Hepatitis: General
Defined as acute or chronic hepatocellular.
- Most common cause of acute hepatitis is viral followed by toxins (*EtOH).
- Most common cause of chronic hepatitis is viral (can also be inherited disorders, autoimmune) |
Viral Hepatitis
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Transmission (A + E) Fecal-oral contamination. Prevent by having a sanitary water supply and hand washing)
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Transmission (B + C + D) Parenterally or by mucous membrane contact
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Progression to serious liver disease in pts. with chronic Hepatitis C 20-30% progress to serious liver disease, usually if EtOH is involved or pt. also has Hep B or HIV
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Clinical Features: general Fatigue, malaise, anorexia, nausea, tea-colored urine, vague abdominal discomfort
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When is Hep D found? In conjunction with Hep B, assoc. w/ more severe course
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Which infectious are frequently found as co-infections? Hep C + HIV, Hep B + HIV
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Lab Findings Elevated aminotransferase levels, bilirubin > 3.0 (=scleral icterus or jaundice), antibodies and antigens present in serology
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Treatment: Acute viral hepatitis Supportive (Hep A pts be careful to wash hands/dishes and not share food), avoid EtOG/toxins
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All HIV-positive pts. with chronic Hep B should be... Treated for HIV (no matter what the CD4 count is) w/ therapies that cover both infx.
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Hep C. patients should also be evaluated for... The level of fibrosis
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Toxic Hepatitis
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Etiology EtOH, acetaminophen, isoniazid, halothane, phenytoin, carbon tetrachloride
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How to diagnose and treat? Eliminate the suspected agent
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What is used for acetaminophen toxicity? Acetylcysteine
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Prognosis? Good if the patient survives the acute episode
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Cirrhosis
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Definition Irreversible fibrosis and nodular regeneration throughout the liver
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Etiology EtOH (causes >45% of cases in US), or Hep B/C or congenital disorders
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Clinical Presentation Weakness, fatigue, weight loss, N/V, anorexia, amenorrhea, impotence, loss of libido, abdominal pain, hepatomegaly.
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Signs/symptoms of late stage cirrhosis Ascites, pleural effusions, peripheral edema, ecchymosis, esophageal varices, and signs of hepatic encephalopathy
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Signs of Hepatic Encephalopathy Asterixis, tremor, dysarthria, delirium, coma
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Lab Findings Can be normal until late-stage disease. Anemia, mild AST elevation.
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Treatment Abstain from EtOH use, salt restriction + bed rest for ascites, can do Spironolactone 100mg qd to diurese. Liver transplant for select patients
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Liver Abscess
- Caused by Entamoeba histolytica or the coliform bacteria
- Happens after travel or secondary to an intra-abdominal infection.
- Presents with fever and abdominal pain
- Treat with abx, percutaneous drainage, surgical excision |
Liver Neoplasm
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General Can be malignant (primary or metastatic) or benign
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Types of benign neoplasm Cavernous hemangioma, hepatocellular adenoma, infantile hemangioendothelioma
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Liver is a common site for... Metastases from other cancers (esp. lung and breast). But if the primary tumor is silent, manifestations may occur in liver first.
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What is associated with primary hepatocellular carcinoma Hep B, Hep C, cirrhosis, aflatoxin B1 exposure (from Aspergillus in foods)
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Clinical Characteristics Malaise, weight loss, abdominal swelling, weakness, jaundice, upper abdominal pain. Signs include hepatomegaly, splenomegaly, hepatic bruit, ascites, jaundice, wasting, fever
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Lab Findings Elevated a-fetoprotein
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Treatment: Benign neoplasms Treat if the tumor size might be in danger of rupturing hepatic capsule
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Treatment: Metastatic disease Treat the primary lesion
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When may surgical resection be attempted? If the cancer is confined to one lobe and there is no concurrent cirrhosis. Liver transplant might be an option. Poor prognosis overall.
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