Transcript Hepatitis - Labmongers

Background

Hepatitis is a general
term that refers to
inflammation of the
liver.

Medications, toxins
and autoimmune
disorders may cause
non-infectious
hepatitis.

Infectious etiologies
include: viral, fungal,
and parasitic
organisms.

There are several
types of hepatitis
which include: A, B,
C, B with D, E, F, and
G
A healthy human liver (top) contrasted with a liver from an individual
that died from hepatitis C (bottom). Note the extensive damage and
scarring from chronic liver disease.
You are at risk for
hepatitis if……





Inject illegal drugs
Have received a tattoo
or body piercing in
unsafe conditions.
Have hemophilia
Travel to areas where
hepatitis is common
Have unprotected sex
with multiple partners
or with someone who
has HBV



Received a blood
transfusion or solid
organ transplant before
July 1992
Received a blood
product for clotting
problems produced
before 1987
Have a job that
involves contact
with human blood
Hepatitis A
o Most commonly, the virus spreads from person to
person via the fecal-oral route. Contaminated water and
food have also resulted in epidemics of HAV.
o The virus may also spread via infected serum.
o The incubation period of HAV is 2-7 weeks, with an
average of 28 days
o Most common signs and symptoms include fatigue,
nausea, vomiting, fever, hepatomegaly, jaundice, dark
urine, anorexia, and rash.
o Other complications can include acute liver failure,
cholestatic hepatitis, and relapsing hepatitis
Hepatitis B



HBV transmits both parenterally and sexually, most often
by mucous membrane exposure or percutaneous exposure
to infectious body fluids.
Another significant mode of transmission is perinatal
transmission.
The incubation period for HBV varies from 28-160 days,
with the average approximately 75 days.

Signs and symptoms include right upper quadrant pain,
fever, arthritis, arthralgias, or an urticarial rash.

As the disease progresses, the liver becomes tender, and
jaundice develops. Patients may note that their urine
darkens and that their stools lighten in color. Other
symptoms include nausea, ascitis, vomiting, and pruritus.
Hepatitis C

HCV can be transmitted parenterally, perinatally, and
sexually.

Needlestick injuries among health care workers place them
at significant risk of infection.

Incubation period for HCV runs 15-150 days, with
symptoms developing anywhere from 5-12 weeks after
exposure.

Symptoms may appear similar to those of HBV infection. In
up to 80% of cases, however, patients are asymptomatic.

Approximately 50-85% of patients with HCV become
chronically infected with HCV; of those, 29-76% later
develop chronic active hepatitis or cirrhosis.
Some famous people living
with hepatitis C…….
Steven Tyler of
Aerosmith
Pamela Anderson
Hepatitis D & E

Hepatitis D


HDV, an incomplete virus,
requires the presence of
HBV to replicate.


The incubation period of
HDV is approximately 35
days. Patients co-infected
with HBV and HDV tend to
have a more severe
disease course than those
infected with HBV alone.


Hepatitis E
Hepatitis E virus is the
primary cause of enterically
transmitted non-A, non-B
hepatitis.
HEV is transmitted primarily
by the fecal-oral route, with
fecally contaminated water
providing the most common
means of transmission.
The incubation period is 2-9
weeks with an average of 45
days.
Diagnosing

Urine panel (for presence of bilirubin)

Liver enzyme panel

Determining the presence of specific antibodies for
hepatitis A, B, & C in serum. The third-generation tests can
detect such antibodies within 4-10 weeks of infection.

Liver biopsy may be recommended for the initial
assessment of disease severity in patients with chronic
hepatitis B or chronic hepatitis C.

There are no specific imaging studies required to make the
diagnosis of hepatitis.
Basic Treatment
o Supportive therapy for existing signs and symptoms and
preventing the transmission of the disease are important in
the treatment





Patients should be admitted if there is; any signs or symptoms of
severe complications, altered mental status, or changes in sleepwake cycle. A PT prolonged greater than 3 seconds, bilirubin
greater than 10 mg/dL, and hypoglycemia. those who are
immunocompromised; and those who are older than 50 years.
Bed rest is commonly prescribed
Alcohol is not allowed for at least 1 year
Most patients will tolerate small frequent meals of a low fat high
carb diet
If the patient is dehydrated, IV fluids with additives of vitamins C, B,
and K are given.
Sample Meds

Drug therapy for both Chronic Hepatitis B and C are
focused on decreasing the viral load, decreasing the rate
of disease progression, and decreasing the rate of drug
resistant B and C.
 Medications for HBV

Lamivudine (Epivir 3TC), & -interferon, and adefovir
dipivoxil (Hepsera)
Medications for HCV
Interferon alfa-2b(Intron A), ribavirin (Rebetol), PEG –
interferon alfa-2a (Pegasys)


Liver Transplant





Recipients can increase both quantity and quality of life.
Liver disease related to chronic viral hepatitis is the leading
indication for liver transplantation. Half of all transplant
recipients are HCV positive.
Most transplanted livers will eventually become infected with
HCV. 20-30 % of patients will develop cirrhosis by the 5th year
of the transplant.
Postoperative care is focused on monitoring for signs of
infection, rejection and hemorrhage, assessment of electrolyte
levels, pulmonary complications, neurological status, and
I&O’s
Emotional support and teaching the patient and the family is
also very essential
Patient teaching

Instruct patients not to share any articles with potential for
contamination with blood, semen, or saliva, including
needles, toothbrushes, or razors.

Inform food handlers suspected of having HAV not to
return to work until their primary care physician can
confirm that they are no longer shedding virus.

Instruct patients to refrain from using any hepatotoxins,
including ethanol and acetaminophen.

Advise patients in general to exercise meticulous
personal hygiene including strict hand washing.

A patient does not have to be at risk, to be told about
the vaccine available for Hepatitis B.
Prognosis






Varies with causative virus
Hepatitis A virus - usually is mild and self-limited.
Infection confers lifelong immunity against HAV.
Hepatitis B virus - Fulminate hepatic failure develops in
0.5-1% of patients infected with HBV; their case-fatality
rate is 80%.
Hepatitis C virus - responsible for 10,000 deaths each
year in the United States.
Hepatitis D virus - Chronic co-infection with HBV and
HDV often leads to rapidly progressive sub acute or
chronic hepatitis with as many as 70-80% of these
patients eventually developing cirrhosis.
Hepatitis E virus - usually is mild and self-limited. Casefatality rate reaches 15-20% in pregnant women. Does
not result in chronic disease.
Liver Abscesses
Another presentation by:
Stephanie Licano
What is it?
How do I know if the patient
has it?

If the body was not successful on destroying bacteria ,
the body builds toxins that attack liver cells. Then the
necrotic tissue that was produced makes a protective
wall. The result is a pyogenic cavity full of dead and living
leukocytes, bacteria, and liquefied liver cells.

Classic (but vague) Signs and Symptoms include:
Fever with chills and abdominal tenderness in the right
upper quadrant. Plus the health care provider may find..
Heptomegaly, jaundice and anemia
Another way to diagnose
Radiograph
 CT scan
 Ultrasound
 Liver scan
 Lab exam of antigen-antibody reaction
of amebae in the serum

Treatment? What does the
patient need to know?




They can usually be managed by medical therapy,
such as a full course antibiotic therapy that is specific
to the organism identified.
Percutaneous draining may be for patients who are
not responding to medical treatment or are at high risk
for rupture
If the abscess has ruptured then open surgical
drainage may also be used
The patient should be aware of an increase of signs
of symptoms and to tell the physician immediately.
Prognosis

The prognosis is much improved from
the old mortality rate of 100%

This is because advanced diagnostic tests, including the
CT scan and liver scans.