Hepatitis A
- Picornavirus
- 4 Week Incubation Period
- Fecal-oral
- Day Care Centers
- Travel to Developing Countries
- Usually Asymptomatic
- Acute Disease
- Jaundice
- Fever
- Vomiting
Hepatitis A (HAV) Assessment
- Fecal-Oral
- Ingestion of Contaminated Food or Water
- 4 Weeks
- Fever
- General Malaise
- Hepatomegaly
- Self-Limiting
- Proper Hand Washing
Hepatitis B (HBV) Assessment
- Bodily Fluids
- Blood Transmission
- People Who Use IV Drugs
- Variable 1-6 Months
- Fever
- Nausea and Vomiting
- Hepatomegaly
- Cirrhosis
- Hepatocellular Carcinoma
- Vaccination
Hepatitis B Virus Disease
- Can turn chronic
- < 10% of adults become chronic carriers
- 90% of newborns become chronic carriers
- Cirrhosis
- Hepatocellular carcinoma
- Membranous Glomerulonephritis
- Polyarteritis nodosa
- Serum sickness like syndrome
Hepatitis B Virus Characteristics
- Hepadnavirus
- Enveloped
- Circular
- Partially Double-stranded DNA
- Has Reverse Transcriptase
- IV Drug Use
- Sex
- Maternal Fetal Routes
- 3 Month Incubation Period
Hepatitis C
- Enveloped
- RNA Virus
- Flavivirus
- Icosahedral
- SS positive Linear
- Most Cases are Due to IV Drug Use
- Turns to Chronic Hepatitis in Over 70% of Cases
- Cirrhosis
- Hepatocellular Carcinoma
- Most Common Indication for Liver Transplantation
- Associated With Type I MPGN
- Porphyria Cutanea Tarda
Hepatitis C (HCV) Assessment
- Blood Transmission
- High Risk Sex (rare)
- IV Drug Users
- 7 Weeks
- Cirrhosis
- Barrier Protection
Cirrhosis Assessment
- Degeneration and Destruction of Liver Cells
- Jaundice
- Fatigue
- Palmar Erythema
- Spider Angiomas
- Hepatosplenomegaly
- Edema
- Gynecomastia
- Change in LOC
Cirrhosis Interventions
- Maintain Nutrition
- Paracentesis
- Drug Therapy
- Endoscopic Band Ligation or Sclerotherapy
- Balloon Tamponade
- Transjugular Intrahepatic Portosystemic Shunt (TIPS)
- Lactulose
- Antibiotics
Complications of Cirrhosis
- Portal Hypertension
- Ascites
- Esophageal Varices
- Coagulation Defects
- Portal-Systemic Encephalopathy
- Hepatorenal Syndrome
Gilbert's Syndrome
- Decreased UDP-Glucuronosyltransferase Activity
- Decreased Bilirubin Conjugation
- Often Asymptomatic
- Jaundice (Mild)
- Fasting
- Stress
- Alcohol Intake
- Increased Unconjugated Bilirubin
Crigler-Najjar Syndrome Type 1
- Autosomal Recessive
- Absent UDP-glucuronosyltransferase
- Neonatal Jaundice
- Kernicterus
- Normal Liver Function Tests
- Elevated Unconjugated Bilirubin
- Phototherapy
- Plasmapheresis
- Calcium Phosphate and Orlistat
- Death often by Age 2
- No Response to Phenobarbital
Budd-Chiari Syndrome
- Pregnancy and Postpartum
- Hematologic Disorders
- Tumors
- Chronic Infections
- Thrombosis of Major Hepatic Veins
- Centrilobular Congestion and Necrosis
- Abdominal Pain
- Ascites
- Hepatomegaly
- Nutmeg Liver
Reye's Syndrome
- Aspirin (Salicylates) to Treat Viral Illness (In Children)
- Cerebral Edema
- Lethargy (Decreased LOC)
- Vomiting
- Liver Failure
- Monitor for Increased ICP
- Mannitol (Osmitrol)
- No Aspirin for Children
Hemochromatosis Pathophysiology
- Hemosiderin Deposition
- Autosomal Recessive
- HLA-A3
- Secondary to Transfusion Therapy
- Increase Iron
- Increase Ferritin
- Increased Transferrin Saturation
Hemochromatosis Signs and Symptoms
- Micronodular Cirrhosis
- Hepatocellular Carcinoma
- Diabetes
- Bronze Skin Coloring
- CHF
- Arthropathy
- Testicular Atrophy
- Impotence
Wilson's Disease Pathophysiology
- Autosomal Recessive
- Mutation in ATP7B gene
- Chromosome 13
- Decrease in Ceruloplasmin
- Inadequate copper excretion
- Liver
- Brain
- Kidney
- Cornea
- Joints
- Treat with Penicillamine
Wilson's Disease Symptoms
- Cirrhosis
- Hepatocellular Carcinoma
- Basal Ganglia Degeneration
- Dementia
- Dyskinesia
- Asterixis
- Kayser-Fleischer Rings
- Slit Lamp Exam
- Hemolytic Anemia
Hyperammonemia
- Hereditary Urea Cycle Defects
- Acquired Through Liver Disease
- Inhibits the Citric Acid Cycle
- Somnolence
- Slurring of Speech
- Tremor
- Cerebral Edema
- Vomiting
- Blurring of Vision
- Limit Protein in Diet
- Lactulose
- Benzoate Binds Amino Acid for Excretion
- Phenylbutyrate
Jaundice
- Due To Elevated Conjugated Or Unconjugated Bilirubin
- Hemolysis
- Crigler-Najjar Or Gilbert's Syndrome
- Physiologic Jaundice Of Newborn
- Biliary Obstruction From Stone Or Mass
- Cholangitis
- Dubin-Johnson And Rotor Syndrome
- Cirrhosis
- Hepatitis
Nonalcoholic Fatty Liver Disease
- Fat Infiltration of Hepatocytes in Absence of Alcohol Consumption
- Obesity
- Hyperlipidemia
- Type II Diabetes
- Often Found Incidentally
- Elevated Liver Enzymes
- Ultrasound
- Weight Loss
- Abstinence From Alcohol
Hepatic Encephalopathy
- Seen in the Setting of Cirrhosis
- Hyperammonemia
- Altered Mental Status
- Coma
- TIPS
- Asterixis
- Lactulose
- Rifaximin
- Liver Transplant
Esophageal Varices
- Cirrhosis
- Portal Hypertension
- Left Gastric Vein and Esophageal Veins
- Hematemesis
- Melena
- Hypotension
- IV Fluids
- Antibiotics
- Octreotide
- Endoscopic Band Ligation or Sclerotherapy
- Balloon Tamponade
- Nonselective Beta Blockers
- Transjugular Intrahepatic Portosystemic Shunt (TIPS)
Spontaneous Bacterial Peritonitis
- Cirrhosis
- Ascites
- Monomicrobial
- Often Asymptomatic
- Change in Mental Status
- Abdominal Pain
- Paracentesis
- PMN >250/mm3
- 3rd Generation Cephalosporin
- Albumin
- Antibiotic Prophylaxis
Hepatocellular Carcinoma Characteristics and Presentation
- Malignant Liver Cancer
- Cirrhosis
- Chronic Hepatitis B or C
- Aflatoxin
- Alcoholic and Nonalcoholic Liver Disease
- Clinical Findings of Cirrhosis
- Often Asymptomatic
- Jaundice
- Ascites
Hepatocellular Carcinoma Diagnosis and Management
- Increased AFP
- Ultrasound
- Abdominal CT or MRI
- Surgical Resection
- Transplantation
- Image-guided Procedures
- Surveillance
- Poor Prognosis
Hepatic Adenoma
- Benign
- Epithelial Tumor
- Anabolic Steroids
- Oral Contraceptives
- Cessation of the Cause
- Surgical Resection
- Spontaneous Regression
- Risk of Rupture
Focal Nodular Hyperplasia
- Benign Tumor
- Unknown Etiology
- Asymptomatic
- Central Stellate Scar on Imaging
- Conservative Treatment
- Excellent Prognosis