module 13 hepatitis

Question 1

hepatitis s/s

Answer 1

sequence

• incubation
• prodromal (preicteric) phase
• • variety of s/s ending with jaundice
• icteric phase: hepatocellular destruction and bile stasis, phase of illness
• recovery phase

Question 2

Hepatitis A

Answer 2

RNA
fecal-oral transmission (enteric)
2-7 week incubation
immunity via IgG

Question 3

Hep A risk factors

Answer 3

crowded, unsanitary conditions

food and water contamination

Question 4

Hep A s/s

Answer 4

anicteric: no s/s or mild without jaundice
Majority
- jaundice
- malaise
- anorexia
- nausea
- low fever
- RUQ pain

Question 5

Hep B

Answer 5

Double stranded DNA
incubation 2-6 months
parental transmission: infected blood, body fluids, or contaminated needles
3 types of viral particles
prodromal period longer with immune-complex related s/s

Question 6

Hep B s/s

Answer 6

urticaria
rashes
arthralgia
arthritis 
angioedema
serum sickness
glomerulonephritis
jaundice

Question 7

Hep B infection to recovery/death

Answer 7

acute infection

• 60-65% sublinical disease -> 100% recovery
• 20-25% acute hepatitis -> 99% recovery, 1% fulminant hepatitis -> death
• 4% chronic hepatitis -> 20-30% cirrhosis -> hepatocellular carcinoma/death

Question 8

fulminant hepatitis

Answer 8

liver coma

Question 9

Hep C

Answer 9

RNA
Parental transmission, though less through sex or perinatal
- drug use, blood transfusion, needle stick

Question 10

Hep C infection to recovery/death

Answer 10

acute infection

• 85% chronic hepatitis -> 80% stable disease, 20% cirrhosis -> 50% stable, 50% death
• 15% resolution
• rare: fulminant hepatitis

Question 11

Hep D

Answer 11

co-infection
- depends on Hep B for replication
Parental transmission

Question 12

Hep A and Hep E similar

Answer 12

typically self-limiting
2-8 wk incubation
does not cause chronic hepatitis or cancer
oral transmission

Question 13

Hep B, Hep C, and Hep D similar

Answer 13

cause carrier state
cause chronic hepatitis and cancer
parenteral transmission

Question 14

Hep E

Answer 14

RNA
transmission: fecal- oral
parental may occur
incubation: 2-9wks

Question 15

chronic hepatitis

Answer 15

inflammation of liver > 6mo.
chronic persistant
chronic active
autoimmune

Question 16

chronic persistant

Answer 16

triaditis, transaminitis

• chronic, low-grade inflammation
• • portal triads w/out destruction of liver structures
• • inc. serum transaminase
• not progressive

Question 17

chronic acute

Answer 17

progressive, destructive
extends beyond portal triad to hepatic lobule
could spontaneously arrest or progress to cirrhosis

Question 18

chronic acute s/s

Answer 18

fatigue
malaise
nause
anorexia
ascites
hepatomegaly
abdominal pain
jaundice

Question 19

autoimmune hepatitis

Answer 19

progressive inflammation characterized by autoantibodies and polyclonal hypergamaglobulinemia

Question 20

cirrhosis

Answer 20

irreversible end stage of many different hepatic injuries
- acute hepatitis
- chronic hepatits
- toxic hepatitis
- metal storage diseases
- alcoholism
nodule regeneration and fibrosis -> dec. hepatic function
Biliary channels obstructed -> portal HTN
-> blood shunting away from liver, hypoxic necrosis

Question 21

alcoholic cirrhosis

Answer 21

more fat delivered to hepatocyte than it can metabolize; defect in fat metabolism 
fatty infiltration (hepatic steatosis)
- inc. lipogenesis and dec. fatty acid oxidation 
Alcohol -> acetaldehyde -> lipid peroxidation -> disruption of cellular function, damage, and inflammation

Question 22

alcoholic cirrhosis s/s

Answer 22

usually mild and asymptomatic
enlarged liver
abdominal discomfort 
portal HTN 
multisystem disease r/t alcohol intake

Question 23

Biliary cirrhosis

Answer 23

end result of continuous inflammation of bile ducts r/t biliary obstruction and backup of bile in the liver
-> inflammation and scarring of liver with obliteration of bile ductules, diffuse, widespread fibrosis, and nodule formation
Portal HTN

Question 24

Biliary autoimmue (1st degree)

Answer 24

unknown etiology
destruction of intrahepatic ducts
portal inflammation
fibrosis

Question 25

Biliary cirrhosis s/s

Answer 25

mitochondrial IgG antibodies inc. serum alkaline phosphotase hyperbilirubinemia

Question 26

biliary obstruction (2nd degree)

Answer 26

prolonged complete or partial block gallstones, tumors, fibrotic stricture - inc. pressure in hepatic bile duct -> accumulation in centrilobular spaces and fibrosis

Question 27

liver fibrosis and scarring ->

Answer 27

``` portal HTN -> ascites edema splenomegaly - anemia - thrombocytopenia - leukopenia varices - esophageal - hemorrhoids - superficial abd. veins ```

Question 28

liver inflammation ->

Answer 28

``` pain fever N/V anorexia fatigue necrosis ```

Question 29

Liver necrosis -> Gi/GU

Answer 29

dec. bilirubiin metabolism - > hyperbilirubinemia, jaundice dec. bile in gastrointestinal tract - > light colored stolls dec. vit. K absorption - > bleeding inc. urobilinogen - > dark urine

Question 30

liver necrosis -> dec. metabolism

Answer 30

dec. metabolism of proteins, carbs, and fats - > hypoglycemia dec. plasma proteins - > ascites and edema

Question 31

liver necrosis -> biochemical alterations

Answer 31

inc. AST and ALT inc. bilirubin dec. albumin inc. PT time inc alkaline phosphatase

Question 32

liver necrosis -> dec. hormone metabolism

Answer 32

inc. androgens and estrogens - gynecomastia - loss of body hair - menstrual dysfunction - spider angiomas - palmar erythema inc. ADH and aldosterone - edema

Question 33

portal HTN

Answer 33

impaired blood flow through liver r/t inc. resistance from fibrosis and degeneration - venous congestion in GI tract

Question 34

portal HTN s/s

Answer 34

few early on, until abnormal vascular patterns | - anorexia

Question 35

portal HTN complications

Answer 35

varices -> uncontrolled bleeding form esophageal ruptures ascites

Question 36

ascites

Answer 36

accumulation of fluid in peritoneal cavity typical with advanced liver disease r/t - portal HTN - dec. albumin -> inappropriate pressure gradient, intraabd. accumulation of Na, H2O, protein

Question 37

hepatic encephalopathy

Answer 37

complex neuropsychiatric syndrome characterized by s/s ranging from mild confusion to stupor and coma - dementia - psychotic symptoms - spastic myelopathy - cerebella or extraprymidal sings Classic findings - asterixis (liver flap): spastic jerking of hands held in force extension assoc. with fulminant hepatic failure and severe chronic liver disease arterial ammonia level directly correlates with level of encephalopathy

Question 38

hepatic encephalopathy s/s

Answer 38

dec. K dec. Na alkalosis hypoxia hypercarbia infection GI hemorrhage protein meal gorging renal failure constipation

Question 39

Hepatic encephalopathy grade 1

Answer 39

confusion subtle behavior change no flap

Question 40

hepatic encephalopathy grade 2

Answer 40

drowsy clear behavior change + flap

Question 41

hepatic encephalopathy grade 3

Answer 41

``` stupor can follow commands marked confusion slurred speech + flap ```

Question 42

hepatic encephalopathy grade 4

Answer 42

coma | no flap

Question 43

Jaundice

Answer 43

yellow-green staining of tissue r/t impaired bilirubin metabolism may occur from dysfunction anywhere along pathway: 3 divisions - prehepatic - hepatic - posthepatic

Question 44

normal bilirubin metabolism

Answer 44

RBC broken down and release Hgb - broken down to unconjugated bilirubin: transferred to liver bound to albumin - liver makes conjugated (water-soluble) bilirubin and excretes in bile -> small intestine, not absorbed - colon: bacterial B-glucuronidase converts it to uribilinogen - > small amount resorbed and excreted by kidneys and liver

Question 45

prehepatic jaundice

Answer 45

hemolysis and ineffective erythropoiesis reabsorption of large hematoma

Question 46

hepatic jaundice

Answer 46

dysfunction of hepatic steps | - many disorders that affect liver function

Question 47

posthepatic jaundice

Answer 47

``` level of canalicular transport inherited: dubin-johnson syndrome, Rotor syndrome -> inc. conjugated bilirubenemia drugs sex hormones mechanical obstruction of bile ducts ```

Question 48

hepato-renal syndrome

Answer 48

complication of liver failure intrarenal blood flow disturbed - imbalance between vasoconstriction/dilation mechanisms r/t liver disease - may follow vigorous diuretic therapy or paracentesis -- diarrhea, nonsteroidal anti=inflammatory drugs, variceal bleeding, sepsis

Question 49

hepato-renal syndrome s/s

Answer 49

inc. creatine AKF oliguria