Week 4 (liver /pancreas)
Hepatitis: inflammation of the liver.
Hep A: RNA virus transmitted via fecal oral route, not
chronic, vaccine avail.
Hep B: DNA virus transmitted via blood/body fluids,
vaccine avail (series of 3 doses). Interferon tx.
Hep C: RNA virus transmitted via blood/body fluids, NO
vaccine.
Hep D: RNA virus transmitted via blood/body fluids, that
requires Hep B exposure, so Hep B vaccine decreases risk.
Hep E: RNA virus transmitted via fecal oral route, usually
contaminated water, rare in developed countries.
Risk factors: IV drug use, body piercings, tattoos,
healthcare workers, people that use frequent blood products
(hemophilia, open heart sx), unprotected sex, traveling to
underdeveloped countries, crowded living environments.
Symptoms Acute phase:
o Hepatomegaly, splenomegaly
o Flu-like symptoms, fever
o Jaundice
o Dark-colored urine
o Clay-colored stools
o Puritus (itching)
Convalescent phase:
Hepatomegaly, malaise, easily fatigable
, Labs: increased ALT (4 – 36 units/L), AST (0 - 35
units/L), bilirubin (< 1.0mg/dL)
Medications:
o Interferon - Antiviral, antiproliferative, and immune
modulating effects. Side effects flu-like sx and
depression. Used for chronic Hep B
Cirrhosis: Normal liver tissue is replaced with fibrotic scar
tissue. Can lead to liver cancer (end stage).
S/S: jaundice (2/2 inability to excrete bilirubin), ascites,
RUQ pain, petechiae, spider angiomas, palmar erythema,
puritus, confusion, fatigue, GI bleeding, peripheral edema,
asterixis (flapping tremors of hand). Fetor hepaticus (fruity
breath).
Labs:
o Decreased serum protein, albumin, RBC, Hgb, Hct,
platelets.
o Increased ALT, AST, bilirubin, ammonia levels (10
– 80 mcg/dL).
Diagnosis: ultrasound, CT, MRI, liver biopsy (most
definitive!)
Medications:
o Lactulose – to remove excess ammonia through stool
(monitor for hypokalemia).
o Diurectics – monitor for hypokalemia
o Antibiotics: rifaximin (reduce ammonia producing
natural gut bacteria)
Hepatitis: inflammation of the liver.
Hep A: RNA virus transmitted via fecal oral route, not
chronic, vaccine avail.
Hep B: DNA virus transmitted via blood/body fluids,
vaccine avail (series of 3 doses). Interferon tx.
Hep C: RNA virus transmitted via blood/body fluids, NO
vaccine.
Hep D: RNA virus transmitted via blood/body fluids, that
requires Hep B exposure, so Hep B vaccine decreases risk.
Hep E: RNA virus transmitted via fecal oral route, usually
contaminated water, rare in developed countries.
Risk factors: IV drug use, body piercings, tattoos,
healthcare workers, people that use frequent blood products
(hemophilia, open heart sx), unprotected sex, traveling to
underdeveloped countries, crowded living environments.
Symptoms Acute phase:
o Hepatomegaly, splenomegaly
o Flu-like symptoms, fever
o Jaundice
o Dark-colored urine
o Clay-colored stools
o Puritus (itching)
Convalescent phase:
Hepatomegaly, malaise, easily fatigable
, Labs: increased ALT (4 – 36 units/L), AST (0 - 35
units/L), bilirubin (< 1.0mg/dL)
Medications:
o Interferon - Antiviral, antiproliferative, and immune
modulating effects. Side effects flu-like sx and
depression. Used for chronic Hep B
Cirrhosis: Normal liver tissue is replaced with fibrotic scar
tissue. Can lead to liver cancer (end stage).
S/S: jaundice (2/2 inability to excrete bilirubin), ascites,
RUQ pain, petechiae, spider angiomas, palmar erythema,
puritus, confusion, fatigue, GI bleeding, peripheral edema,
asterixis (flapping tremors of hand). Fetor hepaticus (fruity
breath).
Labs:
o Decreased serum protein, albumin, RBC, Hgb, Hct,
platelets.
o Increased ALT, AST, bilirubin, ammonia levels (10
– 80 mcg/dL).
Diagnosis: ultrasound, CT, MRI, liver biopsy (most
definitive!)
Medications:
o Lactulose – to remove excess ammonia through stool
(monitor for hypokalemia).
o Diurectics – monitor for hypokalemia
o Antibiotics: rifaximin (reduce ammonia producing
natural gut bacteria)
