NRSG 326 Week 4 - Hepatitis

Functions of the liver

Albumin production, bile production, synthesizes proteins for plasma, cholesterol synthesis, conversion of glucose to glycogen and back, metabolism, conversion of ammonia to urea, clotting, fat-soluble vitamin storage

Hepatitis

Inflammation of the liver

Can be infectious (viral, bacterial, fungal or parasitic) or noninfectious

What percent of acute hepatitis cases are due to ABC

90%

Other viruses that can cause hepatitis (not ABCDE)

Cytomegalovirus, Epstein-Barr, herpes, coxsackie, rubella

Alcohol induced hepatitis

Syndrome

Chronic ETOH use damages hepatocytes and causes inflammation

Symptoms of Alcohol Induced Hepatitis

Hepatomegaly, RUQ pain, fever, jaundice, weakness, decreased appetite, increased liver enzymes, bilirubin, may have increased INR

Nonalcoholic fatty liver disease (NAFLD)

Spectrum of diseases ranging from mild inflammation to cirrhosis

Aka metabolic dysfunction associated steatoic liver disease

Increased risk with obesity, DM type 2 and age

Silent disease

Diagnostics for NAFLD

US, biopsy

AST (aspartate transaminase) indication

Inflammation of several organs

ALT (alanine transaminase) indications

Inflammation of liver

GGT (gamma glutamyl transpeptidase) indications

Gallbladder involvement

Indications of alkaline phosphatase

Nonspecific to liver

Can indicate liver involvement, or bones/kidneys (Paget's, bone ca)

Albumin

Protein which keeps plasma in our blood vessels

Synthesized by hepatocytes

Responsible for colloid osmotic pressure

Bilirubim

End product of heme catabolism, 80% derived from hemoglobin

Unconjugated bilirubin is conjugated and excreted in bile

Causes jaundice if not excreted

Prothrombin time (PT)

Measures Factor II, V, VII, X

Normal is 11-13

Anticoagulated up to x2

Critical value > 20

Increased = increased time to clot

International normalized ratio (INR)

Measures how fast clotting is

Normal is 0.8-1.2

Warfarin = 2.0-3.0

Mechanical heart valves = 3.0-4.0

Critical value > 5

Can reverse high INR with vitamin K or a transfusion of FFP

Hepatitis A transmission

Fecal oral

Can you have a chronic carrier state with hep A

No

Does getting hep A give you lifelong immunity?

Yes

Who qualifies for free hep A immunization in BC

Individuals who are immunocompromised, already have hep b or c, or those who live high risk lifestyles

Serology for no exposure to hep A

Anti-HAV IgM and IgG negative

Serology for resolved infection or immunized for hep A

Anti-HAV IgM negative, IgG positive

Serology for acute infection

Anti-HAV IgM positive and IgG positive

Transmission of hep B

Blood + body fluids

Immunization program for hep B

Dose 1, follow up 4 weeks and 6 mos

Vaccine effectiveness for hep B

95-100%

Does hep B have a chronic carrier state?

Yes

Develops for some not all

Higher chance in younger populations

Serology for no exposure to hep B

AG negative, AB negative

Serology for acute hep B infection

AG positive, AB positive

Serology for hep B immunity

AG negative, AB positive, total anti-HBc negative

Serology for hep b resolved infection

AG negative, AB negative, anti-HBc positive

Serology for chronic hep B infection

AG positive, AB positive, anti-HBc positive

Serology for no exposure to hep C

Anti HCV negative, HCV RNA negative

Serology for resolved hep C infection

Anti-HCV positive, HCV RNA negative

Serology for chronic hep C infection

Anti-HCV positive, HCV RNA positive

Transmission for hep C

Blood and body fluids

Need SC or percutaneous to develop (lower risk to have unprotected sex)

Does hep C have a vaccine?

No

Tx of chronic hep C

Antivirals, removal from chronic infection

Ex: sofosbuvir, daclatsavir and sofosbuvir/ledipasvir

People at risk for HCV

Drug users, incarcerated people, Indigenous people, immigrants, baby boomers, msm

Hep D transmission

Percutaneous, rarely STI

Hep E transmission

Oral fecal