HEPATITIS B

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Hepatobililary System
The hepatobiliary system is essential for digestion and includes: the liver, pancreas, bile ducts and the gallbladder. Many disorders and diseases can affect these organs, some of which are specified below.

Organ Involved

Importances

Bile Salt enables the body to excrete cholesterol and potential toxic compound which is bilirubin and drug.

Liver,Gall Bladder,Bile Duct,Pancreas

Bile salt is excreted into Bilirubin before it is removed from body through the stool. Bilirubin present in bile is a product of the liver’s digestion of worn out red blood cells

Hepatic Portal System Process


4.The hepatic portal vein supplies about 75% of the blood the liver requires, with the other 25% supplied by the hepatic artery.




3.The hepatic vein also drains blood coming from the cystic veins as well as the inferior mesenteric gastric veins.
The hepatic vein is one of the most important portal venous systems in the human body and it is integral to the circulatory system in general.


2.The hepatic portal vein is one of the largest veins in the area and it carries blood to liver from the spleen and the gastrointestinal tract. The hepatic vein begins where the splenic veins and the superior mesenteric meet.




1.One of many primary components of the circulatory system that can be found in the abdominal cavity.


5.Blood from either source passes into cavities between the hepatocytes of the liver called sinusoids, which feature a fenestrated, discontinuous endothelium allowing for the effecient transfer and processing of nutrients in the liver.Blood from the hepatic artery is oxygenated but nutrient-poor compared to that supplied by the hepatic portal vein.
Since blood received from the hepatic portal vein may be contaminated with pathogens such as bacteria, the liver is rich in specialized immune cells called Kupffer cells that can detect and destroy foreign organism.

Liver Function

Metabolism

Metabolizing carbohydrate, lipids, and proteins into biologically useful materials.

Storage

Storage of many essential nutrients, vitamins, and minerals obtained from blood passing through the hepatic portal system.

Digestion

Active role in the process of digestion through the production of bile.Bilirubin present in bile is a product of the liver’s digestion of worn out red blood cells

Production

Production of several vital protein components of blood plasma

Detoxification

The hepatocytes of the liver monitor the contents of the blood and remove many potentially toxic substances

Immunity

The liver functions as an organ of the immune system through the function of the Kupffer cells.

PULSE RATE, FBC TEST & SEROLOGY TEST

Liver Function Test

PULSE RATE :


Average pulse rate of adults
60-100 beats/min


Average pulse rate of kids
80-110 beats/mins


Average pulse rate of an elderly man
67-74 beats/ min

FBC TEST


• Common blood test to check a person's general health and to detect a wide range of disorders including ANAEMIA, LEUKEMIA & INFECTIONS


    MEASURES SEVERAL COMPONENTS

(i) RBC
(ii) WBC
(iii) HAEMOGLOBIN
(iv) HEMATOCRIT
(v) PLATELETS



Serology Test Explanation


(i) ANTI - HCV
~ Negative on patient's test
~ To look for antibodies in the blood. If the test is positive, it indicates that the person is suffering from Hepatitis C
~ Can cause both acute and chronic infection


(ii) HBs AG ( Hepatitis B surface antigen) & HBe AG ( Hepatitis B viral protein )
~ Both positive on patient's test
~ Indicating that the person has Hepatitis B


(iii) ANTI - HBe IgM ( Immunoglobulin M antibodies)
~ Positive on patient's test
~ Indicates that the person has/ have had previous infection of Hepatitis B


(iv) ANTI- HBs ( Hepatitis B surface antigen)
~ Negative on patient's test
~ It indicates recovery and immunity from Hepatitis B virus infection. It will be present if the person is vaccinated against Hepatitis B

Liver Function Test

Bilirubin Metabolism

Jaundice

Presented by

Hemolytic jaundice

Obstructive jaundice

Hepatocellular jaundice

occurs as a result of liver disease or injury

occurs as a result of hemolysis (an accelerated breakdown of red blood cells) leading to an increase in production of bilirubin


occurs as a result of an obstruction in the bile duct (a system of tubes that carries bile from the liver to the gallbladder and small intestine), which prevents bilirubin from leaving the liver

Liver Enzyme

Alkaline Phosphatase (ALP) test

  • Normal range within 124-341 U/L
  • Mr FSY level is 356 U/L which exceeds the normal range

Alanine Transaminase (ALT) test

  • Used by body to metabolize protein
  • Normal range is 5-56 IU/L
  • Mr FSY AST level is 1600U/L which is higher than normal range

Liver Protein

Albumin

  • Low level indicate liver damage
  • Normal range 38-54 g/L
  • Mr FSY's albumin level is 40 g/L and it is still under normal range

Aspartate Aminotransferase (AST) test

  • AST-to-ALT ratio taken for diagnosis
  • Normal range is less than 37 IU/L
  • Mr FSY AST level is 1200U/L which is higher than normal range

Hepatitis: This infection can occur in the liver and can heal itself without treatment or develop into liver damage or liver cancer

Types of liver inflammation

Hepatitis C : inflammation it is one of the most dangerous types of liver damage

Hepatitis D: inflammation is similar hepatitis B

Hepatits B : inflammation serous liver

Hepatitis A: infectionous gastric liver

Bilirubin Test

Prothrombin Time Test

  • Measure the time taken for the blood to clot
  • Longer time indicates liver damage
  • Normal is 10-13.5 s but the patients result showed that he had 17 s

Activated Partial Thromboplastin Time (aPTT)

  • Same function as PTT Test but in a narrower range of time because of an activator that was added
  • Normal time is 26-42 s but the patients result showed beyond the normal which is 47 s
  • Amount of conjugated and unconjugated bilirubin is calculated in this test
  • Abnormalities in amount of both bilirubin indicates liver damage
  • Normal conjugated bilirubin should be less than 5.1 micromol/L but the patient had 13 micromol/L
  • Normal unconjugated bilirubin should be lessthan 12 micromol/L but the patien had 27 micromol/L instead

Hepatitis E : inflammation is similar hepatitis A in transit routes

Hepatitis G : inflammation new discovery has a link to hepatitis

DEFINE CAUSE OF LIVER INFLAMMATION:

  • Alcohol consumption
  • take a large quantity of medication

SYMPTOM :
-Fever
-Weakness
-Anorexia
-Nausea
-Dark Urine
-Joint Pain

Liver Histology

Kupffer cells

bile

axis of liver

organised into

lobes subdivided into lobules

lobes

liver cells

surrounded by thick connective tissue capsule

by looser connective tissue

Glisson's capsule

hexagonal in shape

hepatic sinusoids

separate radial plates

central vein

macrophages

attach to endothelial lining

in sinusoid

portal triad

produced by hepatic cells

collected first in small bile canaliculi

then in small hepatic ductules

carried away by larger branches of bile duct

hepatic portal vein

hepatic artery

bile duct

REGIONS OF ABDOMINAL AREA

Stools

right hypochondrium

abnormal colour

organs included

right kidney

ascending colon

gall bladder

transverse colon

liver

patient experiences tenderness

inflammation

possible liver diseases

hepatitis

hepatoma (cancer)

hepatid cyst

liver abcess

urine's colour

abnormal colour

dark brown

excess billirubin in the urine

define as

a piece of feces

normal colour

brown

clay - grey colour

flow of bile out of the liver is blocked

liver infection which reduce bile production

hepatocytes

form radial plates

Pathophysiology

Specific disease and affected structures

results from

Infections, Drugs, Toxins & Autoimmune diorders

  1. Acute Viral Hepatitis - Hepatocellular Injury (infections) 2. Primary Biliary Cirrhosis - Impairment of biliary secretion (Autoimmune Disease)
  2. Cryptogenic Cirrhosis - Liver Fibrosis (Drugs & Toxins)
  3. MUltiple Liver Structure Destruction - Sever Alcoholic Liver ( Toxins)