Liver Diseases

acute liver diseases
hepatitis, inflammation of the liver caused by viruses( a,b,c,d, e,g & ttv ) bacterial infections, or continuous exposure to alcohol, drugs, or toxic chemicals, such as those found in aerosol sprays and paint thinners. hepatitis can also result from an autoimmune disorder, in which the body mistakenly sends disease-fighting cells to attack its own healthy tissue.hepatitis reduces the liver’s ability to perform life-preserving functions, including filtering harmful infectious agents from the blood, storing blood sugar and converting it to usable energy forms, and producing many proteins necessary for life.
hepatitis a is a mild, epidemic disease spread by contaminated food & h2o does not cause chronic hepatitis or cirrhosis
hepatitis b & c are spread from individual to individual by needles or sexual contact can cause chronic hepatitis or cirrhosis
clinical syndromes of viral hepatitis:
* asymptomatic hepatitis no lasting liver injury
* carrier state harbors virus but is asymptomatic &can transmit to others
mostly hcv
* acute viral hepatitis
4 clinical phases
* chronic viral hepatitis
* fulminant hepatic failure
* hepatocellular carcinoma increased risk with hbv & hcv
acute viral hepatitis 4phases
1 . incubation a few weeks
2 . symptomatic prejaundice phase( preicteric ) malaise ,fatigue nausea/vomiting , anorexia
ruq pain , fever ,headache
3 . symptomatic jaundice phase
jaundice appears & other symptoms fade increase in conjugated bilirubin
pale stools
4 . convalescence jaundice fades infectivity disappears . abs in blood
fulminant hepatic failure : acute liver disease that progresses to hepatic failure or encephalopathy in just a few weeks . more than ½ of the cases are fulminant hepatitis usually involving hav or hbv.
other causes include drugs, heat stroke
hepatitis a
hav epidemic hepatitis
primarily fecal-oral transmission benign & self-limiting
incubation is about 2-6 weeks
most common type in the world
infection more common than the disease
more common in developing nations
about 10,000 new cases/yr in us
fatalities rare
no carrier state
vaccine available indications for vaccination ?
hepatitis b
hbv infects hundreds of millions worldwideincubation varies from a few weeks to 6 months.
acute infection: 
* detected by presence of hepatitis b surface antigen (hbsag)
* viremia may last for many weeks
* 1st antibody to appear is hepatitis b core antigen antibody (anti-hbc)
* beginning of recovery marked by appearance of hepatitis b surface antigen antibodies (anti-hbs) confers immunity
transmitted in:
blood
saliva
semen
almost any bodily fluid

spread by
sexual contact
blood transfusion
renal dialysis
needlestick
iv drug users
fetus in utero or during vaginal delivery (verticalspread or transmis)
1/3 of cases, not known

high risk populations for hbv infection include morticians, homosexual males, iv drug users, hemodialysis clients, people undergoing body tattooing & body piercing

hcv
the hepatitis c virus (hcv), identified in the mid-1980s. according to the centers for disease control and prevention (cdc), anyone who received a blood transfusion prior to 1992, before an accurate routine blood screening was established, may be infected with this virus
the hepatitis c virus (hcv), called the ‘silent epidemic’risk factors same as for hbv (illicit iv drug use, occupational exposure to blood, perinatal exposure, blood transfusion or organ transplant, exposure to contaminated equipment (including toothbrushes and razors), unprotected sexual contact.

hcv about 2% have antibodies indicating previous infectionabout 50% of these have detectable virus in blood indicates a chronic carrier state
transmission : over 12/ of new infections due to iv drug abuse , about 15% through sexual contact, infected health care workers, & neonates and in about 1/3 of cases, not known
mutating rna virus with dozens of subtypes has made developing a vaccine difficult

hepatitis d
hdv delta virus
co-exist with hbv
co-infect or superinfect
infect a carrier of hbv
mostly in
iv drug abusers
hemophiliacs

hepatitis e
rare in developed countries but most common form of epidemic hepatitis in india , transmitted like hav ,mild & self-limiting but mortality reach 10% during pregnancy
pathophysiological changes in acute hepatitis : hepatocytes undergo pathological changes as a result of the body s immune response to the virus. there is generalized inflammation with areas of necrosis . this leads to functional impairment of the liver cells. there is kuppfer cell hyperplasia (increase in number of phagocytes)
disruption of structure and function leads to obstruction of portal & hepatic blood flow.


anatomic pathology of hepatitis
carrier state
liver biopsy normal usually
in hcv, may have evidence of low-grade inflammation
in hbv, may have “ground glass” appearance due to virus particles
acute hepatitis
hydropingic degeneration chronic inflammation
necrosis of individual cells
fulminant hepatitis or hepatic failure extensive necrosis
chronic hepatitis
see those changes seen in acute but more severe damage
disorganized
more intense inflammatory reaction
more extensive necrosis
scar tissue
management :
medications include: vit k if prolonged pt,antiemetics.
bile acid sequestrants (clestid, questran) bind with bile acids in the gi tract and is excreted in feces, relieving pruritis.
skin care: emollients and lipid cream (eucerin)
reduce fatique
diet of low fat, high carb is better tolerated.
na restriction may be necessary
immune globulin (ig): prophylaxis for family and friends exposed to hav
hepatitis b immune globulin (hbig) individuals exposed to b virus contaminated material.
vaccines: available for hav & hbv – recommended for people with potential for exposure (hcps and people who travel to endemic areas)
hav & hae : good hand washing & personal hygiene.
hbv, hcv, hdv: careful handling of needles/sharps, proper sterilization of non-disposable instruments, use of condoms/refrain from multiple partners, needle exchange programs

prevention of liver disease in general:
no more than two alcoholic drinks a day.
be cautious about mixing drinks, combining with drugs otc & prescription
avoid exposure to chemicals whenever possible.
maintain a healthful, balanced diet.
vaccinate against hepatitis
no sharing of needles, razors, toothbrushes
practicing safer sex will minimize the risk of transmission of hepatitis b.