Hepatitis and Liver Function Test

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hepatitis

inflammation of the liver cells (hepatocytes)

Name three types of hepatitis.

1. Toxic hepatitis
2. Autoimmune hepatitis
3. Viral Hepatitis

How many viral hepatitis are there? name them.

consists of 6 (A,B,C,D,E,G)

toxic hepatitis

caused by drugs, alcohol, industrial toxins & plant poisons

autoimmune hepatitis

associated with autoimmune disease. cause unknown

Pathophysiology of hepatitis - 7 steps.

1. virus replicates
2. atacks hepatocytes
3. Liver becomes enlarged and congested due to virus/toxin
4. inflammatiory cells - lymphocytes and edema
5. Lobular pattern becomes distorted due to inflammation, necrosis
6. swelling causes obstruction of portal circulation
7. edema causes liver bile channels to obstruct
8. recovery phase- phagocytosis, removal of damaged cell
9. regeneration - completed 2-3 months

intrahepatic obstructive jaundice

results from edema, fibrosis, or scarring of the hepatic bile channels and bile ducts, which interferes with normal bile and bilirubin excretion

What type of hepatitis only causes acute form?

hepatitis A

How is Hepatitis A confirmed?

testing positive for HAV-IgM antibodies in the blood

Transmission mode of Hepatitis A.

fecal - oral route

Common sources of contamination for Hepatitis A

food prepareer, during floods, poor sanitation

Incubation period for Hepatitis A

15 - 50 days with an average of 1 month

Infectious period of hepatitis A.

period ends 1 week after symptoms subside

Discuss severtiy of Hepatitis A infection.

generally mild; but increases with increasing age

Name 3 high risk groups for aquiring Hepatitis A.

1. institutions for custodial care
2. day care centers
3. travelers to developing countries

Percentage of recovery from hepatitis A.

99% recover with life long immunity

Other methods that hepatitis B spreads?

kissing
sharing tooth brushes
water picks
razor blades
cigarettes
nail clippers
contaminated tattoing
body piercing
acupuncture equipment
hemodialysis
tampons/sanitary napkins
dressings

How is hepatitis B identified and caused by?

HbsAg(surface antigen) and Hbc Ag(Core antigen) in blood; later the anti-BcIgM (Hep Bcore antibodies) appear

how long can hepatitis b live outside the body?

up to 40 days as a fomite

fomite

dried blood, can be transfered from place to place

Incubation period of hepatits B

45 - 180 days; average 2 -3 months after exposure

How long can a carrier harbor hepatitisB without symptoms?

up to 6 months

Primary mode of transmission for hepatitis B>

sexually transmitted

Additional modes of transmission via bodily fluids of hepatitis B.

skin, mucous membrane, parenteral routes,contact with infected blood or serous fluids

the pressence of what antibody for hepatitis B indicates recovery & immunity?

HbsAg

High risk groups for hepatitis B.

1. users of parenteral drugs (via needle sticks)
2. fetuses of infected mothers
3. sexual partners of HBV carriers
4. anyone with pts. on hemodialysis
5. male prisoners
6. healthcare workers

What type of hepatitis can lead to cirrossis?

hepatitis B and C

Name hepatitis type with leading cause of cirrhosis & hepatocellular cancer (HCC) world wide.

Hepatitis C - causes scarring of liver and make tke up to 3 years to manifest itself.

At what age does WHO recommend people to get tested for hepatitis C? and why?

age 40, it is leading cause of liver cancer

High risk groups for hepatitis C.

frequent blood transfusions, veterans injured, IV drug abusers

incubation period of hepatitis C

variable from 21 - 140 days with an average of 50 days

Name coutries where hepatitis D(Delta) is an epidemic

meiditerranean basin, middle east, central Africa, Amazonian baisn and parts of Asia

What is hepatitis D caused by?

caused by HDV a defective RNA virus that seems to be only ative in the presence of HBV

What is the most common chronic blood-borne infection in the USA caused by?

hepatitis C - typical age range 29 to 49 more males than females

Mode of transmission for hepatitis C.

skin & mucous membrane or parenterally or contact with infectious blood, injecting drugs, healthcare workers, intranasal cocaine use

acute viral hepatic syndrome

caused by any virus, malaise, n/v, arthralgia, jaundice, increase of serum AST and ALT

Mode of transmission of hepatitis G

through blood- co-infection with B or C

Where is hepatitis E found?

east and south asia, egypt, mexico, india, sub-Saharan Africa

What vaccine can help prevent Hepatitis C?

Hepatitis B vaccine

Liver injury will produce what type of abnormal labs?

liver injury increases liver enzymes
* elevated ALT (can be as high as 20x's normal)
*elevated AST
*elevated alkaline phosphatase

Normal range of ALT

6 to 37 IU/L

What does a high ALT indicate?

liver injury

What does a hight AST indicate?

liver injury

alkaline phosphate

is manufacutured in bones, kidney, liver and intestine, it is excreted through biliary tact.

What does an elevated alkaline phosphate indicate?level

it is excreted through the biliary tract with obstruction levels rise

As liver becomes more damaged what other symptom may arise?

clotting factors are synthesized in the liver and will begin to decrease with liver damage, therefor clotting time will be prolonged.
*PT will be prolonged
*PTT will be prolonged with severe liver damage

fulminant hepatitis

failure of liver cells to regenerate, progressive necrosis & damage lead to liver failure; fatal form is rare. (most common in kids,esp. neonates. once they develop liver failure with this, life expectancy is about 1 year.)

Signs and symptoms of liver failure.

rapid weight gain from fluid collection with ascites, edema in legs, dark urine, scleral icterus, mental status changes (hepatic encephalopathy)

scleral icterus

An even yellowing of the sclera extending up to the cornea, indicating jaundice

hepatic encephalopathy

central nervous system dysfunction resulting from liver disease; frequently associated with elevated ammonia levels that produce changes in mental status, altered level of consciousness, and coma

Name 2 hepatitis linked to primary liver disease.

HBV and HBC

primary liver disease

- Hepatitis (acute liver failure)

indirect bilirubin

Unconjugated bilirubin, , An increase in this form of bilirubin signifies an increase in the breakdown of red blood cells (hemolysis). Does not increase with hepatitis.

define albumin

smallest of plasma protein, accounts for 60% tho, synthesized in liver, important part of osmotic pressure

Total Bilirubin in serum is composed of

conjugated + unconjugated bilirubin

What happens to the direct conjugated bilirubin level when bile flow is obstructed?

level is elevated, ie. hepatitis, cirrhosis, gallstones, tumors---anything that causes liver damage

Signs and symptoms of jaundice.

dark urine, clay colored stools, pruritis

bilirubin

An orange pigment which is formed by the liver as a result of heme breakdown and excreted in the bile.

How does bilirubin excreted in colon and small intestines?

Bilirubin is released when RBCs are destroyed, it flows in the blood stream attached to albumin and is conjugated (changed to a water soluble form) in the liver. conjugated bilirubin can then be secreted with bile, conjugated bilirubin can then be secreted with bile, transported to the gall bladder and released into the duodenum to aid in digestion; next it is converted to urobilinogen by bacteria in the colon & is excreted in the small intestine and returned to the liver. Eventually conjugated

Prophylaxis for Hepatitis A pre-exposure.

Havix (inactivated vaccine); provides active immunization for 1 year of age & above; used if traveling to developing countries

Prophylaxis for Hepatitis A post-exposure.

for individuals who have contact with persons with HAV; prophylaxis (HIG) must be given within 7-14 days of exposure to be beneficial, 48 hours from the first exposure is best.

Normal range of AST

8 - 20 U/L

Normal range of ALT

5 - 40 U/L

Normal range for cholesterol

112 - 328

Normal range of total bilirubin

0.3 - 1.2 mg/dL

Normal range of direct bilirubin

0 - 0.2mg/dL

Normal range of Na+

135-145 meq/L

Normal range of K

3.5 - 5.0 meq/L

Normal range of BUN

8 - 23 mg/dL

Normal range of Prothrombin time

9.4 - 11.6 seconds

With liver cell damage the following liver enzymes increases

AST (SGOT) increased
ALT (SGPT) increased
LDH increased
Alkaline Phosphatase increased

Nursing assessment pre-icteric phase

*fever, chills
*RUQ tenderness
*fatigue, weight loss

Nursing assessment icteric phase

*obstruction of the livers, rash and worsening symptoms: anorexia, N & V, weakness, malaise

pruritis

Intense itching

cholestatic function

liver produces and secretes bile, is the liver producing & conjugating bile

How can you know if the liver is producing and conjugating bile?

If liver is not producing and conjugating bile, you will see an increase in direct bilirubin and total bilirubin

What does the liver do with blood?

1. clearing blood of drugs and other toxins
2. regulating blood clotting
3. processing of hemoglobin for use of its iron content (liver stores iron)
4. regulation of blood levels of amino acids, which form the building blocks of proteins

What does the liver do with ammonia?

converts poisonous ammonia to urea

urea

one of the end products of protein metabolism that is excreted in the urine

What does the liver do to help with digestion?

* production of bile helps carry away waste and break down fats in the small intestine during digestion
*production of cholesterol and special proteins to help carry fats through the body
*conversion of excess glucose into glycogen for storage

Nursing interventions when caring for hepatitis patients (comfort measures).

1. control pruritis
2. antiemetics as ordered for nausea and vomiting (Tigan, Dramamine)

What type of isolation is required for hepatitis B, C,D, G?

blood and body fluid precautions
*carefule disposal of needles
*careful labeling of blood specimens to protect personnel
*watch open cuts

What type of isolation is required for hepatitis A & E?

Contact isolation (decrease chance of contamination by oral/fecal route). wear gloves, gown, use private toilet, daily cleaning of toilet, isolation of tools, careful hand-washing

If exposed to hepatitis B

can use HBIG (hepatitis B immune globulin) within 7 days and then Recombivax series

HBIG

hepatitis B immune globulin, This contain antibodies to HBV and offers prompt but short-lived protection

What is synthesized in the liver important to blood?.

Clotting factors are synthesized in liver.

What labs will change with loss of liver synthesis?

PT - prolonged
PTT - prolonged
Clotting factors- decreased
Albumin - decreased

What occurs to clotting factors with loss of liver synthesis?

Manufactured in liver but will decrease with liver damage resulting in fewer clotting factors; prolonged clotting times will lead to risk of bleeding.

Normal and therapeuitc range of PT

12 - 14 sec (control)
(1.5 - 2.5 X control Therapeutic range)

Normal range of albumin

3.5 - 5.0 gm/dL

albumin

principal function is to provide colloid osmotic pressure, preventing plasma loss from the capillaries to the interstitial areas that can cause edema

colloid osmotic pressure

keeps fluid in the intravascular compartment by pulling H2O from the interstitial space bank into the capillaries (vascular compartment)

intravascular

WITHIN A VESSEL

interstitial space

The space in between the cells.

What is used to treat chronic hepatitis B & C

Alpha-Interferon a natural product of human leukocytes which helps the body combat viruses

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