Acute Viral Hepatitis + Chronic Liver Disease Flashcards by m3ali alfarsi

systemic infection affecting the liver predominantly

Acute viral hepatitis

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Incubation period is 15–45 days

Hepatitis A

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Incubation period is 30–180days

hepatitis B and D

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Incubation period is 15–160days

hepatitis C

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Incubation period is 14–60 days

hepatitis E

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Non specific symptoms

Anorexia, nausea and vomiting, fatigue, malaise, arthralgias, myalgias, headache, photophobia, pharyngitis, cough, and coryza
low-grade fever
Dark urine

Prodromal symptoms

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more often present in hepatitis A and E than in hepatitis B or C

low-grade fever between 38° and 39°C (100°–102°F)

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may be noticed by the patient from 1–5 days before the onset of clinical jaundice

Dark urine

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precede the onset of jaundice by 1–2 weeks

Prodromal symptoms
Non specific

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Jaundice is evident in this phase

Clinical jaundice / icteric phase

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liver becomes enlarged and tender and may be associated with right upper quadrant pain and discomfort
Splenomegaly and cervical adenopathy

Clinical jaundice phase

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Splenomegaly and cervical adenopathy are present in

10–20% of patients with acute hepatitis

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constitutional symptoms disappear, but the liver may still be enlarged

Recovery phase

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duration of this phase is variable, ranging from 2–12 weeks, and is usually more prolonged in acute hepatitis B & C

Recovery phase

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clinical recovery is expected in all hepatitis A and E is in ……

1–2 months

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clinical recovery is expected in in three-quarters of hepatitis B and C is in ……

3–4 months

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Progressive destruction and regeneration of the liver parenchyma leading to fibrosis or cirrhosis for a period of more than 6 months

Chronic Liver Disease CLD

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consists of (one or more):
Inflammation (chronic hepatitis)
Liver cirrhosis
Hepatocellular carcinoma.

Chronic Liver Disease CLD

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Chronic Liver Disease CLD consists of (one or more)

Inflammation (chronic hepatitis)
Liver cirrhosis
Hepatocellular carcinoma

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Development of liver fibrosis to the point that there is architectural distortion of liver parenchyma with the formation of regenerative nodules

Liver cirrhosis

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Alcoholism

Main Cause of Cirrhosis

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Chronic viral hepatitis
Hepatitis B
Hepatitis C

Main Cause of Cirrhosis

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Nonalcoholic fatty liver disease (NAFLD)

Main Cause of Cirrhosis

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nonalcoholic steatohepatitis (NASH)

Main Cause of Cirrhosis

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Autoimmune hepatitis

Main Cause of Cirrhosis

Cardiac cirrhosis

Less Common Cause of Cirrhosis

Hemochromatosis

Inherited metabolic liver disease Less Common Cause of Cirrhosis

Cystic fibrosis

Inherited metabolic liver disease Less Common Cause of Cirrhosis

α1 Antitrypsin deficiency

Inherited metabolic liver disease Less Common Cause of Cirrhosis

Wilson’s disease

Inherited metabolic liver disease Less Common Cause of Cirrhosis

Primary biliary cirrhosis

Biliary cirrhosis Less Common Cause of Cirrhosis

Primary sclerosing cholangitis

Biliary cirrhosis Less Common Cause of Cirrhosis

Autoimmune cholangiopathy

Biliary cirrhosis Less Common Cause of Cirrhosis

Cryptogenic cirrhosis

Less Common Cause of Cirrhosis

usually well advanced before its symptoms are noticeable enough to cause alarm

Liver cirrhosis

nonspecific, weakness, fatigue, anorexia and weight loss are

earliest and commonest symptoms

yellow discoloration of the skin and mucous membranes (with the eye being especially noticeable) due to increased bilirubin

Jaundice

vascular lesions consisting of a central arteriole surrounded by many smaller vessels and occur due to an increase in estradiol

Spider angiomata or spider nevi

due to increased bilirubin

Jaundice

due to an increase in estradiol

Spider angiomata or spider nevi + Gynecomastia

reddening of palms at the thenar and hypothenar eminences also as a result of increased estrogen

Palmar erythema

result of increased estrogen

Palmar erythema

angle between the nail plate and proximal nail fold > 180 degrees

Clubbing

Thickening and shortening of palmar fascia that leads to flexion deformities of the fingers

Dupuytren's contracture

resulting from decreased production of coagulation factors

Bruising and bleeding

bilateral asynchronous flapping of outstretched, dorsiflexed hands seen in patients with hepatic encephalopathy

Asterixis (Flapping tremor)

Increase in breast gland size in men that is not cancerous, is caused by increased estradiol

Gynecomastia

decrease in sex hormones manifest as impotence, infertility, loss of sexual drive, and testicular atrophy, can result from primary gonadal injury or suppression of hypothalamic/pituitary function

Hypogonadism

result from primary gonadal injury or suppression of hypothalamic/pituitary function

Hypogonadism

In people with cirrhosis Liver size can be ….

enlarged, normal, or shrunken

musty breath odor resulting from increased dimethyl sulfide

Fetor hepaticus

resulting from increased dimethyl sulfide

Fetor hepaticus

Indicates advanced liver disease

Fetor hepaticus

Accumulation of fluid in the peritoneal cavity

Ascites

dilated periumbilical collateral veins due to portal hypertension

Caput medusa

due to portal hypertension

Caput medusa

increases resistance to blood flow and higher pressure in the portal venous system, resulting in portal hypertension

Liver cirrhosis

Effects of portal hypertension include

Splenomegaly Esophageal varices Hepatic encephalopathy

found in 35% to 50% of patients

Splenomegaly

result from collateral portal blood flow through vessels in the stomach and esophagus

Esophageal varices

When these blood vessels become enlarged, they are called

varices

liver does not clear ammonia and related nitrogenous substances from the blood, which are carried to the brain, affecting cerebral functioning

Hepatic encephalopathy

The symptoms may range from mild to severe and may be observed in as many as 70% of patients with cirrhosis

Hepatic encephalopathy

Grading of hepatic Encephalopathy Based on

West Haven State of consciousness

No change in personality or behavior No asterixis (flapping tremor)

Stage 0 of hepatic Encephalopathy Normal

Impaired concentration + attention span Sleep disturbance, slurred speech Euphoria or depression Asterixis present

Stage 1 of hepatic encephalopathy

Lethargy, drowsiness,apathy or aggression Disorientation, inappropriate behavior, slurred speech

Stage 2 of hepatic Encephalopathy

Confusion + disorientation, bizarre behavior Drowsiness or stupor Asterixis usually absent

Stage 3 of hepatic Encephalopathy

Comatose with no response to voice commands Minimal or absent response to painful stimuli

Stage 4 of hepatic Encephalopathy

Jaundice