Hepatitis / Liver Flashcards
Hep B Testing
Positive HBsAg - infected and infectious
Positive anti-HBs / HBc - protected / recovered / infected if HBsAG also positive
Positive IgM anti-HBc - Acute infection
HBV Vaccine
Infants at birth (0, 2, 12 months)
Pregnant women screened
At risk people should be vaccinated, all children should be
Viral Hepatitis Symptoms
asymptomatic to fulminant and fatal liver failure. Progression to CLD, cirrhosis, and hepatocellular cancer (HCC) is possible
Anorexia, fatigue, myalgia, N/V, fever, headache, abdominal pain is usual acute signs. Jaundice is later.
Non-Alchoholic Fatty Liver Disease
Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), a spectrum of chronic disorders associated with the metabolic syndrome (see Chapter 192), are now the most common CLDs in the United States.
Hepatitis Labs
Elevated AST and ALT
Elevated bilirubin in alcoholic liver disease
AST more elevated, think SUBSTANCE cause
ALT more elevated, think LIVER cause (viral)
Elevated PLT and albumin = cirrhosis progresion
Hep C Screening
Once for adults born between 1945 and 1965
A recovering chronic alcoholic reports nausea, vomiting, diarrhea, and abdominal discomfort. A physical examination is negative for jaundice or ascites.
What will the primary care provider do initially?
Patients with alcoholic hepatitis may present initially with signs of gastroenteritis. Based on the history, even without jaundice and ascites, the provider should order a CBC and LFTs.
A patient who is a chronic alcoholic reports weight loss, pruritus, and fatigue, and the primary care provider suspects cirrhosis of the liver. The patient’s urine and stools appear normal.
What do these findings indicate?
Early cirrhosis symptoms are characterized by this patient’s symptoms. Late symptoms would have urine changes and abdominal pain.
Types of Jaundice
Prehepatic jaundice is caused by conditions that produce excessive bilirubin. Examples include any condition that causes hemolysis. Hepatic jaundice is a result of hepatic injury, including infections, toxins, autoimmune disorders, and tumors. Posthepatic jaundice, also called obstructive jaundice, is a result of complete or partial obstruction of the bile ducts. Pancreatic tumors and gallstones are the most common causes of posthepatic jaundice
Bilirubin forms
two forms of bilirubin: indirect, or unconjugated, bilirubin (which is protein-bound) and direct, or conjugated, bilirubin.
The direct form circulates freely in the blood until it reaches the liver, where it is conjugated with glucuronide transferase and excreted into the bile.
Increased unconjugated bilirubin
Increase in destruction of red blood cells
Increased direct / conjugated bilirubin
Liver dysfunction of obstruction. The bilirubin is unable to pass to the intestines for disposal
Hemolytic Jaundice
excess hemolysis of RBCs causes excess unconjugated bilirubin and exceeds the liver ability to process it
Jaundice Assessment Pearls
ever and right-upper-quadrant tenderness are most often associated with choledocholithiasis, cholangitis, or cholecystitis. An enlarged, tender liver suggests acute hepatic inflammation or a rapidly growing hepatic tumor. Splenomegaly suggests portal hypertension from acute or active chronic hepatitis as well as cirrhosis.
Jaundice and normal Liver Panel
Acute non-liver problem
