Gallstones and Cholecystitis

• Gallstones/Cholelithiasis patho involves cholesterol crystals aggregating into stones due to bile secretions becoming saturated with cholesterol, leading to bile stasis and slow secretion.
• Cholesterol gallstone formation occurs with spinal cord injuries, TPN, rapid weight loss, and pregnancy.
• Clinical manifestations of gallstones include severe RUQ pain, fever, and biliary colic, especially after eating high-fat food.
• Labs for gallstones show leukocytosis, increased bilirubin, and elevated ALT.
• Diagnosis of gallstones is via ultrasound, with risk factors being the "4 F’s": forty, fat, female, and fertile.
• Treatment for gallstones includes ERCP and lithotripsy.

Cholecystitis

• Cholecystitis is inflammation of the gallbladder wall and can be acute or chronic.
• Acute cholecystitis presents with elevated temperature, severe RUQ pain, and leukocytosis.
• Chronic cholecystitis is often asymptomatic.
• Diagnostic testing for cholecystitis includes MRI, CT, and ultrasound.
• Diet for cholecystitis should be low in fat, high in protein, avoid gas-forming foods, and exclude alcohol.
• After Endoscopic retrograde Cholangiopancreatography (ERCP), monitor for complications such as fever.
• Post-cholecystectomy, monitor and educate patients to call the surgeon if febrile, avoid fatty foods for 4-6 weeks, and walk to relieve gas pain from surgery.

Portal Hypertension and Liver Failure

• Portal hypertension patho involves GI congestion and enlargement of the portal vein.
• A complication of portal hypertension is advanced liver disease.
• Clinical manifestations of portal hypertension include ascites and esophageal varices.
• Clinical manifestations of liver failure are jaundice, hypoalbuminemia, and splenomegaly.
• Treatment/Interventions for liver disease include using mild soaps, monitoring Prothrombin Time (PT), and avoiding alcohol, Tylenol, and hepatotoxic substances.

Hepatitis A (HVA)

• Hepatitis A (HVA) is an RNA virus caused by lack of safe water and poor sanitation.
• The incubation period for HVA is 2-7 weeks.
• Lab results showing Anti-hepatitis virus A Immunoglobulin G (IgG) indicate immunity to HVA.

Hepatitis B (HBV)

• Hepatitis B (HBV) is a double-stranded DNA virus with an incubation period of 2 to 6 months.
• Risk factors for HBV include IV drug use and transmission via blood and body fluids.
• Clinical manifestations of HBV include anorexia, fever, jaundice, and serum sickness.
• HBV labs include:
  • Surface antigen (HBsAg): early/active and chronic infection
  • Surface antibody (HBsAb): resolution and immunity
  • Core antigen (HBcAg): appears first in active infection
  • Core antibody (HBcAb): seroconversion
  • Hepatitis B e-antigen (HBeAg): viral replication and infectivity
• Treatment/Interventions for HBV include avoiding hepatotoxic substances, no alcohol, a diet high in carbs and low in fat, and avoiding sexual activity until HBV testing is negative.

Hepatitis C (HVC)

• Hepatitis C (HVC) is a single-stranded RNA virus, with similar clinical manifestations to Hepatitis B.
• Chronic HVC can present with peripheral edema, ascites, and changes to mental status.
• Labs for HVC include HVC RNA and anti-HVC, indicating the presence of antibodies to the virus.
• Treatment for HVC involves antiviral medications, taken as prescribed.

Hepatitis E (HVE)

• Hepatitis E (HVE) is a fecal-oral virus from contaminated food/water, contracted by international travel.
• Clinical manifestations of HVE are similar to those of Hepatitis A.
• Education for HVE includes avoiding alcohol and Tylenol and practicing thorough handwashing to prevent spread.

Non-Viral Hepatitis

• Non-viral hepatitis includes Alcoholic Hepatitis and Nonalcoholic Steatohepatitis (NASH).
• Risk factors for Nonalcoholic Steatohepatitis (NASH) include diabetes type 1 and high cholesterol.
• Alcoholic Hepatitis is inflammation of the centrilobular region of the liver, causing liver cell necrosis.
• Clinical manifestations for both include Portal HTN, Encephalopathy, Fever, and Hepatomegaly.
• Treatment involves avoiding ETOH and hepatotoxic medications and using prednisolone, N-acetyl cysteine, and statin medications for cholesterol.
• Isoniazid is liver toxic.
• Treat symptoms with Zofran, Toradol, and docusate.