Hepatitis Overview

bacteria, viruses, drugs, alcohol, or chemicals

Blood or body fluids, co-infected with Hep B

Obstructive jaundice/If there are no complications cells can regenerate and normal function can be restored.

Contaminated water, raw or undercooked pork or venison

good hand hygiene, avoid sharing personal hygiene items, avoid sharing needles, condoms for higher risk sex, vaccinations (Hep A and Hep B)  IG after exposure

Jaundice

Loss of liver function

Individuals born between 1945-1965/have been infected for as many as 20 years and did not know that they were infected.

'Obstructive jaundice'

Avoiding sharing personal hygiene items

Onset of flu-like symptoms/Also known as preicteric stage

Jaundice is present/the urine is usually dark and the liver is enlarged and tender in this stage

Convalescent stage/Full recovery depends on the type of Hepatitis  Depends on the compliance to the treatment regimen. The patient should not have any liver toxic substances for at least a year.

Liver toxic substances

Jaundice appears

high levels of billirubin or Obstruction of bile drainage is obstructed

Heme

Liver

Serological tests  Serum liver enzymes and serum bilirubin- may be elevated.  Prothrombin time (PT)- may be prolonged  Ammonia-May be elevated  Albumin- may be decreased  Abdominal x-ray  Liver biopsy 

Avoid coughing and heavy lifting for a week/Patient lies on right side for 2 hours  Vital signs monitored  Pressure applied to puncture site for 5 minutes

Liver failure/ treatment for hepatits a is Goal is to identify cause, monitor liver status, provide symptom relief, and prevent cirrhosis

Elevated serum bilirubin levels

'Increased bilirubin content'

Increased risk of bleeding

Palms of hands and soles of feet/Pale yellow to orange

Goal is to identify cause, monitor liver status, provide symptom relief, and prevent cirrhosis

To prevent liver cell death and scarring

Monitoring liver enzyme levels

After the development of cirrhosis

Acetaminophen overdose/ctivated charcoal can be given within 1 hour.  N-acetylcysteine is the antidote

By causing liver cell damage and inflammation

When liver dialysis is not effective

Checking elevated bilirubin levels

Administering lactulose and rifaxinim to decrease ammonia levels

Bleeding, The focus of treatment is to stop and reverse damage to the liver. The airway must be supported.  May be intubated  Elevate HOB  Bedrest  NPO  NG tube  Most medications will be stopped  Complete rest of the liver is the goal.  May also require liver dialysi

alcohol misuse is the most common cause in the US.  Hepatitis B and C infection

Avoiding excessive alcohol consumption

When the liver is unable to function properly due to advanced cirrhosis

Regular liver enzyme testing

Prescription of medications to manage symptoms

'Moderate' alcohol consumption is safe for the liver

'Detox' diets for 'liver cleansing'

Increased energy levels

Following a high-fat diet

Obstructed blood flow from liver scarring

Reduce accumulation of ascitic fluid

End-stage liver failure

Daily body weight measurements Ascites is when a large amount of fluid builds up in the abdominal cavity. Low production of albumin and portal hypertension attribute to this condition

Medications to decrease the ammonia level. Ex: Lactulose , Rifaxinim

-Hepatic encephalopathy is the result of increased levels of ammonia  Represents end-stage liver failureAsterixis (flapping tremors)

Increased risk of bleeding

Practicing good hand hygiene

Alanine aminotransferase (ALT)

Alcohol misuse and malnourishment complication of alcoholic liver disease. Occurs when patients experience a deficiency in thiamine

Wernicke encephalopathy- acute condition  Delirium, confusion, visual disturbances  Can be treated with oral or SQ thiamin/ Korasakoff’s psychosis-the result of damage to brain tissue.  Patients have memory and learning deficits that are our of proportion with the other cognitive functions.  Can be prevented but not reversed.

associated with alcohol misuse and gallbladder disease.  Other causes: Tumors, medications, idiopathic

3rd leading cause of cancer related deaths in U.S.  Spreads rapidly  Associated with: smoking, obesity, DM, exposure to chemicals, cirrhosis, chronic pancreatitis, H. pylori infection  African American males have the highest rate

Whipple procedure

Poor

early on no symptoms  Back or epigastric pain, anorexia, nausea, fatigue, malaise, weight loss  If bile duct is obstructed may have jaundice, dark urine, light-colored stools

Smoking cessation

Ensuring adequate hydration

Spread of cancer, gastric or duodenal obstruction; thrombophlebiti

Disseminated intravascular coagulation (DIC)

Avoiding excessive alcohol consumption/V fluids  Pain management: narcotic pain medication may be ordered.  H2 antagonistS  Patients may be kept NPO for 24 hours. Diet may then be started with clear liquid and progressed as tolerated.  NGT  Antibiotics  Electrolytes  Calcium  Insulin as needed  To prevent reoccurrences of this patients are encouraged to stop drinking or to seek treatment for gallbladder issues.

Serum amylase and lipase levels

Autodigestion of the pancreas by activated digestive enzymes/\Patients may experience complications from a secondary source. Cardiovascular, pulmonary, and renal failure are the most likely causes of life-threatening complications.  Disseminated intravascular coagulation (DIC)  Hemorrhage  Turner’s sign and Cullen’s sign.  Infection  Electrolyte imbalance

Managing pain through the administration of narcotic pain medicationH2 antagonists

Hemorrhage due to disseminated intravascular coagulation (DIC)

Avoiding excessive alcohol consumption and smoking

Addressing pain management/Prevention of infection and maintenance of electrolyte and fluid and electrolyte balance  If the patient has nausea and vomiting an antiemetic may be given.  For itching relief may be given Colestid or Questran.

WBC count

Insertion of T-tube drain

Necrosis of the gallbladder

Administration of antiemetics and Murphy’s sign  Ask the patient to take in and hold a deep breath while palpating the right subcostal area  The patient experiences pain/tenderness sufficient to cause an abrupt halt in inspiration

Repeated attacks of pain

HIDA scan

They can occur from aging, obesity, pregnancy, estrogen, stasis of bile, fasting, medication, and can have a familial tendency.  Inactive lifestyle and a diet excessive in cholesterol and fat contribute also.  Hemolytic blood disorders and bowel disorders (Crohn’s disease) are factors as well

Monitoring and lifestyle modifications/reatment for cholelithiasis usually involves cholecystectomy.  Diet after is very important!  Large stones may require an open procedure and placement of T-tube drain  Inserted into common duct to allow bile drainage  Large amount of drainage (500-1000mL) on the first day  Extracorporeal Shock-Wave Lithotripsy  Medication  Diet

Rupture of the gallbladder

Abdominal ultrasound

Cholecystectomy (surgical removal of the gallbladder)

All of the above

All of the above

inflammation of the gallbladder.  Can be acute or chronic  Acute cholecystitis  often the response to an obstruction of the common bile duct. When the bile is stagnant it can be invaded by bacteria. This leads to more inflammation and infection.  Can lead to rupture of the gallbladd

Chronic cholecystitis  Repeated attacks of cholecystitis can lead to the gallbladder becoming thick and hard.

Cholelithiasis if the formation of gallstones in the gallbladder.  can be associated with no symptoms for many years.  Choledocholithiasis refers to gallstones that are wedged in the common bile duct.

To guide symptom relief measures/inflammation of the gallbladder.  Can be acute or chronic

In cases of chronic cholecystitis

Epigastric pain, right upper quadrant pain, nausea, indigestion, intolerance of high fat foods, increased temperature, increased pulse, increased respirations, vomiting and jaundice.  Symptoms usually lasts 1 to 3 hours. If a stone is in the duct the pain may last until it is passed into the duodenum.  Obstruction of the common bile duct can cause clay-colored fatty stools  Absence of bilirubin and bile salts in the small intestine  Jaundice

Pain that is caused by cholesystitis usually lasts 4 to 6 hours. The pain is often made worse with movement.  The patient often has a low grade fever, nausea and vomiting.  Patients often have repeated attacks of this.  Murphy’s sign  Ask the patient to take in and hold a deep breath while palpating the right subcostal area  The patient experiences pain/tenderness sufficient to cause an abrupt halt in inspiration