Disorders of the Hepatobiliary System PDF

25/10/2024, 14:04 4.2: Disorders of the Hepatobiliary System | Moodle 4.2: Disorders of the Hepatobiliary System Site: Federation University Moodle Printed by: Dajou...

25/10/2024, 14:04 4.2: Disorders of the Hepatobiliary System | Moodle 4.2: Disorders of the Hepatobiliary System Site: Federation University Moodle Printed by: Dajou Buloba NURBN 2027 SEM2 2024: Nursing Context 7: Date: Friday, 25 October 2024, 2:04 PM Course: Pathophysiology and Pharmacology Applied to Person- Centered Nursing Practice B Combined 001 Book: 4.2: Disorders of the Hepatobiliary System Table of contents 1. Scenario 2. Hepatitis - Viral /Non-viral 2.1. Hepatitis - types, pathophysiology, clinical features and investigations 2.2. Hepatitis - management, complications, & prognosis 3. Cirrhosis of the liver 4. Portal hypertension 4.1. Ascites 5. Hepatic encephalopathy 6. Monitoring liver function 7. Pharmacology 7.1. Beta Blockers 7.2. Vitamin K/ Phytomenadione 7.3. Rifaximin 7.4. Harvoni (sofosbuvir + ledipasvir) 7.5. Lactulose 8. Case study 9. Engage 10. Acute Pancreatitis https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654100 1/32 25/10/2024, 14:04 4.2: Disorders of the Hepatobiliary System | Moodle 1. Scenario  Activity - Scenario Complete the scenario to prepare for the pathopthysiology book: https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654100 2/32 25/10/2024, 14:04 4.2: Disorders of the Hepatobiliary System | Moodle 2. Hepatitis - Viral /Non-viral Hepatitis Can be Viral or non viral. It is an inflammation of the liver that is caused by a variety of infectious viruses and noninfectious agents leading to a range of health problems, some of which can be fatal. This image summarises the difference between the two types of hepatitis Non-viral hepatitis Non-viral hepatitis describes the inflammation of liver due to non-viral causes. Causes can include: Toxins: paracetamol, benzene, carbon tetrachloride, halothane, chloroform, poisonous mushrooms Alcohol Cholestasis - {disruption of flow of bile (caused by gall stones, allopurinol, contraceptive pill)} Clinical manifestations of non viral hepatitis Jaundice, the classic sign of liver damage - why? Urine dark - why? There are several others, see what your textbook identifies. https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654100 3/32 25/10/2024, 14:04 4.2: Disorders of the Hepatobiliary System | Moodle Progress  Consider What is happening to the liver? What are the similarities to viral hepatitis? Treatment of hepatitis Treatment is dependent on the cause (e.g. alcoholic hepatitis = reduce alcohol intake) Many of you have had a treatment for viral hepatitis, before you went on clinical placement... Other treatments will be discussed in the pharmacology section  Activity Research at least 2 types of viral hepatitis, their mode of transmissions and treatment. Record your findings in your Personal journal for your future reference and revision. https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654100 4/32 25/10/2024, 14:04 4.2: Disorders of the Hepatobiliary System | Moodle 2.1. Hepatitis - types, pathophysiology, clinical features and investigations Acute hepatitis is a term that encompasses conditions characterised by acute inflammation of the hepatic parenchyma or injury to hepatocytes resulting in elevated liver function tests. In general, hepatitis is classified as acute or chronic based on the duration of the inflammation and insult to the hepatic parenchyma. If the period of inflammation or hepatocellular injury lasts for less than six months, characterized by normalization of the liver function tests, it is called acute hepatitis. In contrast, if the inflammation or hepatocellular injury persists beyond six months, it is termed chronic hepatitis Viral hepatitis Definition Diffuse liver inflammation caused by specific hepatotropic viruses (hepatitis A, B, C, D, E), resulting in both acute and chronic forms of liver disease Also relating to hepatocellular injury caused by other (usually more systemic) viruses (EBV, cytomegalovirus, herpes, adenovirus, yellow fever) Epidemiology A B C D E Transmission Faecal-oral Parenteral/ sexual, Parenteral, sexual, Close contact, Faecal oral vertical vertical parenteral, sexual Onset Abrupt Insidious Insidious Abrupt Abrupt Oncogenicity No Yes Yes Unknown No Other Not associated with Acute and chronic Acute and chronic HDV is co-infection of Not associated with chronic liver disease infection infection HBV chronic liver disease Hepatitis A (HAV) Transmission usually precedes symptoms by 2 weeks Patients considered non-infectious 1 week after onset of jaundice Infections in adults are symptomatic, infections in children 10% prevalence in sub-Saharan Africa, East/SE Asia, Pacific Islands, 0.5% prevalence in Australia Burden of chronic disease increasing in Australia Vaccine for at risk groups Hepatitis C (HCV) 55-85% of patients develop chronic hepatitis C ⅔ of infections are asymptomatic Hepatitis D (HDV) Only occurs as super-infection with HBV (Hepatitis B virus) HDV-HBV coinfection is considered most severe form of chronic viral hepatitis Approximately 5% of people with chronic HBV infection are co-infected worldwide Preventable through HBV vaccine Hepatitis E (HEV) https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654100 5/32 25/10/2024, 14:04 4.2: Disorders of the Hepatobiliary System | Moodle Rare in Australia Hepatitis E in pregnancy is dangerous, progressing to liver failure and 20% mortality Cytomegalovirus Beta-herpes virus Primary infection in normal immune function is usually asymptomatic Will establish lifelong latency in host cells Reactivation or primary infection in AIDS leads to fever, bone marrow suppression, tissue invasive disease including hepatitis Aetiology and risk factors Causative agents Hepatitis A, B, C, D, E CMV (Cytomegalovirus) EBV (Epestien Barr virus) Yellow fever Risk factors Poor hygiene (HAV, HEV) Endemic areas in Asia and Africa (HBV) IV drug users (HBV, HCV, HDV) High risk sexual behaviours (HBV) Contaminated blood products or medical/dental equipment (HBV, HCV) Undercooked meat/shellfish (HEV) HIV/AIDS and transplant recipients (CMV) Aboriginal and Torres Strait Islander communities Medical, healthcare workers, carers Pathophysiology All hepatitis viruses cause acute hepatitis following various incubation periods while hepatitis B and C persist in the host and can contribute to chronic hepatitis Liver inflammation -> hepatocyte destruction -> fibrosis -> cirrhosis -> hepatocarcinoma Variable pathogenic effects Common features Damage is mainly due to host immune response response to viral proteins (rather than directly cytotoxic) In acute self-limited hepatitis, a host T cell response will act to eradicate the virus In chronic hepatitis, the immune response will trigger and maintain an inflammatory state -> can progress to carcinogenesis Immune response 1. Direct killing of infected cells by virus specific CD8+ cytotoxic T cells 2. Removal of free viral particles by antibody response 3. Intracellular viral inactivation by inflammatory cytokines (IFN-gamma, TNF-alpha) Morphology Mononuclear infiltrate and ‘spotty necrosis’ Hepatic necrosis and apoptosis lead to cellular debris, collapsed reticulin (collagen framework) fibers, haemorrhage and further inflammation -> can lead to fulminant necrosis/acute liver failure  Watch this video relating to viral hepatitis https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654100 6/32 25/10/2024, 14:04 4.2: Disorders of the Hepatobiliary System | Moodle Viral Hepatitis Made Simple - Pathology , Clinical features & Classifications Hepatitis Clinical Features and Dx Summary Table Pathogen Incubation period (days) Signs and Symtoms Serological Diagnosis HAV 15-50 Acute hepatitis: fever, malaise, loss of Anti-HAV IgM appetite, nausea, abdominal pain, jaundice, raised AST/ALT Children