SEMINAR

• Hepatobiliary / Endocrine


  • A. Hepatitis
  • B. Cholelithiasis
  • C. Liver Cirrhosis
  • D. Pancreatitis
  • E. Diabetes Mellitus

  
• Perception / Coordination


  • A. Cerebrovascular Accident
  • B. Myasthenia Gravis
  • C. Multiple Sclerosis
  • D. Guillain Barre Syndrome (GBS)

  
• Tropical Diseases


  • A. Schistosomiasis
  • B. Filariasis
  • C. Soil Transmitted Helminthiasis
  • D. Food-borne Trematodiasis
  • E. Rabies
  • F. Leprosy

  
• Hepatitis


  An inflammation of the liver. The liver is a vital organ that processes nutrients, filters blood, and fights infections. When the liver is inflamed or damaged, its function can be affected.

  
• Hepatitis


  • It can be caused by a variety of infectious viruses and non-infectious agents: heavy alcohol use, toxins, and some medical conditions
  • There are five main strains of the hepatitis virus: Type A, B, C, D, and E
  • The most common types of viral hepatitis in the United States are Hepatitis A, B, and C
• Acute hepatitis


  Flares up suddenly and then goes away
• Chronic hepatitis


  A long-term condition usually producing more subtle symptoms and progressive liver damage
• Hepatitis A virus (HAV)


  Present in the feces of infected persons and is most often transmitted through consumption of contaminated water or food
• Hepatitis B virus (HBV)


  Transmitted through exposure to infective blood, semen, and other body fluids
• Hepatitis C virus (HCV)


  Mostly transmitted through exposure to infective blood
• Hepatitis D virus (HDV)


  Infections occur only in those who are infected with HBV
• Hepatitis E virus (HEV)


  Mostly transmitted through consumption of contaminated water or food
• Hepatitis B and C lead to chronic disease in hundreds of millions of people and together are the most common cause of liver cirrhosis, liver cancer, and viral hepatitis-related deaths

  
• Liver


  A large organ in the abdomen that performs many important functions, including filtration, digestion, metabolism, and detoxification
• The liver is a dark reddish-brown organ that is shaped like a cone and weighs about 3 pounds

  
• Signs and symptoms of hepatitis

  • Fever
  • Fatigue
  • Nausea
  • Flank pain
  • Jaundice
  • Dark urine

  
• Causes of hepatitis


  • Fecal-oral transmission (food, water)
  • Blood/body fluid transmission (unsafe sex, IV drug use, needles/syringes, long-term dialysis, Hepatitis B co-infection)

  
• Pathophysiology of hepatitis


  • The hepatitis virus infects liver cells and causes an immune response leading to inflammation and liver damage
  • Acute hepatitis has symptoms for up to 6 months, chronic hepatitis has symptoms for longer and can lead to cirrhosis

  
• Types of hepatitis


  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Hepatitis D
  • Hepatitis E
• Diagnostic tests for hepatitis

  • Hepatitis A: Anti-HAV IgM, Anti-HAV IgG
  • Hepatitis B: HBsAg
  • Hepatitis C: Anti-HCV

  
• Hepatitis A


  • Poor hygiene
  • Poor sanitation
• Diagnostic Tests


  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Hepatitis D
  • Hepatitis E
• Anti-HAV IgM


  Hepatitis A immunoglobulin M (IgM anti-HAV) antibody test: When a person is first infected with hepatitis A, the body produces IgM anti-HAV antibodies. These antibodies are usually detectable from two weeks after symptoms begin to around six months later.
• Anti-HAV IgG


  IgG antibodies are detectable in the body for life, providing protection against a future hepatitis A virus infection. The IgG anti-HAV test is used to detect past HAV infections and may occasionally be used to determine if an individual has developed immunity from a previous infection or vaccination.
• HBsAg


  Hepatitis B surface antigen. A "positive" or "reactive" HBsAg test result means that the person is infected with hepatitis B. This test can detect the actual presence of the hepatitis B virus (called the "surface antigen") in your blood. If a person tests "positive," then further testing is needed to determine if this is a new "acute" infection or a "chronic" hepatitis B infection. A positive HBsAg test result means that you are infected and can spread the hepatitis B virus to others through your blood

  
• Anti-HBs


  Hepatitis B surface antibody. A "positive" or "reactive" anti-HBs (or HBsAb) test result indicates that a person is protected against the hepatitis B virus. This protection can be the result of receiving the hepatitis B vaccine or successfully recovering from a past hepatitis B infection. This test is not routinely included in blood bank screenings. A positive anti-HBs (or HBsAb) test result means you are "immune" and protected against the hepatitis B virus and cannot be infected. You are not infected and cannot spread hepatitis B to others.
• Anti-HBc


  Hepatitis B core antibody. A "positive" or "reactive" anti-HBc (or HBcAb) test result indicates a past or current hepatitis B infection. The core antibody does not provide any protection against the hepatitis B virus (unlike the surface antibody described above). This test can only be fully understood by knowing the results of the first two tests (HBsAg and anti-HBs). A positive anti-HBc (or HBcAb) test result requires talking to your health care provider for a complete explanation of your hepatitis B status.
• Anti-HDV


  The test aids in – Diagnosing HDV infection in the person. It helps to determine the rate of anti HDV antibody testing in the patients infected with HBV. Through the test, it aids in interferon treatment. To investigate the possible association of anti HDV antibody IgM with grade and the stage of liver disease
• Antibodies HEV


  • Anti-HEV IgG is the serologic test of choice to determine past exposure to HEV.
  • Positive results indicate past or resolved hepatitis E infection.
  • Negative results indicate absence of previous exposure to hepatitis E virus (HEV).
  • Borderline results may be seen in acute or recent hepatitis E infection with rising level of anti-HEV IgG or cross-reactivity with nonspecific antibodies (ie,false-positive results). Repeat testing of serum for anti-HEV IgG in 4 to 6 weeks is recommended to determine the definitive HEV infection status.
• Telbivudine (Tyzeka)


  An antiviral agent/ antiretroviral agent/ hepatitis B agent. Used for chronic (long term) hepatitis B infection (swelling of the liver caused by a virus) in people who may also show signs of liver damage. Telbivudine is in a class of medications called nucleoside analogues. It works by decreasing the amount of hepatitis B virus (HBV) in the body.

  
• Sofosbuvir (Sovaldi)


  A nucleotide polymerase inhibitors. Used along with ribavirin and sometimes another medication to treat certain types of chronic hepatitis C in adults. Sofosbuvir is also used along with ribavirin to treat certain types of chronic hepatitis C in children 3 years of age and older.
• Gallstones


  Solid, inorganic aggregates that develop in the biliary tract as a result of localized matter accumulation, particularly from mineral salts that are present in the body
• Gallstones


  • Brought on by an imbalance in the bile's chemical composition in the gallbladder
  • An abnormal spike in cholesterol causes the extra cholesterol to crystallize into stones
  • Lack of bile salts and excessive bilirubin are two other causes of gallstones
• Signs and Symptoms of Gallstones


  • Nausea and vomiting
  • Pain in upper right section of the abdomen
  • Biliary Colic
  • Jaundice/ Sclera Icterus and Dark-colored Urine
  • Fever
  • Chronic diarrhea
  • Pale Stool

  
• Predisposing Factors for Gallstones


  • Age (40 and above) - more cholesterol absorption but bile salt discharges and gallbladder contraction decreases
  • Sex (Female) - progesterone
  • Family History
  • Ethnicity
• Precipitating Factors for Gallstones

  • Obesity
  • High fat diet
  • Weight loss
  • Diabetes
  • Estrogen
  • Crohn's Disease
• Diagnostic Tests for Gallstones


  • Abdominal Ultrasonography
  • Cholescintigraphy
  • Oral cholecystography
  • Endoscopic Retrograde Cholangiopancreatography (ERCP)
• Drug Management for Gallstones

  • Gallstone Dissolution Agent -Ex. Ursodiol
  • Nonsteroidal anti-inflammatory drugs - Ex. Ibuprofen
  • Opioids
• Surgical Management for Gallstones

  • Laparoscopic Cholecystectomy
  • Choledochostomy
• Liver Cirrhosis


  Damage to the liver develops over time, preventing it from functioning normally