Chapter 38: Liver Diseases Flashcards Preview

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Flashcards in Chapter 38: Liver Diseases Deck (15):

Acute Viral Hepatitis

- Inflammation of the liver parenchyma

- caused by many viruses (cytomegalovirus, Epstein-Barr)

- "viral hepatitis" (Hepatitis A, B, C, D, & E)


Hepatitis A (HAV)

- RNA virus spread by fecal-oral route

- Also called enteric hepatitis

- 2- to 7-week incubation period

- Prodromal period (Jaundice, RUQ pain. malaise, anorexia, nausea, low-grade fever, children may not experience jaundice)

- Followed by jaundice lasting approx 2 weeks

- Self-limited course

- Serologic Testing (Anti-HAV IgG (previous infection), IgM (acute infection))

- Treatment is supportive (rest, nutritious diet) and includes avoiding ETOH, acetaminophen, and hepatotoxins

- Prevention includes careful hand washing, segregation, cleaning of laundry and personal items, and immunization with y-globulin


Hepatitis B (HBV)

- Partially double-stranded DNA virus

- Spread by parenteral contact with infected blood or blood products (Includes contaminated needles and sexual contact)

- Also called serum hepatitis

- 300 million (5%) of world population have chronic infection

- 1 to 1.25 million in United States

- Risk factors include Perinatal, health care settings (3%); transfusions and dialysis (1%); acupuncture, tattooing, extended overseas travel, residence in an institution

- Incubation period of 2 to 6 months

- Prodromal period that includes Asymptomatic or rashes, arthralgia, arthritis, angioedema, serum sickness, glomerulonephritis, jaundice (lasting 2 weeks on average)


Serologic Testing of Hepatitis B (HBV)

- Surface antigen (HBsAg): early/active and chronic infection

- Surface antibody (HbsAb): resolution and immunity

- Core antigen (HBcAg): appears first in active infection

- Core antibody (HBcAb): seroconversion

- Hepatitis B e antigen (HBeAg): viral replication and infectivity


Treatment of Hepatitis B (HBV)

- Persons with detectable virus and HBeAg positive readily transmit virus to their contacts, and should be counseled

- Supportive: Most nonfulminant infections resolve spontaneously. about 5% progress to chronic infection

- Liver transplant

- Interferon-alpha (24 to 48 weeks of therapy, Response rate of 33%)

- Lamivudine, Telbivudine

- Adefovir, Tenofovir

- Entecavir (TREATMENT OF CHOICE) (Response rate of 67%, Extremely expensive)


Prevention of Hepatitis B (HBV)

- Immunizations (Doses given at 0, 1, and 6 months, 95% response rate, recommended as part of the childhood vaccination regimen and for high-risk individuals, and after exposure)

- Administration of HBIG postinoculation

- ^ Contains high levels of hepatitis B surface antibody

- ^ Given within 7 days of exposure

- ^ Indications include Neonates born to HBsAg-positive mothers, Prophylaxis after needlestick or sexual exposure in nonimmune persons, and After liver transplantation in patients who are HBsAg+ prior to transplantation


Hepatitis C (HCV)

- Single-stranded RNA virus (Flavivirus)

- Spread through IV drug use or blood transfusions prior to 1990

- Also called non-A, non-B hepatitis

- 3% worldwide infected

- Have 6 types (Type 1: most common in the United States but has a lower response rate to treatment; Types 2 and 3: common in N. America; Types 4 to 6: common overseas)


Acute and Chronic Hepatitis C (HCV)

- Acute HCV infection (Usually asymptomatic; Course is erratic with wide fluctuations on liver enzymes)

- Chronic HCV infection (Usually asymptomatic until advanced liver disease intervenes; Most common cause of end-stage liver disease with cirrhosis)


Treatment for Acute Hepatitis C (HCV)

- Supportive and expectant

- Early treatment not recommended (20% to 40% of acute seropositive patients will convert to seronegativity and an undetectable viral load during 1st 6 months after infection; Immune globulin is not helpful in preventing infection


Treatment for Chronic Hepatitis C (HCV)

- Assessed by a viral load and viral genotype

- Liver biopsy to stage disease activity

- Pegylated interferon-alpha with ribavirin and protease inhibitor (5% to 10% drop out of treatment because of side effects and cost (expensive); Type 1: 48 weeks; Other types: 24 weeks)

- Vaccinate against hepatitis A and B

- Counsel regarding blood-borne precautions

- Centers for Disease Control and Prevention does not currently recommend barrier methods for patients with long-term sexual partners because of the apparent low risk of infection


Hepatitis D (Delta)

- Defective RNA virus that requires the helper function of
HBV to replicate
- Infection appears to accelerate and worsen HBV infection symptoms

- Prevention of HBV infection also prevents HDV infection

- Transmitted parenterally and intimate contact


Diagnosis and Prevention of Hepatitis D

- Diagnoisis: Anti-HDV IgM and IgG enzyme linked immunosorbent assay (ELISA)

- Prevention: Safe sexual practices, Avoidance of IV drug use, Vaccination of susceptible persons with HBV vaccine

- No specific treatment


Hepatitis E (HEV)

- RNA virus spread via fecal-oral route (Contaminated H2O and
Parenteral transmission)

- Most common in developing countries or recent travel to these areas

- Relatively high mortality rate in pregnant women

- Incubation period is 2 to 9 weeks

- Prodromal and icteric illness (Usually last only 2 weeks;
Similar to HAV infection)

- Supportive treatment

- Prevention Includes Careful hand washing, Avoidance of undercooked foods, and Drinking safe H2O and beverages


Chronic Hepatitis

- Group of diseases characterized by inflammation of the liver that lasts 6 months or longer

- Causes include Autoimmune disease, Viral hepatitis (B and C), Toxins, Metabolic diseases

- Pathogenesis includes Chronic low-grade liver inflammation of any cause (also called “triaditis” or “transaminitis”) and Inflammation confined to portal triads without destruction of normal liver structures

- Clinical Manifestations are Asymptomatic or mild, nonspecific symptoms

- Treatment: No drug treatment needed; excellent prognosis


Chronic Active Hepatitis

- Progressive, destructive inflammatory disease of the liver lasting >6 months (Extends beyond the portal triad to hepatic lobule (piecemeal necrosis)

- May progress to cirrhosis

- clinical manifestations include Fatigue, malaise, nausea, anorexia, ascites, hepatomegaly, abdominal pain, and jaundice

- Laboratory diagnosis looks for abnormal liver enzymes and serologic studies

- Liver Biopsy confirms diagnosis, and grading and staging

- treatment depends on cause