liver and gallbladder

Hepatitis

• Definition: Inflammation of the liver.

Causes

• Viral infections (most common globally)

• Bacterial infections

• Drug/chemical exposure

Types of Hepatitis

• Hepatitis A & E:

• Transmission: Fecal-oral route (contaminated food, water, or close contact with infected individuals)

Risk Factors and Symptoms of hepatitis A&E

• Risk Factors:

  • Poor sanitation/hygiene

  • Consuming raw or undercooked shellfish

  • Travel to areas with poor sanitation

• Symptoms:

  • Acute illness with flu-like symptoms (fatigue, fever, nausea)

  • Jaundice (yellow skin/eyes), dark urine, clay-colored stools

  • Mild abdominal pain in the right upper quadrant (RUQ)

  • Pruritus (itching) due to bile salt buildup

Types of Hepatitis

Hepatitis B (HBV)

• Cause: Hepatitis B virus (HBV)

• Transmission: Blood & bodily fluids (e.g., sexual contact, IV drug use, mother-to-baby at birth)

• Risk Factors:

  • Unprotected sex, multiple sexual partners

  • Sharing needles (IV drug use)

  • Healthcare workers exposed to blood

  • Infants born to infected mothers

• Symptoms:

  • Many cases are asymptomatic

  • If symptomatic: Fatigue, nausea, vomiting, joint pain, jaundice

  • Chronic HBV: Liver fibrosis, cirrhosis, liver cancer

• Prevention:

  • Hepatitis B vaccine (given at birth, protects for life)

  • Safe sex practices, needle exchange programs

Hepatitis C (HCV)

• Transmission: Bloodborne (IV drug use, unsafe medical procedures, blood transfusions before 1992)

• Risk Factors:

  • IV drug use (most common route)

  • Blood transfusions before 1992 (before screening was implemented)

  • Organ transplants from infected donors

  • Tattooing or piercing with unsterile equipment

• Often asymptomatic for years (silent liver damage)

• Most common cause of liver cancer & liver transplants

• Prevention:

  • No vaccine available

  • Avoid sharing needles, practice safe sex, screen blood donations

• Treatment:

  • Antiviral medications (Direct-Acting Antivirals, or DAAs, can cure >95% of cases)

Hepatitis D (HDV)

• Cause: Hepatitis D virus (HDV)

• Transmission: Bloodborne & bodily fluids (same as HBV)

• Key Feature:

  • Only occurs in people who already have Hepatitis B (HBV)

  • Needs HBV to replicate

• Symptoms & Complications:

  • More severe liver disease than HBV alone

  • High risk of cirrhosis & liver failure

• Prevention:

  • No specific HDV vaccine, but Hepatitis B vaccine prevents HDV

Summary of Hepatitis Types

Type	Transmission	Chronic?	Vaccine?	Notes
A	Fecal-oral (food, water)	No	Yes	Self-limiting, acute only
B	Blood, bodily fluids	10% chronic	Yes	Can lead to cirrhosis, liver cancer
C	Bloodborne	75-85% chronic	No	Most common cause of liver cancer & transplants
D	Bloodborne (requires HBV)	Yes	No (HBV vaccine prevents it)	Makes Hepatitis B more severe
E	Fecal-oral (contaminated water, pork)	Rarely	No	Severe in pregnant women

Complications of hepatitis

• Liver inflammation → can regenerate if no complications.

• Bile duct involvement → Jaundice (yellow skin/eyes).

• Chronic liver failure in severe cases.

Symptoms of Hepatitis

• Right Upper Quadrant (RUQ) pain

• Malaise (general fatigue, feeling unwell)

• Pruritus (itching)

• Nausea, anorexia (loss of appetite)

• Jaundice, dark urine, pale stools

Progression of Acute Hepatitis

• Prodromal Phase (2 weeks post-exposure, before jaundice appears):

  • Early symptoms (fatigue, RUQ pain, malaise, nausea).

• Icteric Phase (Jaundice appears, 2-6 weeks):

  • Increased bile buildup, dark urine, pale stools, severe itching.

• Convalescent Phase (Recovery phase, up to 1 year):

  • Liver function normalizes.

Management of Hepatitis

• Avoid Acetaminophen (Tylenol) (hepatotoxic, worsens liver damage).

• Monitor liver enzymes (ALT, AST, ALP, bilirubin, prothrombin time).

• Manage symptoms:

  • Pain relief (without acetaminophen).

  • Antihistamines for itching.

  • Antiemetics for nausea.

• Supportive care:

  • Small, frequent meals, low-fat diet.

  • Avoid alcohol.

  • Rest and hydration.

• Antiviral therapy for Hepatitis C (cures the infection with minimal side effects).

• Prevent transmission:

  • Hand hygiene (A & E prevention).

  • Safe sex, no sharing needles (B, C, D prevention).

Liver Disease Management

• Monitor medications that are metabolized by the liver.

• Monitor for ascites (fluid accumulation in the abdomen):

  • Daily abdominal girth measurements.

• Dietary support:

  • Low-fat diet, high-protein for healing.

• Prevent transmission for viral hepatitis.

Gallbladder Disorders

Cholecystitis (Gallbladder Inflammation)

• Definition: Inflammation of the gallbladder, often due to cholelithiasis (gallstones).

• Causes:

  • Gallstones blocking bile duct.

  • Chronic inflammation (recurrent attacks).

  • Risk factors: Age, obesity, diabetes, pregnancy, hereditary factors.

• Symptoms:

  • RUQ pain (steady, aching, severe, radiates to back/right shoulder).

  • Triggered by fatty meals (pain lasts 1-3 hours).

  • Nausea, vomiting, bloating, gas, belching.

  • Murphy’s Sign: Pain on deep inspiration with RUQ palpation.

Diagnosis & Management

• Ultrasound (most common diagnostic test).

• Pain control (NSAIDs, avoid morphine as it can worsen symptoms).

• Prevent infection:

  • Monitor for fever, increased pulse, respiratory rate.

• Fluid & electrolyte management.

• Itching control for jaundice patients (bile salts on the skin).

• Low-fat diet (to reduce bile stimulation).

• Surgical removal (Cholecystectomy) if necessary.

Post-Surgical Care (Cholecystectomy)

• Monitor for drainage & infection.

• Encourage deep breathing & coughing (prevent pneumonia).

• Splinting abdomen for pain relief.

• Early ambulation to prevent complications.

• Diet:

  • Low-fat diet post-surgery.

  • High-protein for healing.

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