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Hepatitis A virus (HAV)
- formerly known as infectious hepatitis
- symptoms develop 2-6 weeks after exposure
- water or food is usual source of infection
- mild in children, more severe in adults
- causes little to no liver damage
- immunoglobulin injections provide protection for people exposed to it
- treatments include Hep A vaccine or Twinrix (also protects against Hep B)
- exposure provides lifetime immunity
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Hepatitis B virus (HBV)
- formerly known as serum hepatitis
- symptoms develop 2-6 months after exposure
- fulminating form is sudden in onset, progresses rapidly and is fatal
- increases risk for liver damage, including cirrhosis and liver cancer
- treatments include Hep B vaccine, Hep B immune globulin or Twinrix
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Hepatitis C virus (HCV)
- most HCV infected people have no symptoms
- may not learn of infection until liver damage found during routine medical tests decades later
- ~20% of those affected develop cirrhosis and some will develop end-stage liver disease
- disease persists for months or years
- treatments include antiviral medications or liver transplant for end-stage liver disease
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Hepatitis D virus (HDV)
- uncommon, unique infection requires HBV to replicate and infect other hepatocytes
- more common in adults than children
- higher incidence in IV drug users and in persons from the Mediterranean basin
- complete clinical recovery and clearance of HBV and HDV co-infection is most common outcome
- complication: chronic infection with HBV and HDV in less than 5% of patients
- complication: co-infection or superinfection with HBV and HDV which may result in fulminant liver failure in 1-5% of patients
- some patients may develop cirrhosis and possibly progress to hepatocellular carcinoma
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Hepatits E virus (HEV)
- very rare in US but leading cause of infectious hepatitis epidemics worldwide (third world countries)
- not recognized as a distinct human disease until 1980 by WHO
- transmitted primarily through fecal-contaminated drinking water
- symptoms develop 3-8 weeks after exposure
- no commercially available vaccine exists for prevention
- no evidence that Hep E progresses into chronic disease
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Cirrhosis of the liver
- chronic liver disease characterized by replacement of liver tissue by fibrous connective tissue, scar tissue and regenerative nodules
- all changes result in liver dysfunction
- normal liver is very organized, cirrhotic liver disorganized (central vein is absent, nodules of parenchyma encircled by fibrous septa)
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Causes of cirrhosis of the liver
- alcoholism
- Hep B & C
- non-alcoholic fatty liver disease
- chronic inflammation of the bile ducts
- iron or copper accumulation in the liver
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Stages of liver damage
- liver enlarges
- impaired circulation
- other abdominal organs swell
- spontaneous hemorrhaging may occur
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Signs and symptoms of cirrhotic liver
- ascites
- hypoalbuminemia
- jaundice
- estrogen accumulation in men
- testicular atrophy
- neurological disorders
- hepatic coma
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Treatment for cirrhosis of the liver
- no effect treatment to reverse damage
- treat edema with diuretics
- treat portal vein hypertension with beta-adrenergic receptor antagonists
- liver transplant
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Hepatocellular carcinoma (liver cancer)
- primary malignancy
- rare with a high mortality rate
- more common in Africa & Asia
- caused by viral Hep B, C virus; cirrhosis or aflatoxin
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Symptoms of liver cancer
- weight loss
- enlarged abdomen
- pain in upper right quadrant
- easy bruising or bleeding
- ascites (if tumor blocks portal vein)
- jaundice (if tumor blocks biliary ducts)
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Tests and diagnosis for liver cancer
- liver enzymes
- abdominal CT scan/ultrasound
- liver biopsy
- liver nuclear scan
- serum alpha-fetoprotein
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