Digestive System & Hepatitis Lecture PDF

CHAPTER FOUR Digestive system In this chapter, you’ll learn: - Causes, symptoms, diagnosis and treatment of peptic ulcers, hepatitis and liver cirrhosis. Peptic ulcers § A peptic ulcer is a sore that forms when digestive juices wear away the lining of the digestive system....

CHAPTER FOUR Digestive system In this chapter, you’ll learn: - Causes, symptoms, diagnosis and treatment of peptic ulcers, hepatitis and liver cirrhosis. Peptic ulcers § A peptic ulcer is a sore that forms when digestive juices wear away the lining of the digestive system. § A peptic ulcer can occur in the lining of the stomach, duodenum, or lower part of the esophagus. § When a peptic ulcer affects the stomach, it is called a gastric ulcer, one in the duodenum is called a duodenal ulcer, and an esophageal ulcer is an ulcer in the esophagus. Causes Peptic ulcers normally occur because of:  H. pylori bacteria  Non-steroidal anti-inflammatory drugs (NSAIDs) H. pylori bacteria are responsible for the majority of gastric and duodenal ulcers. NSAIDs are a less likely cause. H. pylori Other causes of peptic ulcers  Genetics: A significant number of individuals with peptic ulcers have close relatives with the same problem, suggesting that genetic factors may be involved.  Smoking: People who regularly smoke tobacco are more likely to develop peptic ulcers when compared with non-smokers.  Alcohol consumption: Regular heavy drinkers of alcohol have a higher risk of developing peptic ulcers.  Corticosteroid use: People on large or chronic doses of corticosteroids are also at greater risk.  Mental stress: This stress has not been linked to the development of new peptic ulcers, but symptoms appear to be more severe in people with ulcers who are experiencing ongoing Symptoms It is not uncommon for people to have a peptic ulcer and no s y m p to m s a t a l l. H o w e v e r, o n e o f t h e m o s t c o m m o n symptoms of peptic ulcers is indigestion-like pain. The pain may occur anywhere from the belly button to the breastbone. It can be brief or may last for hours. It is more severe when the stomach is empty or right after eating (depending on where it is located); sometimes it is worse during sleep. Eating certain foods may relieve it, and some foods may make it worse. Other symptoms include:  difficulty swallowing food  food that is eaten comes back up  feeling unwell after eating  weight loss  loss of appetite ü Over-the-counter (non prescription) medications can often provide relief for these symptoms. ü Rarely, ulcers can cause severe signs and symptoms, such as:  vomiting blood  black and tarry stools, or stools with dark red blood  nausea and vomiting that is especially persistent and severe These symptoms indicate a medical emergency. The patient should see a doctor immediately. Diagnosis A patient's description of symptoms will normally cause a doctor to suspect a peptic ulcer. Tests that can confirm a diagnosis include:  a blood test to check for H. pylori, though a positive test does not always mean there is an active infection  a breath test, using a radioactive carbon atom to detect H. pylori.  a stool antigen test to detect H. pylori in the feces.  An upper gastrointestinal (GI) X-ray to identify ulcers An endoscopy may also be used. This involves a long, narrow tube with a camera attached to the end is threaded down the patient's throat and into the stomach and duodenum. This is the best diagnostic test. Treatment The type of treatment usually depends on what caused the peptic ulcer. Treatment will focus on either lowering stomach acid levels so that the ulcer can heal, or eradicating the H. pylori infection. Proton pump inhibitors (PPIs) PPIs reduce the amount of acid the stomach produces. Treatment usually lasts 1-2 months, but if the ulcer is severe, treatment may last longer. H. pylori infection treatment Ø Patients infected with H. pylori will usually need PPIs and antibiotics. Ø This treatment is effective in most patients, and the ulcer will start to disappear within days. Ø When treatment is over, the individual will have to be tested again to make sure the H. pylori have gone. Ø If necessary, they will undergo another course of different antibiotics. Non-steroidal anti-inflammatory drugs Ø If the ulcer comes from NSAIDs, the patient will have to stop taking them. Ø Alternatives include acetaminophen. Ø If the person cannot stop taking NSAIDs, the doctor may minimize the dosage and review the patient's need for them later. Ø Another medication may be prescribed long term, alongside the NSAID. Hepatitis What is hepatitis? § Hepatitis refers to an inflammatory condition of the liver. § It’s commonly caused by a viral infection, but there are other possible causes of hepatitis. § These include autoimmune hepatitis and hepatitis that occurs as a secondary result of medications, drugs, toxins, and alcohol. § Autoimmune hepatitis is a disease that occurs when the body makes antibodies against the liver tissue. The 5 types of viral hepatitis Viral infections of the liver that are classified as hepatitis include hepatitis A, B, C, D, and E. A different virus is responsible for each type of virally transmitted hepatitis. Hepatitis A is always an acute, short-term disease, while hepatitis B, C, and D are most likely to become ongoing and chronic. Hepatitis E is usually acute but can be par ticularly dangerous in pregnant women. Hepatitis A Hepatitis A is caused by an infection with the hepatitis A virus (HAV). This type of hepatitis is most commonly transmitted by consuming food or water contaminated by feces from a person infected with hepatitis A. Hepatitis B Hepatitis B is transmitted through contact with infectious body fluids, such as blood, vaginal secretions, or semen, containing the hepatitis B virus (HBV). Injection drug use, having sex with an infected partner, or sharing razors with an infected person increase your risk of getting hepatitis B. Hepatitis C Hepatitis C comes from the hepatitis C virus (HCV). Hepatitis C is transmitted through direct contact with infected body fluids, typically through injection drug use and sexual contact. Hepatitis D Also called delta hepatitis, hepatitis D is a serious liver disease caused by the hepatitis D virus (HDV). HDV is contracted through direct contact with infected blood. Hepatitis D is a rare form of hepatitis that only occurs in conjunction with hepatitis B infection. The hepatitis D virus can’t multiply without the presence of hepatitis B. Hepatitis E Hepatitis E is a waterborne disease caused by the hepatitis E virus (HEV). Hepatitis E is mainly found in areas with poor sanitation and typically results from ingesting fecal matter that contaminates the water supply. Causes of noninfectious hepatitis Alcohol and other toxins Excessive alcohol consumption can cause liver damage and inflammation. This is sometimes referred to as alcoholic hepatitis. The alcohol directly injures the cells of your liver. Over time, it can cause permanent damage and lead to liver failure and cirrhosis, a thickening and scarring of the liver. Other toxic causes of hepatitis include overuse or overdose of medications and exposure to poisons. Autoimmune system response In some cases, the immune system mistakes the liver as a harmful object and begins to attack it. It causes ongoing inflammation that can range from mild to severe, often hindering liver function. It’s three times more common in women than in men. Common symptoms of hepatitis If you have infectious forms of hepatitis that are chronic, like hepatitis B and C, you may not have symptoms in the beginning. Symptoms may not occur until the damage affects liver function. Viral hepatitis is known as a silent killer because patients often experience no obvious symptoms until the infection causes serious health complications. Signs and symptoms of acute hepatitis appear quickly. They include:  fatigue  flu-like symptoms  dark urine  pale stool  abdominal pain  loss of appetite  unexplained weight loss  yellow skin and eyes, which may be signs of jaundice Chronic hepatitis develops slowly, so these signs and symptoms may be too subtle (mild) to notice. Signs and symptoms of acute hepatitis How hepatitis is diagnosed 1-History and physical exam ü To diagnose hepatitis, first your doctor will take your history to determine any risk factors you may have for infectious or noninfectious hepatitis. ü During a physical examination, your doctor may press down gently on your abdomen to see if there’s pain or tenderness. Your doctor may also feel to see if your liver is enlarged. If your skin or eyes are yellow, your doctor will note this during the exam. 2-Liver function tests ü Liver function tests use blood samples to determine how efficiently your liver works. ü Abnormal results of these tests may be the first indication that there is a problem, especially if you don’t show any signs on a physical exam of liver disease. ü High liver enzyme levels may indicate that your liver is stressed, damaged, or not functioning properly. 3-Other blood tests ü If your liver function tests are abnormal, your doctor will likely order other blood tests to detect the source of the problem. ü These tests can check for the viruses that cause hepatitis. ü They can also be used to check for antibodies that are common in conditions like autoimmune hepatitis. 4-Ultrasound An abdominal ultrasound uses ultrasound waves to create an image of the organs within the abdomen. This test allows the doctor to take a close at the liver and nearby organs. It can reveal:  fluid in your abdomen  liver damage or enlargement  liver tumors  abnormalities of your gallbladder 5-Liver biopsy ü A liver biopsy is an invasive procedure that involves the doctor taking a sample of tissue from the liver. ü This test allows the doctor to determine how infection or inflammation has affected the liver. ü It can also be used to sample any areas in the liver that appear abnormal. How hepatitis is treated Treatment options are determined by which type of hepatitis you have and whether the infection is acute or chronic. Hepatitis A Ø Hepatitis A usually doesn’t require treatment because it’s a shor t-term illness. Bed rest may be recommended if symptoms cause a great deal of discomfort. Ø If you experience vomiting or diarrhea, follow your doctor’s orders for hydration and nutrition. Ø The hepatitis A vaccine is available to prevent this infection. Most children begin vaccination between ages 12 and 18 months. It’s a series of two vaccines. Ø Vaccination for hepatitis A is also available for adults and can be combined with the hepatitis B vaccine. Hepatitis B Ø Acute hepatitis B doesn’t require specific treatment. Ø Chronic hepatitis B is treated with antiviral medications. Ø This form of treatment can be costly because it must be continued for several months or years. Ø Treatment for chronic hepatitis B also requires regular medical evaluations and monitoring to determine if the virus is responding to treatment. Ø Hepatitis B can be prevented with vaccination. The series of three vaccines is typically completed over the first six months of childhood. Hepatitis C Ø Antiviral medications are used to treat both acute and chronic forms of hepatitis C. Ø People who develop chronic hepatitis C are typically treated with a combination of antiviral drug therapies. Ø They may also need further testing to determine the best form of treatment. Ø People who develop cirrhosis or liver disease as a result of chronic hepatitis C may be candidates for a liver transplant. Ø Currently, there is no vaccination for hepatitis C. Hepatitis D Ø No antiviral medications exist for the treatment of hepatitis D at this time. Ø Hepatitis D can be prevented by getting the vaccination for hepatitis B, as infection with hepatitis B is necessary for hepatitis D to develop. Hepatitis E Ø Currently, no specific medical therapies are available to treat hepatitis E. Because the infection is often acute, it typically resolves on its own. Ø People with this type of infection are often advised to get adequate rest, drink plenty of fluids, get enough nutrients, and avoid alcohol. Ø However, pregnant women who develop this infection require close monitoring and care. Complications of hepatitis Chronic hepatitis B or C can often lead to more serious health problems. Because the virus affects the liver, people with chronic hepatitis B or C are at risk for:  chronic liver disease  cirrhosis  liver cancer When your liver stops functioning normally, liver failure can occur. Complications of liver failure include:  bleeding disorders.  a buildup of fluid in your abdomen, known as ascites.  increased blood pressure in portal veins that enter your liver, known as portal hypertension.  kidney failure  hepatic encephalopathy, (which can involve fatigue, memory loss, and diminished mental abilities due to the buildup of toxins, like ammonia, that affect brain function). (a disease in which the functioning of the brain is affected by some agent or condition).  hepatocellular carcinoma, which is a form of liver cancer  death Cirrhosis of the liver ü Cirrhosis is a type of liver damage where healthy cells are replaced by scar tissue. ü The liver is unable to per form its vital functions of metabolism, production of proteins, including blood clotting factors, and filtering of drugs and toxins. ü Many people think that only drinking excessive amounts of alcohol causes liver cirrhosis, but there are a number of other ways that the liver can be damaged and lead to cirrhosis. Causes of liver cirrhosis The most common causes of cirrhosis of the liver are:  Long-term excessive alcohol consumption.  Hepatitis C, Hepatitis B is an important cause of cirrhosis worldwide.  Non-alcoholic fatty liver disease (NAFLD) is a condition where fat accumulates in the liver.  Some inherited conditions damage the liver and this leads to the scarring that can contribute to cirrhosis. These conditions include: ü Haemochromatosis – the body accumulates iron, which can damage many organs, including the liver. ü Wilson’s disease – the tissues of the body accumulate copper. ü Galactosaemia – the body is unable to process galactose (a sugar) so it accumulates in the blood and can result in liver damage. ü Cystic fibrosis – mainly affects the lungs, but can also cause scarring of the liver. ü Alpha-1 antitrypsin deficiency – is a genetic disorder can affect breathing, but can also affect liver function and lead to cirrhosis and liver failure. Other causes of liver cirrhosis A number of other medical conditions that result in liver damage can cause cirrhosis, including:  Some autoimmune diseases – cause immune cells to attack and damage the liver.  Exposure to poisons – can damage the liver because one of the liver’s main roles is to remove toxins from the blood.  Schistosomiasis – a tropical disease caused by a parasitic worm called Schistosoma. Symptoms of liver cirrhosis Symptoms depend on the severity of the cirrhosis, but may include:  Appetite loss  Nausea  Weight loss  General tiredness  Spidery red veins on the skin (spider angiomas)  Easily bruised skin ( injury, discoloration of the skin)  Yellowing of the skin and eyes (jaundice)  Reddened palms (palmar erythema)  Itchy skin  Hair loss  Dark coloured urine  Fluid retention in the abdomen and legs  Internal bleeding presenting as dark-coloured stools or vomiting blood  Hormone disruptions that could cause a range of problems, including testicular atrophy (shrinking) and impotence in males or amenorrhoea (no periods) in women  Cognitive problems such as memor y loss, confusion or concentration difficulties. Diagnosis of liver cirrhosis Tests used to diagnose liver cirrhosis may include:  medical history  physical examination  blood tests, including liver function tests  urine tests  imaging studies, including ultrasound, computed tomography (CT scan) or magnetic resonance imaging (MRI)  Fibro-scan – also known as transient elastography, this test uses is an ultrasound-based technique that can accurately and non-invasively detect liver cirrhosis  Liver biopsy, obtaining liver tissue for laboratory examination. Treatment of liver cirrhosis  Cirrhosis of the liver is incurable (not able to be cured ) but, in some cases, treatment can help to reduce the likelihood that the condition will become worse. Options include:  treating the underlying cause of liver damage – for example, treating the underlying hepatitis (B or C) virus infection, removal of blood to lower iron levels in haemochromatosis  making dietary and lifestyle changes – a nutritious low-fat diet, high-protein diet and exercise can help people to avoid malnutrition  avoiding alcohol – alcohol damages the liver and harms remaining healthy tissue  Taking certain medication – such as beta-blockers to reduce blood pressure and lower the risk of bleeding, diuretics to remove excess fluid.  avoiding certain medication that can make the symptoms worse – such as non-steroidal anti-inflammator y drugs (NSAIDs), opiates or sedatives.  having regular medical check-ups – including scans to check for liver cancer.  having regular endoscopic procedures to check whether there are varicose veins within the oesophagus or stomach.  having a liver transplant – an option that may be considered in severe cases.  THANK YOU DR/DOAA GALAL