Hepatitis: Risk Factors & Complications

Hepatitis Risk Factors and Complications

• Hepatitis A: Risk factors include poor hygiene, diabetes, elderly age, low socioeconomic status, and injection drug use. Complications are typically acute liver failure, but it's usually self-limiting.
• Hepatitis B: Risk factors include unprotected sex, needle sharing, and mother-to-child transmission. Complications can be acute liver failure, chronic liver disease, glomerulonephritis, cirrhosis, liver cancer, and liver failure.
• Hepatitis C: Risk factors are unsterile medical equipment and sexual contact. Complications include chronic liver disease and glomerulonephritis.
• Hepatitis D: Risk factors include having Hepatitis B, unprotected sex, and mother-to-child transmission. Complications may be rapid and acute liver failure, and chronic liver disease.
• Hepatitis E: Risk factors are contaminated water, pregnancy, and undercooked meat. Complications include acute liver failure and it is typically self-limiting.

Viral vs. Non-Viral Hepatitis

• Viral Hepatitis (A, B, C, D, E): Contagious, with B, C, and D potentially becoming chronic; can lead to liver failure, infection, cirrhosis, and cancer.
• Non-Viral Hepatitis: Caused by alcohol, drugs, toxins, and autoimmune disorders; not contagious; recovery possible if cause is removed, but can lead to failure and cirrhosis.

Congenital Disorders: Manifestations, Risk Factors, and Complications

• Cleft Lip: Manifestations include a separated upper lip and difficulty feeding/sucking. Risk factors are genetic mutations, smoking, alcohol use, and low folate levels. Complications can include aspiration pneumonia, ear infections, and speech/breathing difficulties.
• Cleft Palate: Manifestations include an opening between the oral and nasal cavity and difficulty feeding. Risk factors are genetic mutations, smoking, alcohol use, and low folate levels. Complications include speech and feeding difficulties, ear infections, upper respiratory issues, and malnutrition.
• Esophageal Atresia: Manifestations include drooling, choking, cyanosis, and difficulty feeding. Risk factors are unknown but congenital-related. Complications can include aspiration pneumonia, reflux, dysphagia, and malnourishment.
• Pyloric Stenosis: Manifestations are projectile vomiting, an olive-like periumbilical mass, dehydration, and weight loss. Risk factors include being a white male aged 2-4 weeks postpartum. Complications include malnutrition, gastritis, and hypokalemia.

Risk Factors and Modifications for Gastrointestinal Conditions

• Hiatal Hernia: Risk factors include advanced age and smoking. Modifications include small meals six times a day, the high Fowler's position after meals, elevating the head 6 inches while sleeping, and antacids.
• Acute Gastritis: Risk factors include infections, alcohol, and certain medications. Modifications include avoiding irritants, temporary antacids, small frequent meals, and hydration.
• Chronic Gastritis: Risk factors include alcohol abuse, H. pylori infection, chronic NSAID overuse, and older age. Modifications include an anti-inflammatory diet, probiotics and prebiotics, stress management, and treatment of H. pylori, anemia, and autoimmune conditions.
• Peptic Ulcer Disease: Risk factors include being male, older age, NSAID use, H. pylori infection, gastric tumors, GERD, stress, smoking, and alcoholism. Modifications include surgery and prophylactic medications (acid-reducing agents).

Complications and Teaching/Avoidance Strategies

• Cirrhosis: Complications include hepatic encephalopathy, liver cancer, portal hypertension, jaundice, unpleasant breath, spider nevi, testicular atrophy, liver flap (hand tremor), edema, bleeding tendency, hemorrhoids, ascites, splenomegaly, BM changes, and esophageal varices. Avoid alcohol, drugs, and hepatotoxic medications. Fluid restriction and a low-sodium diet are recommended. Lactulose can be used, and hepatitis-related cirrhosis treated with antivirals and interferons.
• Diverticulitis/Diverticulosis: Complications include fatal obstruction, infection, abscess, perforation, peritonitis, hemorrhage, and shock. Increase fiber intake, avoid foods with seeds, decrease eating during active bleeding, hydrate, maintain proper bowel habits, and use stool softeners, antibiotics, and analgesics. Colon resection and blood transfusions may be necessary.
• GERD: Complications include esophagitis, strictures, ulcerations, esophageal cancer, and chronic pulmonary disease. Avoid triggers (spicy, fatty, acidic foods, alcohol, nicotine, caffeine), wear loose clothing around the waist, eat small frequent meals, lose weight, reduce stress, and elevate the head 6 inches while sleeping. Acid-reduction medications, mucosal barriers, herbal therapy, and surgery may be used.

Clinical Manifestations of Gastrointestinal Disorders

• Acute Pancreatitis: Upper abdominal pain radiating to the back, worsened after eating but relieved by pulling knees in or leaning forward, nausea/vomiting, mild jaundice, low-grade fever, BP/HR changes.
• Chronic Pancreatitis: Upper abdominal pain, indigestion, losing weight, steatorrhea, constipation, and flatulence.
• Crohn’s Disease: Insidious and slow-developing in adolescence, patchy areas of intestinal wall inflammation, thick and rigid wall (cobblestone appearance), granulomas, abdominal cramping in the RLQ, diarrhea, steatorrhea, constipation, palpable abdominal mass, anorexia, weight loss, and flu-like symptoms.
• Ulcerative Colitis: Diarrhea up to 20 times a day, inflammation along the large intestine/colon (continuous, not patchy), watery stools with blood and mucus, tenesmus, proctitis, abdominal cramping in the LLQ, nausea/vomiting, weight loss, and flu-like symptoms.
• Irritable Bowel Syndrome (IBS): Stress/mood disorders worsened by food and hormonal symptoms, abdominal distension, fullness, flatulence, bloating, intermittent abdominal pain exacerbated by eating and relieved by pooping, frequent constipation/diarrhea (may alternate), mucus stool, food intolerance, and anorexia.
• Inflammatory Bowel Disease (IBD): abdominal pain, Diarrhea, Fatigue, joint, skin, and eye issues.
• Diverticulitis: Abdominal cramping, passing frank blood, low fever, abdomen tender, abdomen distension and mass, constipation, obstipation, nausea, and leukocytosis.
• Cholelithiasis: Biliary colic, abdominal distension, nausea/vomiting, jaundice, fever, and leukocytosis.