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viral hepatitis, Types of Jaundice, diagnosis of hepatitis B virus -…
viral hepatitis
Pathophysiology of Cirrhosis
Chronic Liver Injury
Alcohol
Viral hepatitis
NAFLD
Persistent Inflammation
Hepatocyte necrosis
Cytokine release
Activation of Stellate Cells
Collagen deposition
Fibrosis formation
Architectural Distortion
Regenerative nodules
Fibrous septa
Portal Hypertension
Increased resistance to portal flow
Collateral circulation
Complications
Ascites
Esophageal varices
Splenomegaly
Hepatic encephalopathy
Reduced synthetic function
Low albumin
Increased INR
Anatomy of Posterior Abdominal Wall
Boundaries
Posterior surface of abdominal cavity
Between diaphragm and pelvis
Muscles
Psoas major
Hip flexion
Iliacus
Joins psoas to form iliopsoas
Quadratus lumborum
Lateral flexion of spine
Diaphragm posterior part
Major Vessels
Abdominal aorta
Inferior vena cava
Lumbar arteries
Nerves
Lumbar plexus
Femoral nerve
Obturator nerve
Lateral femoral cutaneous nerve
Organs Located Posteriorly
Kidneys
Ureters
Adrenal glands
Pancreas partially
Duodenum second to fourth parts
Viral Hepatitis
Hepatitis A
RNA virus
Fecal oral transmission
Acute infection only
No chronic state
Self limiting
Vaccine available
Hepatitis B
DNA virus
Blood and body fluids transmission
Acute or chronic infection
Risk of cirrhosis and hepatocellular carcinoma
Vaccine available
Hepatitis C
RNA virus
Blood transmission
High rate of chronic infection
Risk of cirrhosis and hepatocellular carcinoma
No vaccine
Pharmacological Treatment of Viral Hepatitis
Hepatitis A
Supportive treatment
No specific antiviral
Hepatitis B
Nucleoside analogs
Tenofovir
Entecavir
Interferon alpha
Goals
Suppress viral replication
Prevent cirrhosis
Reduce cancer risk
Hepatitis C
Direct acting antivirals
Sofosbuvir
Ledipasvir
Daclatasvir
Combination therapy
High cure rates
Types of Jaundice
Pre Hepatic Jaundice
Cause
Hemolysis
Increased red blood cell breakdown
Pathophysiology
Increased unconjugated bilirubin
Liver unable to conjugate excess load
Laboratory Findings
Elevated unconjugated bilirubin
Normal liver enzymes
Increased urobilinogen
Hepatic Jaundice
Cause
Hepatitis
Cirrhosis
Drug induced liver injury
Pathophysiology
Impaired conjugation
Impaired excretion
Mixed unconjugated and conjugated bilirubin elevation
Laboratory Findings
Elevated AST ALT
Elevated bilirubin
Post Hepatic Jaundice
Cause
Gallstones
Tumors
Biliary obstruction
Pathophysiology
Conjugated bilirubin cannot reach intestine
Backflow into bloodstream
Laboratory Findings
Elevated conjugated bilirubin
Pale stools
Dark urine
Elevated ALP
Definition
Yellow discoloration of skin sclera and mucosa
Due to elevated bilirubin
diagnosis of hepatitis B virus
Step 1 Check Core Antibody Anti HBc
Core Antibody Not Present
Not infected
Check Surface Antibody Anti HBs
Surface Antibody Present
Vaccinated
Surface Antibody Not Present
Not vaccinated
Susceptible at risk
Give vaccine
Core Antibody Present
Infected at some point
Check Surface Antigen HBsAg
Surface Antigen Present
Currently infected
Surface Antigen Absent
Infected in the past
Resolved infection