Hepatitis and Hemochromatosis

Hepatic Disorders

• Hepatic disorders refer to diseases affecting the liver.

Hepatitis

• Hepatitis involves inflammation of the liver.
• Common causes of hepatitis include viral infections but alcohol, drugs, toxins, and autoimmune disorders can also cause hepatitis.

Phases of Hepatitis

• Preicteric (prodromal) phase lasts from the time of infection until the start of signs and symptoms, such as malaise, fever, nausea, and vomiting.
• Icteric phase occurs when jaundice sets in; urine can darken due to increased bilirubin, and cholestasis may develop.
• Posticteric phase is known as the recovery phase, where jaundice resolves and the liver begins to repair itself.

Types of Hepatitis

• Acute Hepatitis occurs in the initial period after infection, with clinically similar symptoms for all viral types.
• Chronic Hepatitis lasts longer than six months.
  • Can be caused by hepatitis B, C, and D viruses.
  • It can also be caused by alcohol, hepatotoxic substances like carbon tetrachloride, drug-induced factors, and some hereditary conditions.

Types of Hepatitis Viruses

• Hepatitis A is an RNA virus of the enterovirus family, transmitted via the fecal-oral route with an incubation period of 2-6 weeks, and an average of 28 days.
  • HAV (Havrix, Vaqta) vaccines exist
  • People living with infected individuals, sex partners of infected people, and travelers going to countries where HAV is common are at risk.
  • Anti-HAV is detected in serum to confirm the diagnosis.
  • Treatment includes Hepatitis A IG immediately after exposure and supportive care after diagnosis.
  • The disease usually resolves on its own and has no known chronic carrier state.
• Hepatitis B is a serum hepatitis, double-shelled DNA virus with core and surface antigens, transmitted via blood and body fluids.
  • The average incubation period is 30-180 days
    • HBV is 100 times more infectious than HIV and 10 times more infectious than HCV.
  • Serum testing and vaccines exist
  • Health care workers, inmates, sexually active individuals, hemodialysis patients, and babies born to infected mothers are at risk.
  • Diagnostic signs and symptoms include anorexia, nausea, jaundice, fatigue, and more.
  • Testing of mothers with HBsAg and vaccination of all newborns is also critical.
  • Treatments include HBIG and HBV vaccines.
• Hepatitis C is an RNA virus, most often spread through blood and plasma.
  • The incubation period is 15-160 days, with chronic infection occurring in about 85% of cases.
  • This can lead to cirrhosis, liver failure, and liver cancer without vaccines exist.
  • IV drug users, those with tattoos, and people who receive blood products are potential risk groups.
  • People who are affected have developed Anti-HCV antibodies in serum.
  • Treatment consists of interferon, pegylated interferon, and Ribavirin in combination; accounts for half of liver transplants.
• Hepatitis D is an RNA virus that requires the helper function of HBV to infect and replicate and is spread similarly to HBV.
  • The incubation period is 30-150 days, with chronic hepatitis usually developing.
  • Prevention involves preventing HBV.
  • Testing looks for Anti-HDV antibodies.
  • HBIG can be a treatment
• Hepatitis E is an RNA virus transmitted via the fecal-oral route. Common in Asia, Middle East, Africa, and Central and South America.
  • The incubation period averages 15-65 days.
  • There's uncertain effectiveness to the vaccine.
  • People traveling where HEV is endemic are at risk.
  • Diagnostic testing includes identifying Anti-HEV in serum.
  • After exposure, IG is warranted but supportive care is more important after diagnosis.
• Hepatitis F could be a variant of the HBV.
• Hepatitis G is a Non-A, non-E hepatitis RNA flavivirus-like agent, transmitted by blood and plasma.
  • The incubation period is unknown
  • Chronic infection can occur.
  • There is no vaccine and concentrate on standard precautions.

Nursing Care for Hepatitis

• Standard precautions must be followed at all times.
• Educate patients about handwashing, safe food handling, and sexual intercourse.
• In cases of illness, ensure adequate rest, limit fat and protein in the diet, offer small frequent meals, and increase antioxidants.

Alcoholic Hepatitis

• Alcoholic Hepatitis is inflammation of the liver caused by alcohol.
• Treatment is about teaching the use of corticosteroids and prescribing antibiotics to combat permeability and antioxidant supplements.

Toxic & Drug-Induced Hepatitis

• Toxic & Drug-Induced Hepatitis is inflammation of the liver caused by toxic substances and medications.
• Toxic substances include carbon tetrachloride, medications including isoniazid, methyldopa, amiodarone, and MAOIs.

Fulminant Hepatic Failure

• Fulminant Hepatic Failure is a clinical syndrome of sudden and severely impaired liver function.
  • It causes progression to encephalopathy and cerebral edema, and blood brain barrier disruption
• Categories are classified on the duration of the jaundice before onset of more impactful symptoms.

Hereditary Diseases of the Liver

• This is a condition when either liver function or structure are atypical due to genetics.

Wilson's Disease

• This is an autosomal recessive disorder related to copper metabolism.
• Manifestations include tremors, rigidity, changes in behavior, and Kayser-Fleischer rings in the eyes.
• Complications include bone fractures, infection, and impaired kidney function.
• Tests include checking ceruloplasmin and liver biopsies.
• Treatments include foods that are low in copper as well as copper-binding drugs.

Hemochromatosis

• Hemochromatosis involves excessive accumulation of iron in the organs.
• This causes symptoms like fatigue, decreased libido, skin changes, etc as well as medical issues like cirrhosis and cardiac damage.
• It can be detected via checking serum ferritin and liver biopsies.
• Treatments include decreasing iron.

Liver Cirrhosis

• Liver Cirrhosis is a chronic and progressive condition characterized by destroying liver cells leading to scar tissue that reconfigures healthy liver tissue.
  • Major types are categorized as alcoholic, postnecrotic, biliary, or cardiac.
  • Esophageal Varices also occur.

Complications of Cirrhosis

• Ascites is a complication of cirrhosis and involves accumulation of fluid in the peritoneal cavity.
  • It happens because congestion within the liver means plasma leaks into the peritoneum.
  • This makes the pressure in the liver vasculature increases, causing venous congestion.
  • It also can lead to Spontaneous Bacterial Peritonitis (SBP), which is when the ascitic fluid becomes infected with bacteria in the absence of a known reason
  • Treatments range from restrictions on fluid and sodium intake.
  • Patients have a reduced albumin production, high ammonia levels, etc as a complication.
  • Paracentesis and a LeVeen Shunt are treatment options.
• Portal Hypertension involving the pressure within the liver.
  • Surgical treatments of the area include methods to decompress and reroute the blood.
  • There also includes the Transjugular and Sclerotherapy procedure.
• Hepatic Encephalopathy is related to the development of Portal-Systemic Encephalopathy.
  • It causes a neurological condition, which also leads to hepatic coma.
  • Tests for this include checking for Asterixis or “liver flaps” on the wrists.
  • Treatment options include using lactulose and antibiotics to reduce ammonia.

Fatty Liver (Hepatic Steatosis)

• This is a condition known as excessive lipids.
• Major types of fat cells that cause this are Cholesterol, and Triglycerides
• Chronic Alcohol Ingestion increases liver diseases

Clinical Manifestations of Fatty Liver

• Macrovesicular fatty livers exhibit fat droplets, while microvesicular has smaller droplets.
• Symptoms can range from general fatigue to being hypoglycemia and an excess of other problems.

Hepatic Abscesses

• It is an area of infection in the liver caused by bacteria, amoeba, or protozoa.
• Some predisposing factors can be traced to other disorders that involve inflammation.
• Mycobacterium Tuberculosis and Amoebic Dysentery can also cause this.
• Treatments include antibiotic therapy, anti-infection, and drainage.

Liver Transplantation

• The first successful human liver transplantation was performed in 1967 by Dr. Thomas Starzl at the University of Colorado. This groundbreaking procedure marked a significant advancement in organ transplantation, providing hope for patients with end-stage liver disease.
• There are both living and cadaveric donors, each contributing to organ transplantation in unique ways and contexts.
• Candidates will have to be prioritized if their life expectancy is under 7 days.
• There are a few disqualifications for the procedures including failure to follow standard precautions and medical advice post procedure.
• Acute Graft Rejection is a serious complication that can arise following an organ transplantation. Key symptoms include not only pain or nausea but also fever, swelling at the transplant site, and decreased organ function.
• There are numerous pharmaceuticals available for the treatment of fatty liver disease, each with varying mechanisms of action designed to address the underlying issues of hepatic steatosis. For instance, some medications work by enhancing lipid metabolism, while others aim to reduce inflammation within the liver. However, a key concern to consider is the potential side effects associated with these medications. Side effects can range from mild and transient symptoms, such as gastrointestinal disturbances or fatigue, to more severe reactions, including liver toxicity or allergic responses. These adverse effects can significantly impact patient compliance, leading to decreased adherence to treatment regimens and ultimately affecting overall health outcomes. It is crucial for healthcare providers to monitor patients carefully and adjust medications as necessary to mitigate these risks.

Questions about the causes, phases, and characteristics of hepatitis viruses, including Hepatitis A, B, C, D, and E. Questions also cover hemochromatosis, including its manifestations, diagnostic tests, and treatment.