Acute Hepatitis B

Acute Hepatitis B GNUR543 St. John Fisher College Mr. Wilson is a 47 ex dispose of study old man being evaluated for complaints of fatigue, anorexia and abdominal distention. On examination, it is noted that the contend is jaundiced and the coloured enlarged. D. W. denies signifi toilettet alcohol or drug use. He denies any known exposure to hepatitis and has never been vaccinated for hepatitis. He is victorious no medication. Laboratory tests reveal the following and a diagnosis of vivid hepatitis B is made 1. Review and analyze the research laboratory data. What diagnosis is support by these values? Give your rationale. Mr.Wilsons lab trim is reviewed to a lower place * AST142 IU/L * AST (Aspartate aminotransferase) is an enzyme and declension sample results can detect if in that respect is colored footing. AST is found in the heart and colorful with much lower levels in muscles and kidneys. In a healthy person the AST is between 10-40 IU/L. If the coloured-colored is harmd, AST is released into the prodigal stream (Hepatitis B, 2011). * raising120 IU/L * ALT (Alanine aminotransferase), if kick upstairs can too be an indication of coloured damage. ALT is an enzyme that is commonly in the coloured-colored and kidneys. If the case-by-case is healthy, the ALT is low, between 7-56 IU/L.overhead railway ALT is an early indicator of liver damage usually elevating prior to a persevering become jaundice (Hepatitis B, 2011). * GGT 42 IU/L * GGT (Gamma-glutamyl transferase) is an enzyme that is found in the liver but may as well be in the spleen, kidneys and pancreas. As with AST/ALT, GGT is elevated when there is liver damage. The general test range is 0 51 IU/L. GGT leave behind be elevated when there is subtile damage to the liver (or bile ducts) (Hepatitis B, 2011). * Alk Phos 84 IU/L * Alk Phos (Alkaline Phosphatase or ALP) is an enzyme found in the liver, tog out, kidney and GI tract. traffic pattern range for this stock test is 44 147 IU/L.Alk Phos, if elevated broadly speaking indicates that there is a cube in the bile ducts. Also, if it is found to be high this federal agency the unhurried can either have kidney unsoundness or bone complaint. To differentiate, a GGT test is in any case interpreted. If that result is high as well, a liver disease is present if the GGT is within normal limits so the persevering has bone disease (Hepatitis B, 2011). * Total Bilirubin1. 0 mg/dl * Total haematoidin is the product of damaged or broken down red production line cells in the body. The bilirubin is processed through the liver and the normal levels in the body be 0. 3 1. 9 mg/dL.If this level is increased, it means that the liver is not processing the bilirubin due to liver disease (Hepatitis, 2011). * Albumin4. 3 g/dl * Albumin (ALB) measures the level of albumin in the longanimouss plasma. Albumin is a protein that is made in the liver and is sensitive to any changes in liver function. Albumin m ainly ensures that the cells in the body dont leak, keep the tissues nourished and transports vitamins, calcium, hormones through the body. The normal range for Albumin is 3. 4 5. 4 g/dL. Albumin go out-of-door be lower than normal in the case of malnutrition or liver disease (Hepatitis, 2011). HBsAgpositive * Anti-HBSnegative * Anti-HCVnegative * HIVnegative Test Name Mr. Wilsons Result Normal Ranges AST 142 IU/L 10-40 IU/L Elevated ALT 120 IU/L 7-56 IU/L Elevated GGT 42 IU/L 0 51 IU/L Normal Alk Phos 84 IU/L 44 147 IU/L Normal Total Bilirubin 1. 0 mg/dl 0. 3 1. 9 mg/dL Normal Albumin 4. 3 g/dl 3. 4 5. 4 g/dL Normal Mr. Wilsons labs indicate that he has degenerative Hepatitis B. This is chronic because the indicators for subtle liver damage ar within normal limits. For example, if the patient were having an smashing onset of Hepatitis B his Albumin would be low.Albumin is made in the liver and is very sensitive to any changes in the liver. If there was corking damage to the liver the Albumin value would not be in normal range. Also, Mr. Wilsons bilirubin would be higher if he was having acute hepatitis B. For the skin to be noticeably jaundiced the bilirubin level would usually be 2. 0 mg/dL (Hepatitis, 2011). The patients GGT would be elevated also if he was experiencing an acute episode of hepatitis B. Additional tests that might be accommodating to making an accurate diagnosis would be IgG-anti-HBc and IgM-anti-HBc.These tests show if the hepatitis is acute or chronic. The IgG-anti-HBc is positive if the patient is chronically polluteed. The IgM-anti-HBc would show positive if the patient is aggressively infected with hepatitis B. The HBs-Ag exit be positive in both acute and chronic cases. See the table below for an overview of the assessment and tests that be generally given when a new Hepatitis B diagnosis is reached. (Lok A. S. , 2011) 2. Explain the hepatocellular changes that top with the above diagnosis. The liver has numerous roles in the body that associate it with many systems.For example, it acts as a digestive organ by secreting bile for the partitioning of fat (Copstead, 2010). The liver also removes bilirubin from the fund, temporarily stores blood and synthesizes the blood coagulate factors (Copstead, 2010). Other functions of the liver are removing toxins from the blood, metabolizing both sex hormones and steroid hormones. Any damage to the liver can in turn disrupt any of these processes and functions that it performs. Some of the processes and functions can be changed in the following ways * Liver inflammation Inflammation in chronic hepatitis is associated with scarring.Severe inflammation can bridge together portal tracts within the liver, this is called bridging necrosis (Mani & Kleiner, 2009). It can also bridge to central veins, confluent necrosis (Mani & Kleiner, 2009). This leads to scarring, the creation of fibrous strands and in many cases will lead to fibrosis. Throughout the li ver cells are becoming damaged therefore blocking and limiting the livers functionality. Hormone secretion, chemicals and toxins in the blood, clotting factors and other defense fighting macrophages are interrupted (Copstead, 2010).Along with the inflammation, the patient will feel fatigued and will have a lowered immunity. * Ascites and marginal edema Abdominal distention, ascites, is a result of the damaged cells within the liver and to a greater extent specifically the membrane of the cell has been damaged. There is an intra-abdominal buildup of sodium, water and protein. The cells in the liver are unable to maintain the appropriate osmotic slope across the pleura (Copstead, 2010). This extra fluid is likely to accumulate in the pendent areas of a persons body, such as ankles, legs, and arms (Kukka, 2010). acrimony Red blood cells have a short life authorise and as they die and/or are damaged the body will break them down and dispose of them. This is referred to as bilirubi n metabolism and this happens in three phases pre, intra and posthepatic. (Copstead, 2010). The red blood cells should be broken down, delivered to the liver and then transported through the biliary system and thus be wasted via the kidneys or the colon. With damaged liver cells, the bilirubin is not excreted from the liver and there is a buildup of the conjugated bilirubin and the result is jaundice (Copstead, 2010).Other changes due to the liver damage are portal hypertension, gastric and esophageal varacies, vitamin mal-absorption, poor blood clotting and altered mental status (Copstead, 2010). The liver has such removed reaching effect on so many organs and systems in the body that any damage to the liver will result in decreased functioning of other systems. Immediate tests to determine the cause and extend of the damage would be imperative to managing the disease going forward. 3. How should the disease be managed and monitored? Explain your rationale.If pharmacotherapeutics are employ, explain your rationale and their mechanism of action. First go would be to order additional labs including, IgM-anti-HBc, IgG-anti-HBc, HBeAg, HBV deoxyribonucleic acid, CBC with PT and electrolytes. In cases of acute hepatitis B, symptoms sometimes go unnoticed. The computer virus will normally go away on its own and if treatment is given, it is for the symptoms and most adults recover fully (Hepatitis B, 2011). save in the case of chronic HBV, the patient will need to be monitored to see if the virus is replicating (Lok A. S. , 2011). In patients with chronic HBV, the treatment oals are to trim the long term effects of liver damage, prevent the transmission of the virus to others and manage any complications along the way (Lok A. S. , 2011). A clear diagnosis of chronic hepatitis B is needed. Results of blood work will determine the course of treatment. In Mr. Wilsons case, with only the first lab results, it appears that he is in the active chronic infection stag e. At this take aim the liver damage is still minimal. Because there does not seem to be significant liver damage a liver biopsy would not be indicated at this point (Lok A. S. , 2011).As the practitioner, I would recommend more blood tests, as noted above, and current monitor of the virus every few months. This will help in determining the activity of the virus. The medications use to treat chronic hepatitis B tend to have serious side effects. The patient essential be will to make a commitment to continue the therapy and adhere to close monitoring during any drug treatments (Hepatitis B, 2011). Supportive medicines are important to assist in treating side effects of the virus. For example, diuretics are prescribed if edema is not resolution on its own.Vitamins and minerals are indicated if labs show deficiency due to decreased liver function. If it is determined that Mr. Wilsons virus is active (meaning he is able to infect others) there are new drugs available to choose from. Antiviral treatments accept (Hepatitis, 2011) 1. Entecavir a. A oral contraceptive taken once a day for up to a year b. Used when DNA viral cells are actively replicating 2. Interferon Alpha c. Injection a few times per week for up to a year d. Used when patient has compensated liver disease 3. Pegylated Interferon e. Injection once per week for up to a year f.Used when patient had compensated liver disease and evidence of viral replication and liver inflammation 4. Lamivudine g. A yellow journalism taken once a day for a year or more h. Used when patient has active liver inflammation and active viral replicating 5. Adefovir Dipivoxil i. A pill taken once a day for a year or more j. Used in patients with chronic HBV 6. Telbivudine k. A pill taken once a day for a year or more l. Used in patients with active viral replication, persistent elevations in ALT or AST or histologically active disease 7. Tenofovir m. A pill taken once a day for a year or more n. Used in patients with chronic HBVThe medicines listed above are used alone or more likely in conjunction with others. These are currently the only hepatitis B drugs that are approved by the FDA (Lok & McMahon, 2009). fit in to the American tie-in for the Study of Liver Diseases (AASLD) Practice Guidelines, the ultimate tendency of therapy is to suppress the replication of the virus and put the liver disease into remission (Lok & McMahon, 2009). This is monitored by delaying the patients ALT, AST and other liver, viral and blood tests. The viral tests are imperative to determine the proper adjustments in medications.For example, interferon has been shown to reduce the viral replication and inducing liver disease remission (Lok & McMahon, 2009). Also, a newer drug, tenovir has shown significant forebode in reducing viral levels in patients as compared to adefovir (Lok & McMahon, 2009). Practitioners need to watch for resistance as well when using the anti-viral drugs. As noted, the drugs are used in combination as well and these have shown to be more effective than when they are used alone. The effects of combined usage are better antiviral effects and delayed resistance (Lok & McMahon, 2009).Mr. Wilsons ALT, HBeAg lab values and his HBV DNA will be a main classical to the type of therapy he will receive. A liver biopsy will be indicated later on if hisHBsAg is positive for more than six months, his serum HBV DNA is greater than 20,000 IU/mL and he has persistent or intermittent elevations in his ALT/AST levels (Kukka, 2010). Summary Hepatitis B can be chronic or acute. When a person has acute hepatitis B they generally dont even notice and never need treatment. If treatment is needed it is adjunct treatment for the symptoms of the acute virus infection.Chronic hepatitis B patients are at endangerment for cirrhosis and HCC (hepatic cellular carcinoma) (Kukka, 2010). Patients that have chronic HBV need to be amend on the risk of infecting others and will, in some cases, need to alter their life style to protect others from getting the virus. Treatment is dependent on the blood work up that is obtained. It is very important that a patient that goes on antiviral treatment remain on it to reduce drug resistant strains. Also, patients must be evaluated and treated for the side effects of the anti-virals as well as the symptoms of other affected organs and systems in the body.References Copstead, L. -E. C. (2010). Pathophysiology. St. Louis Saunders. Hepatitis. (2011, July 6). Retrieved swear out 26, 2012, from Lab Tests Online http//labtestsonline. org Hepatitis B. (2011, July 6). Retrieved March 25, 2012, from Lab Tests Online http//labtestsonline. org Hepatitis B. (2011, September 1). Retrieved March 24, 2012, from Mayo Clinic http//www. mayoclinic. com/health Kukka, C. M. (2010). Hepatitis B concomitant Sheet. HCSP Publications. Lexicomp. (2012). Retrieved February 5, 2012, from Lexicomp https//online-lexi. com Liver Blood Tests. (2012, March 28).Ret rieved March 30, 2012, from e Medicine health http//www. emedicinehealth. com/ Lok, A. S. (2011, February 16). Overview of the management of hepatitis B. Retrieved March 24, 2012, from UpToDate http//www. uptodate. com Lok, A. S. , & McMahon, B. J. (2009). Chronic Hepatitis B Update 2009. Alexandria American Association for the Study of Liver Diseases. Mani, H. , & Kleiner, D. E. (2009, May 1). Liver Biopsy Findings in Chronic Hepatitis B. Retrieved April 1, 2012, from University of Pennsylvania, discussion section of Medicine http//webdev. med. upenn. edu