Hepatic Disorders-Jaundice, Hepatitis, and Cirrhosis

Fulminant Hepatic Failure -definition -mortality -causes

-Clinical syndrome of sudden and severely impaired liver function in a previously healthy person -High mortality rate (This is how most workers that were poked from needle died from hepatic failure) Causes 1. Viral hepatitis 2. Toxic medications and chemicals 3. Metabolic disturbances 4. Structural changes

Symptoms of Obstructive Jaundice

-Dark orange-brown urine -Light clay-colored stools -Due to bile being excreted in the urine -Pruritus -Dyspepsia and intolerance of fats, impaired digestion

Hepatocellular Jaundice -definition -example

-Inability of damaged liver cells to process normal amounts of bilirubin -Example: Cirrhosis, viral infection, medication, toxins

Hemolytic Jaundice -definition -example

-Increased destruction of red blood cells = increased bilirubin Example: Hemolytic transfusion reactions

S/S of Hepatocellular Jaundice

-May appear mildly or severely ill -Lack of appetite, nausea, weight loss -Malaise, fatigue, weakness -Headache chills and fever if infectious in origin

Hep. D -transmission -symptoms

-Only persons with hepatitis B are at risk for hepatitis D -Symptoms and treatment are similar to hepatitis B but more likely to develop fulminant liver failure and chronic active hepatitis and cirrhosis (more severe than Hep. A or B)

Hep. A -transmission -symptoms -diagnosis -extra info.

-Transmission: Fecal-oral transmission (hand-to-mouth contact, close contact, or through food and fluids) Symptoms: -Early: mild flu-like symptoms, low-grade fever, anorexia -Late:jaundice and dark urine, indigestion and epigastric distress, enlargement of liver and spleen Diagnosis: Anti-HAV antibody in serum after symptoms appear -Self-limited illness, no carrier state or increased risk of liver disease

Hep. E -transmission -information

-Transmitted by fecal-oral route -Resembles hepatitis A and is self-limited with an abrupt onset (no chronic form)

Hepatic Cirrhosis Causes

1. Alcoholism 2. Chronic Hepatitis 3. Autoimmune Hepatitis 4. Bile Duct Disorders 5. Nonalcoholic Fatty Liver Disease (NAFLD) (usually in obese) 6. Hereditary Disorders

Hepatic Cirrhosis Medical Management

1. Antacids, H2 blockers: helps w/ symptoms similar to GERD, these symptoms are due to increased abdominal pressure 2. Vitamins, nutritional supplements: compensate for loss of proteins made in liver -encourage small frequent meals -sodium restriction for ascites 3. Adequate diet, avoid alcohol 4. Potassium sparing diuretics - spironolactone: gets rid of ascites and puts fluid back into circulation 5. Colchicine: prevents muscle cramping in legs 6. Angiotensin inhibitors: get blood pressure under control 7. Ursodeoxycholic (Actigall) for primary biliary cirrhosis to breakdown stones that are made of cholesterol 8. Silybum marianum (herb milk thistle): works against a lot of other medications that p/t is taking, see if they are willing not to use natural ways

Early Signs of Hep.

1. Flu like manifestations (fatigue, malaise, N/V, diarrhea, HA) 2. Abdominal/epigastric pain 3. Low-grade fever 4. Pruritus 5. Jaundice symtoms

Later signs of Hep.

-Bleeding tendencies -Anemia

Hepatitis Causes

-Virus -Bacteria -Exposure to medications -Hepatotoxins

Hereditary Hyperbilirubinemia

genetic

Advanced Manifestations of Cirrhosis

1. Ascites 2. Hypotension 3. G.I. bleeding secondary to esophageal varicies 4. Hepatic encephalopathy 5. Ammonia levels elevate 6. Anemia & Vitamin Deficiencies 7. Weight loss/Weakness and muscle wasting 8. Infection and Peritonitis 9. Caput medusae/Purpura 10. Spontaneous bruising/Epistaxis 11. Gonadal atrophy/Gynecomastia 12. Body hair and nail changes (proteins in liver not being made)

Early Clinical Manifestations of Cirrhosis

1. Hepatomegaly (enlarged liver; firm, nodular) 2. LFT's elevated 3. Intermittent mild fevers 4. Epistaxis 5. Ankle edema 6. Indigestion/Abdominal pain 7. Splenomegaly 8. Palmar erythema (reddened palms) 9. Vascular spiders

Obstructive Jaundice

Cause: Occlusion of the bile duct -Due to inflammation, a tumor, pressure from an enlarged organ OR -Intrahepatic obstruction (thickened bile within the canaliculi-passageway) -Prolonged obstructive disease will lead to cellular damage and hepatocellular jaundice

Hepatic Cirrhosis Definition

Chronic disease characterized by replacement of normal liver tissue with diffuse fibrosis that disrupts the structure and function of the liver

Hep. C -transmission -symptoms -treatment -extra info.

Transmission: by blood and sexual contract, including needle sticks and sharing of needles -Symptoms: usually mild Treatment: -Alcohol encourages the progression of the disease, so alcohol and medications that effect the liver should be avoided -Antiviral agents: interferon and ribavirin (Rebetol) -The most common blood-borne infection -Chronic carrier state frequently occurs

Hep. B -transmission -symptoms -diagnosis -treatment -extra info.

Transmission: via. body fluids (contaminated needs or sexual contact), and in to baby from mother Symptoms: similar to Hep. A Diagnosis: The virus has antigenic particles that elicit specific antibody markers during different stages of the disease Treatment: Medications for chronic hepatitis type B include alpha interferon and antiviral agents: lamividine (Epivir), adefovir (Hepsera) A major worldwide cause of cirrhosis and liver cancer