Topic 8 Liver, Pancreas, Biliary Tract, Female Reproductive

• What is hepatitis?

  Inflammation of the liver.
• The most common cause of hepatitis is viral infection.
• How is hepatitis A transmitted?

  Fecal to oral.
• How is hepatitis B transmitted?

  Hepatitis B is transmitted through contact with infected blood or other body fluids, such as semen or vaginal fluids.
• How is hepatitis C transmitted?

  Blood or blood products, needles and syringes, sexual contact.
• Hepatitis A is most infectious during the 2 weeks before onset of symptoms.
• Hepatitis A is infections until 1 - 2 weeks after the start of symptoms.
• Hepatitis B is infectious before and after symptoms appear, can be infectious for months, and carriers continue to be infectious for life.
• Hepatitis C is infectious 1 - 2 weeks before symptoms appear, continues during clinical course and 75 - 85% go on to develop chronic HCV and remain infectious.
• HAV is self limiting, causes flu like illness and jaundice, and is an RNA virus.
• The presence of HAV antibodies HAV IgM indicate acute hepatitis and stay high for about 8 weeks.
• HAV IgG without HAV IgM indicates past infection and HAV IgG provides lifelong immunity.
• How can you prevent HAV?

  Vaccination and handwashing.
• Hepatitis B or HBV is a DNA virus.
• Where is the greatest prevalence of HBV?

  Sub-Saharan Africa, Western Pacific Regions, and Southeast Asia.
• Sexual transmission is a common mode of HBV transmission with MSM at an increased risk for HBV.
• HBV has a higher incidence among Asian Americans and Pacific Islanders.
• HCV has a higher incidence and deaths are more common in Blacks.
• Primary liver cancer has the highest incidence in Hispanics.
• Pancreatic cancer occurs more often among Black.
• Whites and Native Americans have the highest incidence of gallbladder disease.
• What is screened for when looking for HBV?

  HBsAg the surface antigen, anti-HBs the antibodies, anti-HBc the core antibody.
• Presence of anti-HBs in the blood indicate immunity to HBV or from past HBV infection.
• HBsAg in the serum for 6 months or longer after infection indicates chronic HBV infection.
• Hepatitis C or HCV can result in both acute illness or chronic infection.
• Acute HCV can be hard to detect unless a diagnosis is made with laboratory testing.
• The most common causes of acute HCV outbreaks are among IV drug users and MSM with HIV infection.
• The only way to distinguish the type of viral hepatitis is by testing blood for specific antigens or antibodies.
• What does an elevated alkaline phosphatase level mean?

  Impaired excretion of liver.
• What does an elevated GGT mean?

  Liver cell injury.
• What does elevated AST and ALT mean?

  Liver cell injury.
• What does a prolonged Prothrombin time mean?

  Decreased prothrombin production by the liver.
• What does decreased albumiun and globulin mean?

  Liver cell injury and impaired clearance from liver.
• What does elevated bilirubin mean?

  Liver cell injury.
• Liver biopsies are done in acute hepatitis if the diagnosis is in doubt.
• A noninvasive assessment of liver fibrosis that can replace liver biopsy is ultrasound elastography (Fibroscan) to determine the degree of liver fibrosis.
• Magnetic resonance elastography (MRE) is another noninvasive imaging technique to measure liver fibrosis.
• FibroSure (Fibrotest) uses biomarkers and serum test results to assess the extend of liver fibrosis.
• For hepatitis patients, avoid alcohol and notify contacts for testing and prophylaxis if needed.
• Preoperative care before a liver biopsy involves getting consent and checking PT and PTT for bleeding disorders.