Liver Diseases: Hepatitis, Cirrhosis, and HCC

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Questions and Answers

Which broad category of hepatic injury directly contributes to the formation of esophageal varices?

  • Cirrhosis
  • Ascites
  • Hepatic encephalopathy
  • Portal hypertension (correct)

Which of the following conditions is characterized by the irreversible replacement of normal liver tissue with non-functional scar tissue?

  • Portal hypertension
  • Hepatitis
  • Steatosis
  • Cirrhosis (correct)

What is the most common cause of cirrhosis?

  • Hepatitis B
  • Alcoholic hepatitis (correct)
  • Metabolic dysfunction associated steatotic liver disease
  • Hepatitis C

Which of the following complications of cirrhosis directly leads to an increased risk of bleeding due to platelets getting trapped in the spleen?

<p>Splenomegaly (A)</p> Signup and view all the answers

What is the underlying cause of caput medusae in patients with cirrhosis?

<p>Portal hypertension (C)</p> Signup and view all the answers

What is the primary goal of treatment for alcoholic hepatitis?

<p>Eliminating alcohol consumption (D)</p> Signup and view all the answers

Which type of viral hepatitis is most likely to lead to chronic hepatitis?

<p>Hepatitis C (D)</p> Signup and view all the answers

Which of the following is a rare, but recognized, sign and symptom of Hepatitis A?

<p>Arthropathy (A)</p> Signup and view all the answers

In the context of Hepatitis B infection, what does a positive Hepatitis B Surface Antigen (HBsAg) test indicate?

<p>Acute or chronic infection with Hepatitis B (B)</p> Signup and view all the answers

A patient with known cirrhosis presents with jaundice, ascites, and hepatic encephalopathy. Which of the following conditions is most likely contributing to these clinical signs?

<p>Portal hypertension (B)</p> Signup and view all the answers

Which of the following best describes the underlying process of cirrhosis?

<p>Irreversible replacement of normal liver tissue with scar tissue. (A)</p> Signup and view all the answers

Which of the following is a common complication of cirrhosis that can lead to cognitive impairment and altered levels of consciousness?

<p>Hepatic encephalopathy (B)</p> Signup and view all the answers

A patient with cirrhosis develops ascites. Which physiological mechanism directly contributes to the formation of ascites in this condition?

<p>Portal hypertension (A)</p> Signup and view all the answers

What laboratory findings would be most indicative of cirrhosis?

<p>Elevated liver enzymes (AST, ALT), elevated bilirubin, decreased albumin. (C)</p> Signup and view all the answers

Which of the following signs and symptoms is associated with portal hypertension in cirrhosis?

<p>Ascites (C)</p> Signup and view all the answers

Which of the following signs and symptoms is more related to declining liver function?

<p>Jaundice (B)</p> Signup and view all the answers

What is the likely underlying cause of spider telangiectasia (spider angiomas) seen in patients with cirrhosis?

<p>Elevation in vascular endothelial growth factor and altered estrogen/testosterone ratio. (C)</p> Signup and view all the answers

What is the primary treatment strategy for alcoholic hepatitis?

<p>Eliminating alcohol consumption (B)</p> Signup and view all the answers

A male patient with cirrhosis exhibits gynecomastia, testicular atrophy, and thinning of armpit hair. What hormonal imbalance is most likely contributing to these findings?

<p>Increased estrogen, decreased testosterone. (C)</p> Signup and view all the answers

Why is digital clubbing seen in some patients with cirrhosis?

<p>Pathogenesis is unclear. (C)</p> Signup and view all the answers

What is the role of diuretics in managing cirrhosis?

<p>Reduce fluid accumulation. (D)</p> Signup and view all the answers

Which of the following is the most direct consequence of portal hypertension?

<p>Abnormally high BP in the branches of the portal vein. (A)</p> Signup and view all the answers

What underlying condition most commonly leads to portal hypertension?

<p>Cirrhosis. (B)</p> Signup and view all the answers

If portal hypertension is left untreated, what can it lead to?

<p>Esophageal varices. (D)</p> Signup and view all the answers

What is the primary aim of using medications like beta-blockers in the treatment of portal hypertension?

<p>Reduce portal blood pressure. (B)</p> Signup and view all the answers

What is the underlying mechanism behind the formation of esophageal varices?

<p>Retrograde flow into the lower esophageal vessels causes distention and eventually leads to varices (D)</p> Signup and view all the answers

A patient diagnosed with esophageal varices is prescribed beta-blockers. What is the intended therapeutic effect of this medication in this context?

<p>To reduce blood pressure (C)</p> Signup and view all the answers

What is the most immediate life-threatening risk associated with esophageal varices?

<p>Mild to fatal hematemesis (A)</p> Signup and view all the answers

How does increased BP in the portal vein lead to hepatic encephalopathy?

<p>Bypasses the liver causing a build up of toxins (D)</p> Signup and view all the answers

Which substance, when elevated in the bloodstream due to liver dysfunction, directly contributes to the development of hepatic encephalopathy?

<p>Ammonia (C)</p> Signup and view all the answers

What are early signs of hepatic encephalopathy?

<p>Subtle changes in logical thinking. (C)</p> Signup and view all the answers

What dietary modification is typically recommended in the treatment of hepatic encephalopathy to reduce ammonia production?

<p>Reduce protein intake (C)</p> Signup and view all the answers

A patient with hepatic encephalopathy is prescribed lactulose. What is the mechanism of action of lactulose in treating this condition?

<p>Reducing blood ammonia (D)</p> Signup and view all the answers

What causes Jaundice?

<p>Excess amounts of bilirubin circulating in the blood stream. (D)</p> Signup and view all the answers

In which scenario does bilirubin filtered from the blood cannot drain properly into the bile ducts or digestive tract to be passed out of the body

<p>Posthepatic jaundice (B)</p> Signup and view all the answers

What is fulminant hepatitis?

<p>Rare, life-threatening complication of acute hepatitis. (C)</p> Signup and view all the answers

What type(s) of hepatitis can progress to fulminant hepatitis if it's of that/those strains?

<p>Hepatitis B, D or E (D)</p> Signup and view all the answers

Which of the following describes Hepatitis?

<p>Inflammation of the liver (C)</p> Signup and view all the answers

Hepatitis A is primarily transmitted through which route:

<p>Fecal-oral (A)</p> Signup and view all the answers

Which of the following statements is true regarding hepatitis A?

<p>No carrier state (C)</p> Signup and view all the answers

Which hepatitis is transmitted via blood and body fluids?

<p>Hepatitis B (A)</p> Signup and view all the answers

Which of the following is used for diagnosis of Hepatitis B?

<p>Hepatitis B Surface Antigen Test (HBsAg) (A)</p> Signup and view all the answers

What preventative measure is most effective in reducing the risk of hepatitis B infection?

<p>Vaccination (A)</p> Signup and view all the answers

What is true of individuals who are 'healthy carriers' of hepatitis B?

<p>Surface antigen present months, years, or sometimes for life but otherwise healthy and unaware of status (A)</p> Signup and view all the answers

How is Hepatitis C transmitted?

<p>Blood (D)</p> Signup and view all the answers

Which factor increases the likelihood of developing hepatitis C?

<p>Needle sharing (C)</p> Signup and view all the answers

A patient is diagnosed with Hepatitis D. What other hepatitis virus must this patient also have?

<p>B (C)</p> Signup and view all the answers

What is the primary mode of transmission for hepatitis E?

<p>Fecal-oral (D)</p> Signup and view all the answers

Which patient population faces the greatest risk of severe complications from hepatitis E?

<p>Pregnant women (A)</p> Signup and view all the answers

What is the gold standard for treatment of Hepatitis?

<p>Typically, no treatment is needed (D)</p> Signup and view all the answers

What is a common symptom of alcoholic hepatitis?

<p>Tender hepatomegaly (D)</p> Signup and view all the answers

How is chronic hepatitis defined?

<p>Inflammation of the liver lasting longer than 6 months. (B)</p> Signup and view all the answers

Which of the following viruses is most commonly responsible for chronic hepatitis?

<p>Hepatitis C (A)</p> Signup and view all the answers

How does MASH develop?

<p>Initially hepatocyte ballooning, lobular inflammation, and steatosis (D)</p> Signup and view all the answers

What are the main treatments for MASH?

<p>Losing weight, medication to reduce cholesterol or triglycerides (C)</p> Signup and view all the answers

What is a sign and symptom of HCC?

<p>Early signs: abdominal pain, fever, weight loss, and palpable mass in RUQ (B)</p> Signup and view all the answers

Which of the following represents the typical prognosis for an individual diagnosed with cirrhosis who does not undergo a liver transplant?

<p>The patient usually dies within 5 to 15 years due to complications. (C)</p> Signup and view all the answers

Which laboratory finding is commonly associated with cirrhosis due to the decreased functionality of the liver?

<p>Elevated bilirubin and decreased albumin levels. (A)</p> Signup and view all the answers

Which of the following is the most accurate description of portal hypertension?

<p>Abnormally high BP in the branches of the portal vein. (A)</p> Signup and view all the answers

What is a key element in the pathogenesis of caput medusae in individuals with portal hypertension?

<p>Development of collateral venous pathways due to increased portal pressure. (C)</p> Signup and view all the answers

Which of the following is a serious risk factor that is a consequence of esophageal varices?

<p>Life-threatening hemorrhage. (C)</p> Signup and view all the answers

What is the primary component in the pathogenesis of hepatic encephalopathy?

<p>Accumulation of toxic substances in the brain due to impaired liver function. (C)</p> Signup and view all the answers

Which dietary adjustment is most appropriate to minimizing the effects of hepatic encephalopathy?

<p>Reduction in protein intake to decrease ammonia production. (C)</p> Signup and view all the answers

Which assessment finding is indicative of jaundice?

<p>Yellowish discoloration of the sclera and skin. (A)</p> Signup and view all the answers

When considering the etiology of jaundice, which scenario represents a posthepatic cause?

<p>Obstruction of the bile ducts preventing bilirubin excretion. (D)</p> Signup and view all the answers

What characteristics define fulminant hepatitis, distinguishing it from other forms of hepatitis?

<p>Sudden, massive liver necrosis with encephalopathy. (A)</p> Signup and view all the answers

Which acute viral hepatitis types can progress to fulminant hepatitis?

<p>Hepatitis B, D, and E (D)</p> Signup and view all the answers

Which is a description of Hepatitis?

<p>Inflammation of the liver that can result from a variety of causes, such as viral infections, heavy alcohol use, autoimmune disorders, drugs, or toxins. (B)</p> Signup and view all the answers

Hepatitis A is usually transmitted into a new host through which route?

<p>Fecal-oral (C)</p> Signup and view all the answers

A characteristic to Hepatitis A is:

<p>Often linked to contamination of water supply (D)</p> Signup and view all the answers

Which of the following is true regarding hepatitis B's mode of transmission?

<p>Transmitted via blood and body fluids. (C)</p> Signup and view all the answers

When diagnosing Hepatitis B, what factor would be analyzed?

<p>Blood Analysis (D)</p> Signup and view all the answers

What action best reduces the risk of contracting hepatitis B?

<p>Vaccination. (A)</p> Signup and view all the answers

What may occur in 'healthy carriers' of hepatitis B?

<p>They can transmit the virus to others without showing symptoms themselves. (A)</p> Signup and view all the answers

How is hepatitis C typically transmitted?

<p>By sharing needles (C)</p> Signup and view all the answers

Which activity significantly elevates the risk of contracting hepatitis C?

<p>Sharing needles for drug use. (C)</p> Signup and view all the answers

What action is needed to contract Hepatitis D?

<p>You need to have an existing Hepatitis B infection (A)</p> Signup and view all the answers

What is the primary mechanism of Hepatitis E transmission?

<p>Fecal-oral (D)</p> Signup and view all the answers

Which group demonstrates a risk of developing a severe from of Hepatitis E?

<p>Pregnant women (D)</p> Signup and view all the answers

When is massage contraindicated for acute viral hepatitis?

<p>If the patient has a fever. (D)</p> Signup and view all the answers

Which process is most crucial for treating acute viral hepatitis?

<p>Typically no treatment is required (D)</p> Signup and view all the answers

What is the recommended course of action with hepatitis A, B, and/or E?

<p>Usually no specific Tx necessary (A)</p> Signup and view all the answers

Can hep B, D, and/or E require specific treatments to fully overcome the hepatitis strain?

<p>Yes, antivirals treatments are available and necessary (D)</p> Signup and view all the answers

What is the recommended amount of drinks to consume per week?

<p>2 Drinks a week (C)</p> Signup and view all the answers

A typical sign and symptom associated with alcoholic hepatitis is:

<p>Jaundice (C)</p> Signup and view all the answers

What is the most effective treatment for Alcoholic Hepatitis?

<p>Alcohol cessation (C)</p> Signup and view all the answers

How long does inflammation typically last for a person to characterized as having 'Chronic Hepatitis'?

<p>Inflammation of the liver lasting longer than 6 months (D)</p> Signup and view all the answers

What are common causes of chronic conditions?

<p>All of the above (D)</p> Signup and view all the answers

Select a sign and symptom that can arise as a result of chronic hepatitis:

<p>Brain deterioration (C)</p> Signup and view all the answers

What is the first step a doctor will do when they suspect a chronic Hepatitis?

<p>May suspect hepatitis in people who present with typical SSx, abnormal blood LFT, or Hx of hepatitis. (D)</p> Signup and view all the answers

What can be effective when treating a chronic Hepatitis infection?

<p>All of the above are effective (D)</p> Signup and view all the answers

What percentage typically turns into cirrhosis from MASH?

<p>10-20% (D)</p> Signup and view all the answers

What is the main route for treating MASH in the population?

<p>Medication to control diabetes (C)</p> Signup and view all the answers

What vague sign may indicate Hepatocellular Carcinoma (HCC)?

<p>Usually presents with vague signs of abdominal pain, fatigue, loss of weight and appetite (B)</p> Signup and view all the answers

Which factor primarily dictates the appropriateness of massage for a patient with cirrhosis?

<p>The patient's overall comfort and current symptoms. (B)</p> Signup and view all the answers

In the progression of liver disease, what directly precedes the development of cirrhosis in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)?

<p>MASH. (D)</p> Signup and view all the answers

What is the MOST likely consequence if esophageal varices remain untreated?

<p>Massive hematemesis. (B)</p> Signup and view all the answers

What aspect needs to be considered when you may apply massage to someone with esophageal varices?

<p>Some cases may be a medical emergency. (B)</p> Signup and view all the answers

Digital clubbing is sometimes seen in patients with cirrhosis. Existing research suggests it involves increased vascular endothelial growth factor and fibroblast growth factor or an altered estrogen/testosterone ratio, but the underlying mechanisms is:

<p>Unclear. (A)</p> Signup and view all the answers

How long does liver inflammation has to last in order for it to be categorized as 'Chronic Hepatitis'?

<p>6 months. (C)</p> Signup and view all the answers

Which of the following is LEAST likely to be associated with portal hypertension?

<p>Elevated hepatic enzyme levels. (B)</p> Signup and view all the answers

Which of the following is TRUE regarding treatment for acute viral hepatitis?

<p>Antiviral treatments are available for hep C and hep D. (B)</p> Signup and view all the answers

If a person has co-infection of hep B with D, what would that indicate?

<p>Co-infection of hep B with D increases severity. (C)</p> Signup and view all the answers

What is the MOST important aspect of treatment for alcoholic hepatitis?

<p>Complete cessation of alcohol consumption. (B)</p> Signup and view all the answers

Which of the following is accurate of a chronic viral hepatitis patient?

<p>Certain hepatitis viral strains will cause gradually worsening Signs and Symptoms. (D)</p> Signup and view all the answers

What is pathologically found in alcoholic hepatitis?

<p>Steatosis. (A)</p> Signup and view all the answers

Which population faces the greatest risk of complication from hepatitis E?

<p>Pregnant women. (C)</p> Signup and view all the answers

Early in the infection stage, what are the typical Symptoms associated with Hepatitis B?

<p>Low-grade fever, N/V, anorexia, myalgia, weakness. (C)</p> Signup and view all the answers

Which of the following chronic conditions will have the greatest risk of cirrhosis?

<p>Hep C. (C)</p> Signup and view all the answers

Compared to Hepatitis B, how is Hepatitis C transmitted?

<p>Hepatitis C doesn't easily spread through body secretion. (C)</p> Signup and view all the answers

Which of the following infections requires a previous infection in order to acquire it?

<p>Hepatitis D. (C)</p> Signup and view all the answers

How should any abdominal massages be performed if a patient has portal hypertension?

<p>It should be performed with very light pressure (B)</p> Signup and view all the answers

Which of the following signs or symptoms is more typically associated with symptoms related to portal hypertension, rather than declining liver function?

<p>Caput medusae. (A)</p> Signup and view all the answers

What signs shows the progression from non-alcoholic fatty liver disease (NAFLD) to NASH to cirrhosis?

<p>Isolated fatty liver --&gt; Non-alcoholic steatohepatitis (NASH) --&gt; Cirrhosis (A)</p> Signup and view all the answers

What is a key characteristic differentiating simple hepatic steatosis (NAFLD) from MASH?

<p>Hepatocyte ballooning and lobular inflammation. (D)</p> Signup and view all the answers

Which of the following best describes the 'two-hit' model in the pathophysiology of MASH?

<p>Hepatic fat accumulation and increased oxidative stress. (D)</p> Signup and view all the answers

A patient with MASH is MOST likely to exhibit clinical findings related to which co-existing condition?

<p>Atherosclerotic disease/diabetes (A)</p> Signup and view all the answers

What percentage of MASH cases progress to cirrhosis?

<p>10-20% (D)</p> Signup and view all the answers

Which of the following is a primary treatment strategy for Metabolic dysfunction-associated steatohepatitis (MASH)?

<p>Managing cholesterol, blood pressure, and diabetes (B)</p> Signup and view all the answers

How does the initial presentation of hepatocellular carcinoma (HCC) typically manifest?

<p>Vague signs of abdominal pain, fatigue, loss of weight and appetite. (D)</p> Signup and view all the answers

What is the MOST effective preventative measure for hepatocellular carcinoma (HCC)?

<p>Hepatitis B vaccination (C)</p> Signup and view all the answers

Which chronic hepatitis infections require annual screening for liver cancer?

<p>Hepatitis B (D)</p> Signup and view all the answers

What histological finding is characteristic of alcoholic hepatitis?

<p>Fatty liver (steatosis). (B)</p> Signup and view all the answers

In patients with cirrhosis, what is the primary rationale for implementing a low sodium diet?

<p>To minimize ascites formation (D)</p> Signup and view all the answers

For hepatitis treatment, which approach addresses the underlying triggers of Hepatic Encephalopathy?

<p>Reduction of protein intake (B)</p> Signup and view all the answers

Which symptom suggests the transition between MASH and progressing to cirrhosis?

<p>Overt hepatic failure (A)</p> Signup and view all the answers

Which factor influences appropriateness of massage with viral hepatitis?

<p>The patient's symptoms (A)</p> Signup and view all the answers

As for general concerns with viral hepatitis, what is the length required to pass without fever for a better massage condition?

<p>24 hours (C)</p> Signup and view all the answers

What lifestyle choice would most need consideration by a therapist prior to treating a client?

<p>Alcohol usage (C)</p> Signup and view all the answers

How can you categorize appropriate usage time frame with alcohol consumption

<p>less than 3 drinks per week (D)</p> Signup and view all the answers

How long must liver inflammation last to be considered chronic hepatitis?

<p>6 months (D)</p> Signup and view all the answers

What is required when someone has chronic Hepatitis B?

<p>Annual Screening (D)</p> Signup and view all the answers

A patient presents with fatty liver, hepatocyte ballooning, and lobular inflammation. Which condition is most likely?

<p>Metabolic Dysfunction-Associated Steatohepatitis (MASH) (B)</p> Signup and view all the answers

When administering abdominal massage, what aspect MOST needs attention? (Assume patient safety has already been addressed)

<p>Amount of force (B)</p> Signup and view all the answers

What indicates an important symptom of the icteric phase of Hepatitis B infection?

<p>Jaundice and hepatomegaly (B)</p> Signup and view all the answers

Which Hepatitis strain is MOST likely to develop into a chronic condition?

<p>Hepatitis C (C)</p> Signup and view all the answers

What is the MAIN treatment option for patients that have already contracted Hepatitis C

<p>Antiviral Treatment (B)</p> Signup and view all the answers

What statement regarding portal hypertension needs to take into account in order to massage?

<p>Abdominal massage should be performed with very light pressure (B)</p> Signup and view all the answers

Ascites, jaundice, and splenomegaly are primarily associated with which broad category of hepatic injury?

<p>Portal hypertension (D)</p> Signup and view all the answers

A patient with known cirrhosis develops dark urine, fatigue, and greasy, foul-smelling stools (steatorrhea). What is the MOST likely underlying cause of these symptoms?

<p>Reduction in bile production (C)</p> Signup and view all the answers

Which symptom is MOST likely related to portal hypertension rather than declining liver function, and should be considered before massaging?

<p>Ascites (A)</p> Signup and view all the answers

Small yellow nodules especially around the eyes, or xanthelasma, are associated specifically with:

<p>Portal Hypertension (D)</p> Signup and view all the answers

Which sign is commonly associated in Hep B but can also appear in Hep C infections?

<p>Urticaria (C)</p> Signup and view all the answers

Following the convalescent stage where viral antigens disappear and immune antibodies appear, which description would be MOST accurate?

<p>Resolution of signs and symptoms (D)</p> Signup and view all the answers

What is the leading cause of liver disease within US borders?

<p>Steatosis (A)</p> Signup and view all the answers

Which Hepatitis strains have a vaccine present in the market and are commonly recommended for those with high risk?

<p>Hep A and B (A)</p> Signup and view all the answers

Which symptoms are apparent during acute stage?

<p>Low appetite (D)</p> Signup and view all the answers

Alcohol hepatitis is MOST associated with damage to which site?

<p>Hepatocytes (D)</p> Signup and view all the answers

In relationship with other risk factors, the highest chance for people to develop chronic condition has

<p>High Alcohol intake and cirrhosis (C)</p> Signup and view all the answers

What is MOST likely required in order to resolve an alcoholic hepatitis infection overall?

<p>Complete resolve from alcohol (A)</p> Signup and view all the answers

In what region within the body is pain MOST likely if problems with Gallbladder function arise?

<p>Right Upper Quandrant (C)</p> Signup and view all the answers

When testing, which choice can the doctor order to find out the severity of your hepatitis?

<p>liver Biopsy (C)</p> Signup and view all the answers

When determining whether any Hep A,B,C,D,E will turn into a chronic condition, how much does Genetic makeup effect the decision? (Low, Somewhat, High, Does not contribute)

<p>Somewhat (C)</p> Signup and view all the answers

Which of the following Hepatitis strains require the co-infection of Hep B, in order?

<p>Hep D (D)</p> Signup and view all the answers

What description can help indicate for fulminant hepatitis?

<p>Rapid onset of liver failure (B)</p> Signup and view all the answers

Due to its transmission route, which population should exercise extra caution regarding the risk of hepatitis E?

<p>Pregnant Women (A)</p> Signup and view all the answers

Which of the following describes the progression that leads to cirrhosis as a result of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)?

<p>The liver initially experiences hepatocyte ballooning, lobular inflammation, and steatosis, progressing to fibrosis and eventually resulting in cirrhosis. (B)</p> Signup and view all the answers

What is the MOST likely underlying cause for the presence of ascites, jaundice, and splenomegaly in a patient?

<p>Portal Hypertension (C)</p> Signup and view all the answers

What is a key characteristic to Hepatitis A?

<p>Will not go beyond 6 months (A)</p> Signup and view all the answers

What is the primary rationale for recommending a low-sodium diet to individuals with cirrhosis?

<p>To manage ascites (C)</p> Signup and view all the answers

In the context of acute viral hepatitis, which of the following statements is TRUE regarding vaccination?

<p>Vaccines are available for hepatitis A and B viruses, and these can reduce the risk of hepatitis D. (D)</p> Signup and view all the answers

Which factor increases the risk of alcoholic hepatitis?

<p>Gender differences increases female prevalence (A)</p> Signup and view all the answers

For a client with cirrhosis, what assessment details would be MOST important to gather before providing massage therapy?

<p>Whether the client has experienced any recent changes in cognitive function or confusion. (D)</p> Signup and view all the answers

What is the primary characteristic of hepatic encephalopathy?

<p>Impaired brain function (D)</p> Signup and view all the answers

A patient is suspected of having chronic hepatitis. What action would be MOST definitive in DIAGNOSING the conditions?

<p>Lab work helps to determine severity and identify the cause, but biopsy is essential for definitive dx. (D)</p> Signup and view all the answers

Following the progression of Hepatitis B infection, which description would be considered MOST accurate during the convalescent phase?

<p>Viral Antigen will disappear and immune Antibodies will appear (B)</p> Signup and view all the answers

Which statement regarding portal hypertension must a massage therapist consider when working on a client?

<p>Abdominal massage if done MUST be of very light pressure (A)</p> Signup and view all the answers

What is the major symptom that may result in the transition of MASLD to Cirrhosis?

<p>Enlarged abdomen (C)</p> Signup and view all the answers

What is the typical means of getting Hepatitis A?

<p>Fecal-oral (D)</p> Signup and view all the answers

During the icteric phase of hepatitis B infection, what would a patient exhibit?

<p>Elevated level of bilirubin (C)</p> Signup and view all the answers

How many standard drinks per week is considered to be too much alcohol consumption, per the information given?

<p>3 (A)</p> Signup and view all the answers

What is a common EARLY sign and symptom associated with alcoholic hepatitis?

<p>Yellowing of the skin and eyes (B)</p> Signup and view all the answers

What is a characteristic associated with hepatitis C?

<p>Initial infection is usually mild and without symptoms (A)</p> Signup and view all the answers

What is a key aspect to keep in mind regarding viral hepatitis and massage therapy?

<p>Always proceed with caution dependent on client's symptoms (D)</p> Signup and view all the answers

What sign(s) and symptom(s) are more related to a decline in liver function?

<p>Dark urine (C)</p> Signup and view all the answers

Which factor has the HIGHEST association in developing a chronic condition.

<p>Hepatitis virus and the overuse of certain drugs (C)</p> Signup and view all the answers

Which of the following factors is the MOST important determining factor when applying massage to a patient?

<p>Knowing their overall comfort levels (C)</p> Signup and view all the answers

When considering Hepatitis B, what does a blood test for Hepatitis B Surface antigen (HBsAg) indicate?

<p>Its presence indicates acute or chronic infection of varying levels. (B)</p> Signup and view all the answers

While diagnosing the severity of fulminant hepatitis, which symptom(s) can you expect?

<p>Rare and life-threatening (C)</p> Signup and view all the answers

What is occurring when a patient is affected by jaundice?

<p>Excess amounts of bilirubin (D)</p> Signup and view all the answers

When a patient is suspected of having portal hypertension, which sign or symptom would be displayed?

<p>Enlarged Abdomen (D)</p> Signup and view all the answers

If a patient has Esophageal Varices, which of the following points is MOST important to consider?

<p>Can be dangerous and some cases of Esophageal Varices may be a medical emergency (B)</p> Signup and view all the answers

What is a known method of action required to contract Hep D?

<p>Requires a previous infection of Hep B to facilitate (C)</p> Signup and view all the answers

Which is a recommendation for acute viral hepatitis?

<p>Avoid alcohol and medications metabolized in the liver (A)</p> Signup and view all the answers

When approaching a case of MASLD, what should the doctor be looking for primarily?

<p>If there are high levels of steatosis present, in the absence of significant alcohol consumption (C)</p> Signup and view all the answers

What sign or symptom is MOST likely related to portal hypertension, rather than declining liver function?

<p>Jaundice (C)</p> Signup and view all the answers

While dealing with Hep C infections, what is the percentage of chronic infections that occur as a result

<p>75% (A)</p> Signup and view all the answers

In treating Alcoholic Hepatitis, what is MOST important?

<p>Stop Alcohol consumption (A)</p> Signup and view all the answers

When testing to determine the source of a Hepatitis virus, what can the doctor order?

<p>LFT (liver tests) (D)</p> Signup and view all the answers

From a massage therapist's perspective, what should be initially discussed with a client that mentions their alcohol intake is high?

<p>Lifestyle and habits (A)</p> Signup and view all the answers

For individuals with chronic hepatitis, which action is recommended to screen for liver cancer?

<p>Annual blood work and ultrasound, if they are Hep B positive. (D)</p> Signup and view all the answers

When dealing with a Hep B with Hep D infection, what does that typically mean?

<p>Increases the infection severity. (B)</p> Signup and view all the answers

How does the transmission of Hepatitis C primarily occur?

<p>Through needle sharing and blood transfusion (B)</p> Signup and view all the answers

In patients with cirrhosis, what is a primary comfort measure to be taken during a session?

<p>Avoid high-pressure massage (C)</p> Signup and view all the answers

What pathophysiological process underlies the development of ascites in patients with cirrhosis?

<p>Reduced oncotic pressure due to decreased albumin synthesis (B)</p> Signup and view all the answers

Which diagnostic finding is MOST indicative of the progression from steatosis to steatohepatitis in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)?

<p>Presence of hepatocyte ballooning and inflammation on liver biopsy (B)</p> Signup and view all the answers

Which of the following explains why a patient with cirrhosis may develop splenomegaly?

<p>Portal hypertension causing blood to back up into the splenic vein (B)</p> Signup and view all the answers

How does the pathophysiology of MASH increase the risk of hepatocellular carcinoma (HCC)?

<p>Chronic inflammation and fibrosis in MASH create a pro-cancerous environment. (A)</p> Signup and view all the answers

What is the underlying rationale for the use of lactulose in the management of hepatic encephalopathy?

<p>To promote the excretion of ammonia from the body (A)</p> Signup and view all the answers

Which of the following best describes the 'two-hit' hypothesis in the context of Metabolic dysfunction-associated steatohepatitis (MASH)?

<p>The combination of hepatic fat accumulation followed by oxidative stress and inflammation. (B)</p> Signup and view all the answers

Why is it important for individuals with chronic hepatitis B to undergo regular screening for hepatocellular carcinoma (HCC)?

<p>Chronic hepatitis B increases the risk of HCC development due to ongoing liver damage. (A)</p> Signup and view all the answers

In the context of cirrhosis, which complication is most directly associated with a risk of life-threatening hemorrhage?

<p>Esophageal varices (A)</p> Signup and view all the answers

What is the rationale behind recommending a low-sodium diet to patients with cirrhosis and ascites?

<p>To decrease fluid retention and ascites formation (B)</p> Signup and view all the answers

Which of the following histological findings is MOST suggestive of alcoholic hepatitis?

<p>Mallory bodies and neutrophil infiltration (B)</p> Signup and view all the answers

If a patient has Hepatitis B and Hepatitis D, what is the primary concern?

<p>Increased mortality (C)</p> Signup and view all the answers

For a patient with cirrhosis, what massage considerations should a massage therapist be aware of?

<p>All the above (C)</p> Signup and view all the answers

Which of these options are required to contract Hepatitis D?

<p>All the above (A)</p> Signup and view all the answers

What typically happens after someone has Hepatitis A?

<p>There is no carrier stated and doesn't result in chronic hepatitis (B)</p> Signup and view all the answers

A client in their early 30s has been a heavy drinker for many years. They're now experiencing early symptoms of liver dysfunction. This client is MOST likely dealing with which disease?

<p>Alcoholic Hepatitis (A)</p> Signup and view all the answers

For most people with acute viral hepatitis, what is the typical treatment plan?

<p>Usually no specific treatment. (D)</p> Signup and view all the answers

What happens if a person continues to drink alcohol when diagnosed with Alcoholic Hepatitis?

<p>All the above (D)</p> Signup and view all the answers

Following the convalescent stage of hepatitis B, what happens to a person's blood?

<p>Viral Ag disappear and immune Ab appear (D)</p> Signup and view all the answers

Which of the following is a risk factor for contracting Hepatitis C?

<p>Needle sharing (B)</p> Signup and view all the answers

A patient presents with fatty liver, hepatocyte ballooning and lobular inflammation. Which condition corresponds with these symptoms?

<p>Alcoholic Hepatitis (C)</p> Signup and view all the answers

Flashcards

Cirrhosis

Irreversible replacement of normal liver tissue with non-functional scar tissue.

Portal hypertension

Abnormally high blood pressure in the branches of the portal vein, often leading to complications.

Esophageal varices

Engorged, tortuous varicose vessels in the lower esophagus that often appears secondary to cirrhosis.

Hepatic encephalopathy

Deterioration of brain function due to toxic substances normally removed by the liver reaching the brain.

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Jaundice

Excess amounts of bilirubin circulating in the blood stream, causing a yellowish appearance of the skin and eyes.

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Hepatitis

Inflammation of the liver that can result from a variety of causes.

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Alcoholic hepatitis

Liver inflammation due to excessive alcohol consumption over an extended period.

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Chronic Hepatitis

Inflammation of the liver lasting longer than 6 months, often caused by hepatitis B and C.

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MASLD

Steatosis (fatty build up)in the absence of significant alcohol use.

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Hepatocellular Carcinoma (HCC)

Most common primary liver tumor, usually caused by cirrhosis.

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Cirrhosis Definition

Replacement of normal liver tissue with non-functional scar tissue.

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Portal Hypertension Definition

A condition where blood pressure is abnormally high in the portal vein system.

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Esophageal Varices Definition

Distended, fragile vessels in the lower esophagus due to portal hypertension.

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Hepatic Encephalopathy Definition

Decline in brain function due to toxins accumulating in the blood, that the liver would normally remove.

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Jaundice Definition

Yellowing of the skin and eyes due to excess bilirubin.

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Hepatitis Definition

Inflammation of the liver, often from viral infections, toxins or alcohol.

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Alcoholic Hepatitis Definition

Liver inflammation caused by long-term, heavy alcohol consumption.

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Chronic Hepatitis Definition

Persistent liver inflammation for over 6 months.

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MASLD Definition

Fatty liver disease not caused by alcohol.

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Hepatocellular Carcinoma Definition

Primary liver cancer, frequently linked to cirrhosis.

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Hepatocellular Carcinoma

Cancer that originates in the liver cells.

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Hepatocellular Carcinoma

Cancer of the hepa/liver cells.

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Hepatocellular Carcinoma

Cancer that is primary in liver cells.

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Alcoholic Hepatitis (Etiology)

Etiology of cirrhosis due to excessive alcohol consumption, causing liver inflammation and damage.

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Hepatic Injury

A broad category of liver diseases marked by abnormal conditions caused by liver damage.

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Cirrhosis and Bile

A complication that leads to decreased vitamin D absorption, potentially causing osteoporosis.

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Cirrhosis Epidemiology

Twice as common in males; 5% population reveal cirrhosis after autopsy. 25,000 deaths yearly.

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Cirrhosis Prognosis

Without a transplant, patients usually die within 5 to 15 years due to related complications.

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Cirrhosis Symptoms: Declining Liver

Symptoms of cirrhosis arise due to declining liver function often involving greasy stool, dark urine, edema, and malabsorption.

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Cirrhosis: Xanthomas

Yellow nodules, especially around the eyes, in cirrhosis.

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Cirrhosis: Other Signs

Palmar erythema, gynecomastia, testicular atrophy, and thinning of armpit hair.

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Dupuytren's Contracture

A complication in cirrhosis involving a contracture due to fibrosis of the palmar aponeurosis.

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Cirrhosis Diagnosis

Diagnosis of cirrhosis often involves liver palpation, imaging, and blood tests to assess liver function.

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Cirrhosis Treatment

Crucial, especially in alcoholic hepatitis, along including dietary changes, medications, and supplements.

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Portal Hypertension Symptoms

The increased BP causes abdominal dissension, confusion, and internal bleeding.

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Portal Hypertension Etiology

Cirrhosis is a common cause, leading to decreased blood flow through the liver, as well as thrombosis, infections, and malignancy.

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Esophageal Varices Symptoms

Medical emergency involving bloody stools or vomit from esophageal varices.

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HE Signs and Symptoms

Early signs include confusion, changes in judgement, later signs/sx include disorientation, asterixis, and sluggish movements/speech.

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Hepatic Encephalopathy: Diagnosis

Detect HE via brain scans electroencephalogram and blood tests for liver function and ammonia.

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Hepatic Encephalopathy: Treatment

Focus on alleviating underlying triggers, reducing protein intake, and treating with lactulose.

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Acute Viral Hepatitis SSx

Yellow fever; nausea and appetite loss; right upper quadrant pain; are signs and symptoms of acute viral Hepatitis

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Hepatitis Treatment Comparison

No specific treament for Hep A, B, or E; antiviral treatment for C and D; Vax for A, B, and D.

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Hepatitis Acute Cycles

Ranges between 40 to one/ two months, but can last up to six months with resolution.

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Hep C spread

No vaccine currently available; blood to blood via the sharing of drug equipment.

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Hepatitis serious infection

Rare complication of acute hepatitis, marked by liver necrosis, also called fulminant Hepatitis

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Fatty Liver Treatment

Only effective treatment is alcohol cessation w/recovery programs, plus liver transplant.

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Appropriateness of Massage

Determining of massage is determined by patient symptoms regarding all types of liver based disorders.

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Study Notes

Diseases of the Liver

  • Lecture outline covers Hepatitis, MASLD (previously NAFLD), Cirrhosis, and Hepatocellular Carcinoma (HCC).
  • Liver failure has been added to the list.
  • Dr. Kevin Tipper, ND

Major Liver Diseases

  • Conditions include various forms of hepatitis, metabolic dysfunction-associated steatotic liver disease, hepatocellular carcinoma and liver failure.

Broad Categories of Hepatic Injury

  • Liver damage can lead to cirrhosis, portal hypertension, esophageal varices, and hepatic encephalopathy.
  • Complications arise from liver disease due to these secondary complications.

Cirrhosis: Definition

  • Cirrhosis involves irreversible replacement of normal liver tissue with non-functional scar tissue.
  • This damage is typically irreversible.

Cirrhosis: Etiology

  • The most common cause is alcoholic hepatitis with liver inflammation due to alcohol consumption.
  • Caused by viral hepatitis specifically Hep B and Hep C.
  • It is also caused by metabolic dysfunction-associated steatotic liver disease (MASLD).

Cirrhosis: Epidemiology

  • Cirrhosis is twice as common in males.
  • Autopsies in the US show that 5% of the population has cirrhosis.
  • Causes 25,000 deaths per year in US.

Cirrhosis: Prognosis

  • Without a transplant, patients usually die within 5 to 15 years after diagnosis.
  • Death is usually due to complications of cirrhosis.

Cirrhosis: Complications

  • Portal hypertension may lead to esophageal and rectal varices, ascites, kidney failure, and hepatic encephalopathy.
  • Decreased bile production leads to decreased vitamin D absorption and possibly osteoporosis.
  • Poor vitamin K absorption can lead to a tendency for bleeding.
  • Splenomegaly can lead to platelets being trapped in spleen, which causes bleeding that can lead to anemia.

Cirrhosis: Signs and Symptoms

  • Many patients may have no symptoms for several years.
  • Symptoms can be related to declining liver function or portal hypertension
  • Common symptoms include weakness, malaise, fatigue, weight loss, ascites, and loss of appetite.
  • Declining liver function leads to reduced bile production, resulting in decreased absorption of fat and fat-soluble vitamins, and can cause greasy stool, fatigue, appetite loss, dark urine, generalized edema, and malabsorption.
  • Portal hypertension symptoms include jaundice, ascites, hepatomegaly, splenomegaly, digital clubbing, caput medusae, spider telangiectasia, and small yellow nodules around the eyes.

Cirrhosis: Spider Talangiectasia

  • Pathogenesis in cirrhosis is unclear, but possibly results from elevation in vascular endothelial growth factor, fibroblast growth factor, or an altered estrogen/testosterone ratio.

Cirrhosis: Digital Clubbing

  • Pathogenesis is unclear, but is indicated by an elevated vascular endothelial growth factor or fibroblast growth factor, or an altered estrogen/testosterone.

Cirrhosis: Caput Medusae

  • Swollen veins around the umbilicus happen due to portal hypertension.

Cirrhosis: Xanthelasma

  • Xanthelasma is a benign yellow growth by the corners of the eyelids
  • It includes cholesterol deposits under the skin to form mass.
  • Pathogenesis: Dyslipidemia, altered lipoprotein profiles, altered fat metabolism, and association with metabolic disease.

Cirrhosis: Other Symptoms

  • Sarcopenia, muscle atrophy, palmar erythema, gynecomastia, testicular atrophy, thinning of armpit hair, and Dupuytren's contracture can occur.

Cirrhosis: Dupuytren's Contracture

  • Dupuytren's contracture is fibrosis of the palmar aponeurosis.
  • Exact mechanisms linking cirrhosis and Dupuytren's contracture are not fully understood.

Cirrhosis: Diagnosis

  • Diagnosis is based on history, symptoms, physical exam, and blood tests
  • Liver feels nodular and firm during palpation.
  • Requires advanced imaging like ultrasound or CT scan.
  • Biopsy may be done to confirm.
  • Blood tests will show elevated liver function tests, elevated bilirubin, decreased albumin, and signs of anemia.
  • Blood work may be done to find cause like Hep B and C serology.

Cirrhosis: Treatment

  • Eliminating alcohol is crucial, especially if the patient has alcoholic hepatitis.
  • Improving diet and activity are important if caused by metabolic disease.
  • Reviewing medications (Rx and OTC) and supplements with a GP.
  • Diuretics and a low-sodium diet can help.
  • Liver transplant if 80-90% of liver is destroyed.

Cirrhosis: Massage

  • Cirrhosis has no contraindications.
  • Consider using less pressure to avoid easy bruising.
  • Consider the patient's overall comfort.

Portal Hypertension: Definition

  • Abnormally high blood pressure in the branches of the portal vein is portal hypertension.
  • Portal hypertension can cause an enlarged abdomen, abdominal discomfort, confusion, and internal bleeding.
  • Most common cause is cirrhosis.

Portal Hypertension: Etiology

  • Cirrhosis leads to scarring and decreased blood flow through the liver.
  • Thrombosis in portal veins can be a cause
  • Less common etiologies are parasitic infection called schistosomiasis and malignancy.

Portal Hypertension: Signs and Symptoms

  • Portal hypertension itself does not cause symptoms, but creates consequences that do.
  • Ascites, telangiectasia, caput medusae, esophageal varices with potential mass hematemesis, and splenomegaly can occur.
  • Hepatic encephalopathy may cause drowsiness, confusion, and coma.
  • Leads to can lead to gastrointestinal bleeding.

Portal Hypertension: Diagnosis

  • Based on symptoms, history, and physical exam
  • Confirmed with an ultrasound.

Portal Hypertension: Treatment

  • Most cases are irreversible.
  • Medications include beta blockers to reduce portal blood pressure.
  • Managing complications include emergency treatments such as surgery to reduce bleeds and a bypass shunt between the portal venous system and general circulation.

Portal Hypertension: Massage

  • No contraindications
  • Any abdominal massage should be performed with light pressure.
  • Consider using less pressure to avoid easy bruising and consider the patient's overall comfort.

Esophageal Varices: Definition

  • Esophageal varices are engorged, tortuous, and fragile varicose vessels of the lower esophagus.

Esophageal Varices: Etiology

  • Portal hypertension is a cause
  • Retrograde flow into the lower esophageal vessels causes distention and leads to varices.

Esophageal Varices: Symptoms and Treatment

  • Presents with mild to fatal hematemesis, black and tarry stool due to blood loss, and lightheadedness.
  • Treatment includes betablockers to reduce blood pressure, banding off or injecting veins, vasopressin via I.V., transfusion to replace loss and it is a medical emergency.

Esophageal Varices: Massage

  • Esophageal varices is a possible contraindication.
  • It depends on severity of esophageal varices.
  • Some cases may be a medical emergency.

Hepatic Encephalopathy: Definition

  • Deterioration of brain function due to buildup of toxic substances normally removed by liver reaching the brain is known as.
  • Ammonia, end product of normal protein breakdown, plays a large role.

Hepatic Encephalopathy: Etiology

  • Portal hypertension can cause increased blood pressure in the portal vein, which lets blood bypass the liver.
  • Liver failure is a cause
  • Can be triggered by an alcohol binge, drug intake, or other liver stressors in individuals with longstanding liver disorders.

Hepatic Encephalopathy: Signs and Symptoms

  • Decreased brain function, reduced alertness, and increased confusion occur
  • In early stages subtle changes in logical thinking, judgement, mood, personality ,and behavior occur.
  • In late stages, drowsiness, confusion, disorientation, asterixis, sluggish movements and speech are indicated.
  • Uncommon symptoms: agitation, seizures.
  • Eventual loss of consciousness and coma may develop.

Hepatic Encephalopathy: Diagnosis

  • Based on symptoms, history, and physical exam.
  • CT scan and EEG (electroencephalogram) can be used.
  • Blood tests for liver function and presence of ammonia are typical.

Hepatic Encephalopathy: Treatment & Prognosis

  • Treatment involves identifying and eliminating triggers
  • Reducing protein intake and other dietary restrictions are part of treatment
  • Lactulose sugar in diet helps reduce blood ammonia.
  • Liver treatment may be required
  • Prognosis: Reversible with complete recovery possible, though chronic liver failure predisposes one to future episodes. Ongoing therapy is typically needed. Fatal in > 50% of cases or acute hepatic encephalopathy, and 80% of people who fall into coma.

Jaundice: Definiton

  • Yellowish appearance of the skin and whites of the eyes due to excess bilirubin circulating in the blood dissolving into subcutaneous fat

Jaundice: Etiology

  • Prehepatic: Conditions impacting the blood’s rate of breakdown affect breaking down blood cells cause bilirubin to overflow into bodily tissues. For example, sickle cell anemia and thalassemia can be causes
  • Intrahepatic: In Intrahepatic cases, the liver tissue becomes becomes not as effective, which makes it hard to correctly filter out bilirubin. Examples: hepatitis, cirrhosis, hepatocellular carcinoma
  • Posthepatic: The bilirubin filtered from the blood fails to drain correctly, unable to enter digestive tracts and bile ducts. Examples: cholelithiasis, pancreatitis, pancreatic cancer

Jaundice: SIgns and Symptoms

  • Yellow skin, sclera, and color inside the mouth
  • Urine is dark or brown in color
  • Clay and pale colored stools
  • Itching and Irritation is common with jaundice

Jaundice: Massage

  • Treatment indicated by cause, severity.

Hepatitis

  • Inflammation of the liver from a variety of causes such as viral infections, heavy alcohol use, autoimmune disorders, drugs, or toxins.
  • Types include viral and alcoholic.
  • Alcohol consumption include over consumption of EtOH
  • Both can lead to chronic hepatitis and liver inflammation.

Active Viral Hepatitis

  • Liver infection due to one of the five hepatitis viruses A-E.
  • Hepatitis A is the most common cause.
  • Has a rapid onset with short duration
  • Symptoms range from none to severe
  • Includes N/V, poor appetite, fever, RUQ pain, and jaundice.

Comparing Types of Hepatitis

  • Nonspecific treatment for A B and E, watch and wait.
  • Specific Antiviral treatment for C and D
  • Hepatitis C becomes chronic
  • Hepatitis D can only be acquired through already having hep B
  • Vaccines for A,B and D are available
  • China's vaccines are neither offered in the U.S or Canada

Progressions of Viral Hepatitis

  • Mild severity is the cause of A and C, Sometimes Unnoticed.
  • Hep B ad E may become more severe
  • Coinfections of B with D significantly increases the severity

Hepatitis Comparison

Feature Hep A Hep B Hep C Hep D Hep E
Route Fecal-Oral Blood, body fluids Blood Blood Fecal-Oral
Incubation 2-6 weeks 40-180 days
Chronic No Yes (5-7%) Yes (75%) Yes (increases chance if chronic B) No
Carrier No Yes
Vaccine Yes Yes No No (only with Hep B vaccine) No
Severity Mild Mild-severe Moderate
Acute Symptoms Common cause Joint pain, urticaria in 10-20% of cases Less likely

Common Viral Hepatitis Symptoms

  • Has a sudden onset, typically N/V, fever.
  • Splenomegaly also possible
  • Symptoms of B infections include joint pain along with urticaria

Progressive Symptoms

  • As symptoms disappear, other symptoms may remain for approximately a month.
  • May cause cholestasis and pale stool
  • Progression is rare, although it may occur in Hep B infections

Viral Hepatitis: Diagnosis

  • Positive symptoms may allude to common forms
  • RUQ, tenderness/Hepatomegaly in nearly 50% of all active cases
  • DDX from EtOH tests may influence Viral infections

Viral Hepatitis: Prevention

  • Vaccines available for A and B
  • Without B, D infections can not be present
  • Washing hands
  • No sharing
  • Safe sex

Viral Hepatitis: Prognosis

  • Typically treatment is not needed
  • No need for dietary restrictions or vitamin supplementation
  • Avoid Alcohol and Medications during liver function
  • Normal ADL is possible until signs of jaundice goes away, even if LFT not done
  • Typical clearing of A in 4-8 weeks

Hepatitis A: Transmission & Details

  • Poor food hygiene in food handlers, childcare workers
  • Shellfish contaminated in water
  • Changes in Diapers, often in childcare centers
  • Often contaminates through water, and can also spread through blood

Hepatitis A: Epidemiology

  • Rare in Canada
  • Between 2011-2015 there were approximately 236 cases of Hep. A
  • Typically found in ages 30-59
  • Possible in Sub-Saharan, South Asia, and North Africa

Hepatitis A: Symptoms and Prognosis

  • Incubation last 2-6 weeks
  • Can be ignored due to infections being unnoticed
  • Fever, vomiting/nausea
  • Symptoms are rare, but arth, renal failure and pancreatitis
  • Recovery period consists of a few months
  • No long-term symptoms

Hepatitis A: Prevention:

  • Proper hand hygiene
  • Avoid contaminating water
  • Recommending TwinRix vaccinations

Hepatitis B: Transmission

  • Transmission Through blood and bodily fluids
  • Through blood
  • Sexually
  • Sharing needles
  • Birth (Child birth vaginal or caesarean)

Hepatitis B: Epidemiology:

  • Approximately 178 cases of acute infections in Canada
  • More common with S.America, Asia and Africa

Hepatitis B: Signs & Symptoms

  • Requires 40-180 days to incubate
  • Similar ranges with symptoms, from mild to severe
  • Choluria also common
  • Possibility of joint pain and or Urticaria
  • Serious Infections result in potential infection with Hepatitis D

Hepatitis B: Diagnosis

  • Involves confirm blood tests
  • Presence of antigen for HBsAg may indicate results

Hepatitis B: Treatment

  • Most can resolve themself
  • Between 5%-7% of neonates will continue symptoms
  • A strong rate correlated with younger age

Hepatitis B: Carriers

  • Approximately 10% have antigen present
  • Those previously infected can be potential
  • 70% with long term disease not being well

Hepatitis B: Phases

  • Pre - Icteric (Days to weeks) = Mild fever, Vomiting,Anorexia, Muscle Pain
  • Icteric : (1-2 Months)= May cause Jaundice,Hepatomegaly or tenderness
  • Convalescent : may indicate a decline after many months

Hepatitis B: Prevention

  • Recommended to those under 18
  • Avoid sharing needles, always engage in safe sex and receive B immunoglobulin

Hepatitis C : Transmission

  • Through blood primarily, usually sharing needles
  • Uncommonly due to screens
  • Pregnancy and Sex rarely
  • For unknown reasons with those with Liver Disease, Hep.C is possible

Hepatitis C :Signs and Symptoms

  • Symptoms appear unpredictably
  • Usually indistinguishable from HBV but are less serve

Hepatitis C: Prognosis

  • 75% result after chronic hepatitis
  • Mild for decades
  • Lead to Steaosis, CA, and Cirrhosis
  • Small fraction in a long- term carrier state

Hepatitis C: Prevention

  • No vaccines currently available
  • Avoid dangerous habits primarily through sharing needles

Hepatitis D/E

  • D infections can only show if B infections occurs
  • Cause symptoms even death, but is severe
  • Requires Fecal Oral Transmission, but commonly dangerous for those that are pregnant

Fulminant Hepatitis:

  • A potential compilation after acute Hepatitis
  • Can occur if the Hepatitis type is B,D, or E
  • Often includes Edema, Encephalopathy GI Bleeds and Kid Failure
  • In some instances the B,D, or E strain can progress and be life-threatening

Hepatitis: Massage

  • Use only if symptoms indicate little to mild, other contraindicate.
  • Must have 24 hours fever free before a therapy without the use of antipyretics

Alcoholic Hepatitis: Definition

  • Liver inflammation due to long- term alcohol consumption

Alcoholic Hepatitis: Details

  • Alcohol is an irritant and may negatively effect the liver - if it doesn't heal it may have negative implications
  • Female individuals are at a higher risk

Heavy Drinking Limits.

  • 1 drink is 14g of Alcohol
  • It is indicated that you should consume < 3 drinks a week

Alcoholic Hepatitis: Epidemiology

  • Normally in the ranges of 30-5,- years of age and typically most patients will be less than 60 years of age, most often with long- term drinking
  • Most often, those with a history of daily heavy alcohol use(>100g daily)

Alcoholic Hepatitis: Pathologic Findings

  • Histological examination, appearance looks fatty

Alcoholic Hepatitis: Common Symptoms

  • Anorexia, Ascites, Jaundice, RUQ/ Epigastric Abdominal Pain, Tenderness when hepatomegaly occurs

Alcoholic Hepatitis: Details

  • To have an affect, must be alcohol removal
  • Damage done often results in kidney failure

Alcoholic Hepatitis: Massage Details

  • Only recommended with mild causes
  • Typically little to no general contraindications is needed

Chronic Hepatitis: Mass Notes

  • Inflammation more then 6 months can be an Indicator
  • Viruses, or some meds may be a cause
  • Hep C is commonly responsible for long - term infections
  • Use or overuse of certain drugs( e.g. Tylenol), Alcohol, or Metabolize factors are causes

Chronic Hepatitis: Common Complications

  • Symptoms may include fevers , rare chances for Jaundice
  • Common symptoms such as Liver Fail often include, cancer

Chronic Hepatitis: More notes

  • Little Symptoms show up
  • Hepatitis can lead to different out looks depending on the cause
  • Chronic Heps will include CIRRHOSIS from 15-25%, those that are infected will be at risk

Chronic Hepatitis: Mass Notes

  • With abnormal LFT, it may have a serious problem through abnormal symptoms
  • Biopsy helps diagnosis that and helps further with determining issues

Chronic Hepatitis: Treatment

  • Eliminate all substances that may effect you
  • Those will hepatitis B are recommended for immunization for those closed will
  • More severe infections typically require Transplant

MASLD definition

  • Previously known as NAFLD
  • Is Steatosis with no Alcohol involvement
  • Often most cases are liver cases in US population, and an estimate of 25% of the adult population worldwide with NAFLD

MASH definition

  • Associated with hepatic issues
  • Progress may result, eventually leading to Cirrhosis
  • Often combined with Metabolic Syndrome

MASH Common details

  • Asymptotic often
  • Often have Athero issues associated with diabetics, fat, and cirrhosis
  • Hepatogellular can often cause high-death tolls

MSMD

  • Cirrhosis: with liver issues
  • Often combined with the other details listed in other lists

Metabolic Issues: Treatment

  • Losing weight, reduce cholesterol, and medication, limiting drugs,
  • Avoiding alcohol to have a long term effect

MASLD: Mass Details.

  • Use only if symptoms indicate little to mild, other contraindicate.

Hepatocellular Mass Details

  • Another name is Heptoma
  • Caused by Cirrhosis
  • Common symptoms to include, fatigue/abdominal pain and loss of weight

HCC: Symptoms

  • Early symptoms abdominal pain, fever, weight loss and RUQ
  • Individuals with Cirrhosis may have unexcepected increase in illness
  • Rupture of tumor may cause abdominal pain shocks

HCC: Mass

  • Blood tests
  • Finding Liver Mass
  • Biopsy
  • Images to look for Liver Mass, this includes Advanced images(US, CT, MRI
  • Blood tests
  • PE (Palpable Liver Mass)

HCC: Prevent

  • Hepatitis B shot
  • Treat Hepatitis C
  • Alcohol Treatment for causation

HCC: Common Treatment

  • Surgery
  • Radiation and Chemotherapy, with Tumor Embolization

HCC: Final Notes

  • Long term Vague long term effects in prognosis
  • 5 year survivor rate with 18% typically

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