Defined as acute or chronic hepatocellular.
- Most common cause of acute hepatitis is viral followed by toxins (*EtOH).
- Most common cause of chronic hepatitis is viral (can also be inherited disorders, autoimmune)
Transmission (A + E)
Fecal-oral contamination. Prevent by having a sanitary water supply and hand washing)
Transmission (B + C + D)
Parenterally or by mucous membrane contact
Progression to serious liver disease in pts. with chronic Hepatitis C
20-30% progress to serious liver disease, usually if EtOH is involved or pt. also has Hep B or HIV
Clinical Features: general
Fatigue, malaise, anorexia, nausea, tea-colored urine, vague abdominal discomfort
When is Hep D found?
In conjunction with Hep B, assoc. w/ more severe course
Which infectious are frequently found as co-infections?
Hep C + HIV, Hep B + HIV
Elevated aminotransferase levels, bilirubin > 3.0 (=scleral icterus or jaundice), antibodies and antigens present in serology
Treatment: Acute viral hepatitis
Supportive (Hep A pts be careful to wash hands/dishes and not share food), avoid EtOG/toxins
All HIV-positive pts. with chronic Hep B should be...
Treated for HIV (no matter what the CD4 count is) w/ therapies that cover both infx.
Hep C. patients should also be evaluated for...
The level of fibrosis
EtOH, acetaminophen, isoniazid, halothane, phenytoin, carbon tetrachloride
How to diagnose and treat?
Eliminate the suspected agent
What is used for acetaminophen toxicity?
Good if the patient survives the acute episode
Irreversible fibrosis and nodular regeneration throughout the liver
EtOH (causes >45% of cases in US), or Hep B/C or congenital disorders
Weakness, fatigue, weight loss, N/V, anorexia, amenorrhea, impotence, loss of libido, abdominal pain, hepatomegaly.
Signs/symptoms of late stage cirrhosis
Ascites, pleural effusions, peripheral edema, ecchymosis, esophageal varices, and signs of hepatic encephalopathy
Signs of Hepatic Encephalopathy
Asterixis, tremor, dysarthria, delirium, coma
Can be normal until late-stage disease. Anemia, mild AST elevation.
Abstain from EtOH use, salt restriction + bed rest for ascites, can do Spironolactone 100mg qd to diurese. Liver transplant for select patients
- Caused by Entamoeba histolytica or the coliform bacteria
- Happens after travel or secondary to an intra-abdominal infection.
- Presents with fever and abdominal pain
- Treat with abx, percutaneous drainage, surgical excision
Can be malignant (primary or metastatic) or benign
Types of benign neoplasm
Cavernous hemangioma, hepatocellular adenoma, infantile hemangioendothelioma
Liver is a common site for...
Metastases from other cancers (esp. lung and breast). But if the primary tumor is silent, manifestations may occur in liver first.
What is associated with primary hepatocellular carcinoma
Hep B, Hep C, cirrhosis, aflatoxin B1 exposure (from Aspergillus in foods)
Malaise, weight loss, abdominal swelling, weakness, jaundice, upper abdominal pain. Signs include hepatomegaly, splenomegaly, hepatic bruit, ascites, jaundice, wasting, fever
Treatment: Benign neoplasms
Treat if the tumor size might be in danger of rupturing hepatic capsule
Treatment: Metastatic disease
Treat the primary lesion
When may surgical resection be attempted?
If the cancer is confined to one lobe and there is no concurrent cirrhosis. Liver transplant might be an option. Poor prognosis overall.