- Located at the upper right quadrant of the abdomen
- Stellate reticuloendothelial (Kupffer) cell – destroys worn out WBC and RBC, bacteria and other foreign matter
- Hepatocytes produce bile stored in the gallbladder
- Functions:
- Carbohydrate, lipid, protein metabolism
- Process drugs and hormones
- Excretion of bilirubin and bile salts
- Activation of Vit D
- Storage of ADEK, iron, copper
- Phagocytosis
- Hepatitis
- Inflammation of the liver due to damage with hepatic cells degeneration and necrosis
- Caused by infection, hepatotxins like medications
- Viral hepatitis involves widespread inflammation of the liver and the most common cause of hepatitis
- 5 types of hepatitis virus are named: Hepatitis Virus A, B, C, D, and E
- Other types of hepatitis are alcoholic hepatitis and toxic non viral hepatitis
- Hepatitis A
- IP: 15-45 days
- Fecal- oral route
- Often occurs in crowded living conditions
- From contaminated foods
- Hepatitis B
- IP: 50-180 days
- Transmitted by blood and body fluids
- Often by contaminated needles
- Polygamous sexual contact
- Hepatitis C
- IP: 7-50 days
- Transmission same as HBV
- 40 % of cases leads to chronic liver disease
- Hepatitis D
- IP: 14-56 days
- Same as HBV
- Co infects people w/ HBV
- Commonly seen in drug abuser
- Hepatitis E
- IP: 15-64 days
- Fecal oral route, usually water-borne
- Alcoholic hepatitis
- Caused by heavy alcohol ingestion
- Often leads to liver cirrhosis
- Toxic non viral hepatitis
- Exposure to hepatotoxic drugs paracetamol, aspirin, isoniazid, tetracycline
- Clinical manifestations (divided into 3 stages)
- Pre-icteric stage
- Fatigue, malaise, anorexia, nausea and vomiting, constipation or diarrhea, abdominal discomfort, RUQ pain, weight loss, hepatomegaly
- Elevated AST, ALT, and bilirubin
- Icteric stage
- Jaundice, pruritus, fatigue, malaise, n&v, large tender liver
- Dark urine, light colored stools
- Post icteric stage
- Fatigue, decreasing jaundice, improved appetite
- Decreasing of hepatomegaly, stool and urine color return to normal
- Diagnostics
- Serum AST, ALT, bilirubin, blood glucose,
- Liver biopsy
- Ultrasound
- Specific diagnostics for Viral hepatitis
- Hepatitis A
- HAV on stool before onset of dse
- Presence of anti HAV(IgM) confirms dx in acute stage
Anti HAV (IgG) indicates previous infection HAV and provides lifelong immunity
- Hepatitis B
- Hepatitis B surface antigen indicates acute infection
- Hepatitis B e antigen (HBVeAg) infection disappears before jaundice
- Antibody to HB surface antigen indicates immunity and HBV vaccination
- Hepatitis C
- HCV antigen and antibodies
- ELISA
- Hepatitis D
- HDV antibodies titer
- Hepatitis E
- Anti HEV
- Management: based on presenting signs and symptoms
- Dramamaine for severe nausea
- IVF to prevent dehydration
- Vit B complex
- Vit K
- Nursing intervention
- Small frequent meals of low Na, low fat, moderate to high protein, high CHO,
- Bed rest for 1-2 weeks gradually increasing activity as tolerated
- Skin care
- Abstain from alcohol
- Increase fluid intake
- Administer medications as ordered
- Give daily vitamins supplements
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