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Liver Disorders

Liver Disorders. John Nation, RN, MSN Fall 2011 From the notes of Charlene Morris, RN, MSN Austin Community College. Overview of Today’s Lecture. A & P Review Hepatitis A Hepatitis B Hepatitis C Cirrhosis Portal Hypertension Esophageal Varices Hepatic Encephalopathy

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Liver Disorders

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  1. Liver Disorders John Nation, RN, MSN Fall 2011 From the notes of Charlene Morris, RN, MSN Austin Community College

  2. Overview of Today’s Lecture • A & P Review • Hepatitis A • Hepatitis B • Hepatitis C • Cirrhosis • Portal Hypertension • Esophageal Varices • Hepatic Encephalopathy • Hepatorenal Syndrome • Liver Transplant

  3. A and P Review

  4. A and P Review Largest internal organ-weighs around 3 lbs!

  5. A Liver B Hepatic vein C Hepatic artery D Portal vein E Common bile duct F Stomach G Cystic duct H Gallbladder

  6. Blood Supply – 2 sources Hepatic artery: 500ml/min of oxygenated blood. 30% of Cardiac output goes to the liver Portal vein – 1000ml/min partly oxygenated blood supplies 50 - 60% O2 plus rich supply of nutrients, toxins, drugs from stomach, small and large intestines, pancreas and spleen

  7. Hepatic Blood Supply (Cont’d) • Both empty into capillaries/sinusoids • Liver filters the blood • Hepatic vein to inferior vena cava

  8. Lobule – Functional unit of the liver Capillaries

  9. Metabolic Functions of the liver “Body’s Refinery” Over 400 functions Primary role in anabolism and catabolism

  10. Metabolic Functions of the Liver 1. Metabolism of Glucose 2. ProteinStorage 3. Fatty acids 4. Cholesterol

  11. Other functions Immunologic Blood storage Plasma protein synthesis Clotting Waste products of hemoglobin Formation and secretion of bile Steroids and hormones Ammonia Drugs, alcohol and toxins metabolism

  12. To Summarize…. The liver: • changes food into energy • removes alcohol and poisons from the blood • makes bile, a yellowish-green liquid that helps with digestion

  13. Hepatitis Simply means inflammation of the liver “itis” means inflammation, “hepa” means liver. Viral hepatitis Most common cause Viral types include A, B, C, D, E, and G

  14. Hepatitis Other possible causes Drugs (alcohol) Chemicals Autoimmune liver disease Bacteria (rarely)

  15. Hepatitis Etiology Causes A, B, C, D, E, and G virus Cytomegalovirus Epstein-Barr virus Herpes virus Coxsackie virus Rubella virus

  16. Hepatitis A Hepatitis A virus (HAV) RNA virus Transmitted fecal–oral route, parenteral (rarely) Frequently occurs in small outbreaks

  17. Hepatitis A 61,000 cases of hepatitis A occur annually in the United States 10 million cases of hepatitis A occur worldwide Nearly universal during childhood in developing countries

  18. Hepatitis A Hepatitis A virus (HAV) Found in feces 2 or more weeks before the onset of symptoms and up to 1 week after the onset of jaundice Present in blood briefly No chronic carrier state

  19. Hepatitis A:Incubation Period 2-6 weeks Acute onset Mild flu-like manifestations Symptoms last up to 2 months Liver usually repairs itself, so no permanent effects

  20. Hepatitis A Hepatitis A virus (HAV) Anti-HAV immunoglobulin M (IgM) Appears in the serum as the stool becomes negative for the virus Detection of IgM anti-HAV indicates acute hepatitis

  21. Hepatitis A Hepatitis A virus (HAV) Anti-HAV immunoglobulin G (IgG) IgG anti-HAV: Indicator of past infection Presence of IgG antibody provides lifelong immunity

  22. Hepatitis A:Mode of Transmission Mainly by ingestion of food or liquid infected with the virus Poor hygiene, improper handling of food, crowding housing, poor sanitation conditions are all factors related to Hepatitis A

  23. Hepatitis A:Mode of Transmission (Cont’d) Occurs more frequently in underdeveloped countries Contaminated waters Drinking water, contaminated seafood Food-borne Hepatitis A outbreaks usually due to infected food handler Contamination of food during preparation

  24. Hepatitis A: Vaccine 2 doses IM Initial dose Booster in 6 to 12 months

  25. Post-exposure Prophylaxis Standard IG-immune globulin Given IM within 2 weeks of exposure Hepatitis A Vaccine IG is recommended for persons who do not have anti-HAV antibodies and have had food borne exposure or close contact with HAV-infected person

  26. Remember 2/2/2/2 Rule 2 doses IM for vaccination Signs & symptoms last 2 months Contagious 2 weeks before signs & symptoms Post-exposure dose given IM within 2 weeks of exposure Must report within one day

  27. Hepatitis B Nearly 400 million people infected with Hepatitis B 50% to 75% active viral replication 73,000 new cases of Hepatitis B annually in United States Incidence decreased due to HBV vaccine

  28. Hepatitis B Hepatitis B virus (HBV) DNA virus Transmission of HBV Perinatally by mothers infected Percutaneously (IV drug use) Mucosal exposure to infectious blood, blood products, or other body fluids

  29. Hepatitis B Hepatitis B virus (HBV) Transmission occurs when infected blood or other body fluids enter the body of a person who is not immune to the virus

  30. Hepatitis B Hepatitis B virus (HBV) Sexually transmitted disease Can live on a dry surface for 7 days More infectious than HIV

  31. Hepatitis B- PrecautionsSource: Uptodate • PREVENT INFECTION OF FAMILY — Acute and chronic hepatitis B are contagious. Thus, people with hepatitis B should discuss measures to reduce the risk of infecting close contacts. This includes the following: • Discuss the infection with any sexual partners and use a latex condom with every sexual encounter. • Do not share razors, toothbrushes, or anything that has blood on it. • Cover open sores and cuts with a bandage. • Do not donate blood, body organs, other tissues, or sperm.

  32. Hepatitis B- PrecautionsSource: Uptodate • Immediate family and household members should have testing for hepatitis B. Anyone who is at risk of hepatitis B infection should be vaccinated, if not done previously. (See "Patient information: Adult immunizations".) • Do not share any injection drug equipment (needles, syringes). • Clean blood spills with a mixture of 1 part household bleach to 9 parts water.

  33. Hepatitis B- Prevention Hepatitis B cannot be spread by: • Hugging or kissing* (some disagreement) • Sharing eating utensils or cups • Sneezing or coughing • Breastfeeding Source: Uptodate

  34. Hep B Incubation Period 6-24 weeks Prevention Vaccine-3 doses Initial dose Dose at 4 weeks Dose 5 months later

  35. Post-exposure Hep B Hepatitis B Immune globulin IM in 2 doses First dose within 24 hours to 7 days of exposure Second dose 20 to 30 days post-exposure Provides short-term immunity Give HBV vaccine concurrently- vaccine can be beneficial post- exposure

  36. Hepatitis B Hepatitis B virus (HBV) Complex structure with three antigens Surface antigen (HBsAg) Core antigen (HBcAg) E antigen (HBeAg) Each antigen—a corresponding antibody may develop in response to acute viral Hepatitis B

  37. Hepatitis B Virus Presence of Hepatitis B Surface Antibodies Indicates immunity from HBV vaccine Past HBV infection With chronic infection, liver enzyme values may be normal or ↑ 15% to 25% of chronically infected persons die from chronic liver disease

  38. Hepatitis C Approximately 170 million people are infected with the hepatitis C virus (HCV) Estimated 30,000 new cases diagnosed annually

  39. Hepatitis C 8000 to 10,000 people in the United States die each year from complications of end-stage liver disease secondary to HCV Approximately 30% to 40% of HIV-infected patients also have HCV

  40. Hepatitis C Hepatitis C virus (HCV) Transmitted primarily percutaneously Risk factors IV drug use Most common mode of transmission in United States and Canada Blood transfusions

  41. Hepatitis C Hepatitis C virus (HCV) Risk factors (cont’d) High-risk sexual behavior Hemodialysis Occupational exposure Perinatal transmission

  42. Hepatitis C:Transmission Hepatitis C virus (HCV) Up to 10% of patients with HCV cannot identify a source Risk of body piercings, tattooing, and intranasal drug use in transmission of HCV

  43. Hepatitis CDiagnostic Studies Anti-HCV antibody HCV RNA

  44. Hepatitis C Interventions • Harm Reduction - Austin Harm Reduction Coalition

  45. Hepatitis D Hepatitis D virus (HDV) Also called delta virus Defective single-stranded RNA virus Cannot survive on its own Requires the helper function of HBV to replicate

  46. Hepatitis D Hepatitis D virus (HDV) (cont’d) HBV-HDV co-infection ↑ Risk of fulminant hepatitis More severe acute disease

  47. Hepatitis E Hepatitis E virus (HEV) RNA virus Transmitted fecal–oral route Most common mode of transmission is drinking contaminated water Occurs primarily in developing countries

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