Untitled Flashcards Set

Grades of Hepatic Encephalopathy

• Grade 0

  • Nearly asymptomatic, normal level of consciousness.

  • No detectable personality or behavior changes.

  • Minimal changes in memory and concentration (e.g., mildly forgetful or confused).

  • Minimal changes in intellectual function.

• Grade 1

  • Slight personality changes, mood swings (irritability, restlessness).

  • Short attention span, mild confusion.

  • Minimal changes in memory and concentration.

  • Muscular incoordination, impaired handwriting.

  • Sleep disorders (inverted sleep patterns).

  • Tremor; asterixis may be observed with clinical testing.

• Grade 2

  • Tremor progresses to asterixis (liver flap).

  • Resistance to passive movement.

  • Bilateral numbness/tingling.

  • Myoclonus; hypoactive deep tendon reflexes.

  • Apraxia, ataxia.

  • Slow or slurred speech.

  • Unusual behavior (abusive, violent, noisy).

  • Disorientation to time and place.

• Grade 3
  
  

  • Hyperventilation.

  • Marked confusion, amnesia.

  • Incoherent speech.

  • Muscle rigidity.

  • Hyperreactive deep tendon reflexes.

  • Positive Babinski sign.

  • Positive Oculocephalic reflex (doll’s eye).

  • Sleeps most of the time but can be aroused.

  • Disinhibited (inappropriate) behavior.

  • Dilated pupils.

• Grade 4

  • Comatose; unresponsive to verbal or noxious stimuli.

  • No asterixis.

  • Lack of response to stimuli.

  • Decerebrate posturing.

Viral Hepatitis

• Incubation period:

  • HAV: 15 to 50 days

  • HBV: 1 to 6 months

  • HCV: 1 week to 6 months

• HAV (Hepatitis A Virus)

  • Formerly known as infectious hepatitis

  • Transmitted by fecal-oral route

  • Primarily from poor or improper handwashing and hygiene

  • Shared use of oral utensils such as straws, silverwares, and toothbrushes

  • Commonly affects children, sexual activities with the same gender, people who live or travel in underdeveloped countries

  • Rarely transmitted through transfused blood

  • Highly contagious

  • Greatest danger of infection: incubation period, when a person is unaware that the virus is present

  • Illness can last from 4 to 8 weeks

  • Last longer and more severe in persons older than 50 years

• HBV (Hepatitis B Virus)

  • Transmitted percutaneously or mucosal contact

  • Highly infectious (100 times infectious than HIV)

  • Can be transmitted through heterosexual or homosexual intercourse (considered to be a sexually transmitted disease)

• HCV (Hepatitis C Virus)

  • Formerly posttransfusion non-A, non-B hepatitis

  • Most commonly associated with injection-drug use

  • Period of infectivity: before the onset of symptoms

  • May become a lifetime carrier of the virus

• HDV (Hepatitis D Virus)

  • "Delta virus"

  • Defective single-stranded RNA that presents as a coinfection or superinfection of HBV

  • Requires hepatitis B surface antigen (HBsAg) for its replication

  • Symptoms are similar to those who have HBV

• HEV (Hepatitis E Virus)

  • Previously known as enteric non-A, non-B hepatitis

  • Transmitted by contaminated water via fecal-oral route

  • Clinically resembles HAV

  • Travel-associated, acute, self-limiting liver disease

  • Occurs in poor socioeconomic conditions

• HGV (Hepatitis G Virus)

  • Accepted term: GBV-A and GBV-B

  • GBV-B:

    • Most prevalent in African countries

    • Identified as the causative agent of approximately 20% of posttransfusion hepatitis cases

Clinical Manifestations

• Most acute viral hepatitis are asymptomatic

• Classic symptoms:

  • Malaise

  • Fatigue

  • Mild fever

  • Nausea

  • Vomiting

  • Anorexia

  • Right upper quadrant discomfort

  • Diarrhea

  • Jaundice (except acute HCV)

  • Dark urine

  • Clay-colored stools

  • Extrahepatic manifestations

Medical Management

• Prevention (primary, secondary, tertiary)

• Primary: Education, practicing protective sex or avoiding sexual contact during the period of HBsAg

• Secondary: Passive immunization, travel precautions

• Tertiary: Education to those infected

• Diagnosis: Serology (standard)
  Cholelithiasis (Gallstone Disease)

  • Common: 20-35% of people by age 55

  • Types:

    • Cholesterol stones (80%)

    • Bilirubin salts (20%)

  • Risk Factors: Obesity, pregnancy, women > men

  • Symptoms:

    • Pain (RUQ, radiates to right shoulder/back)

    • Nausea, vomiting, belching, food intolerance

  • Complications:

    • Choledocholithiasis: gallstones in the common bile duct

    • Pancreatitis, cholangitis

  Cholecystitis

  • Inflammation of the gallbladder (gallstone obstruction)

  • Acute Cholecystitis: more common in older men

  Acute Cholangitis

  • Biliary tree infection

  • Stages:

    • Mild (Grade I): responds to therapy

    • Moderate (Grade II): needs further treatment

    • Severe (Grade III): organ dysfunction

  • Symptoms:

    • Charcot’s Triad: fever, jaundice, right upper quadrant pain

    • Reynold’s Pentad: Charcot’s Triad + hypotension, confusion

  Primary Sclerosing Cholangitis

  • Progressive bile duct destruction (intrahepatic & extrahepatic)

  • Common in ages 20-40, often asymptomatic

  • Symptoms: jaundice, itching, fatigue, anorexia, weight loss

  • Severe complications: Cirrhosis, portal hypertension

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  Key Takeaways

  • Liver diseases involve metabolic dysfunction, jaundice, and severe complications like cirrhosis, portal hypertension, hepatic encephalopathy.

  • Hepatitis can be viral, autoimmune, or drug-induced, with HAV, HBV, HCV being the most common.

  • Pancreatic diseases include pancreatitis, which is often alcohol- or gallstone-related.

  • Biliary diseases involve gallstones, cholecystitis, cholangitis, and progressive bile duct damage (sclerosing cholangitis).