the clinical manifestations of hepatitis A
- Flu-like symptoms!
- Fever
- Painful/enlarged liver
- Fatigue
- Loss of appetite
- Nausea/vomiting
- Abdominal pain
- Dark urine
- Diarrhea
- Joint pain
- Jaundice
What are the preventative measures against hepatitis 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
What are the serologic markers for hepatitis 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
Pathophysiology and complications of hepatitis 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
What questions would you want to ask your patients regarding their history that are important in diagnosing hepatitis A?
- International travel
- Military personnel
- Illicit drug users
- Male homosexuals
What is the mode of transmission for hepatitis B?
- 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
What is the incubation period for hepatitis B?
60-180 days
What information regarding your patient’s history would you want to obtain to help diagnose hepatitis B?
- 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
What are the clinical manifestations of acute hepatitis B?
- 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
What are the clinical manifestations of chronic Hep B?
- Hx: Serological testing + for 6 months
- S/S’s:
- Might be asymptomatic
- Nephritis
- Abdominal pain
- Hepatomegaly /hepatosplenomegaly
- Spider telangiectasis
- Ascites
- Jaundice
- Peripheral edema
What are the serologic markers and abnormal liver enzymes for hepatitis B?
-
HBsAg= Marker of active disease
- Diagnostic test
- Marker of acute OR chronic disease
- Shows surface antigen
- Marker for active disease/infection if +
- Diagnostic test
- 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
What are some complications associated with hepatitis B?
- 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