Hepatitis B and Cirrhosis
Introduction
The human liver perfoms one of the most vital functions in the body which is detoxification of the blood. The liver basically cleans the blood of toxins such as ammonia and other poisons. Liver damage can occur due to excessive use of medications, excessive alcohol use as well as infections such as hepatitis B. Liver Cirrhosis occurs as a result of damages caused by disease and toxins in the liver. The purpose of this paper is to decipher the impact of hepatitis B on the liver and the cause of bleeding for patients suffering from liver cirrhosis.
Describe the pathophysiology of acute hepatitis B infection.
Hepatitis is the inflammation of the liver due to viral infection by the virus HBV. HBV virus is transmitted through body fluids such as saliva, sweat, semen, mucus and blood. The virus attacks the liver cells damaging the cell’s immune responses that are meant to attack the virus and prevent the body form diseases (Terrault, et al., 2016). When liver cirrhosis can become chronic if the inflammation becomes persistent for a period of more than six months.
Hepatitis b can lead to increased serum levels in some patients. The elevated serum levels mostly occur among children who get infected with hepatitis B as neonates. The patients also show a positive blood test when tested for HBeAg; these patients however have normal levels of alanine aminotransferase (ALT) (Terrault, et al., 2016). Young patients also show minimal levels of histolgic liver damage. Patients with low levels of liver damage are said to be in an immune intolerant phase.
Hepatitis B has an incubation period of approximately twelve weeks where the patient is mostly asymptomatic. After the incubation period, the clinical illness for [patients with acute HBV may range from mild to severe. Less that 1% of hepatitis infected patients get to the acute level of the disease. After the disease resolves, patients may develop antibodies against the diseases surface antigens otherwise known as antigen HbsA leading to full recovery for such patients.
Explain why the early stage of cirrhosis is relatively asymptomatic 200
For the initial stages of liver cirrhosis, patients may fail to show symptoms of liver damage. The symptoms at this stage are often vague and mild. Patients may experience unexplained fatigue, diarrhea, anorexia, loss of body weight and anemia. Some patients may experience a dull pain in the upper quad but may not show any indications of liver damage (European Association for the Study of the Liver, 2018).
The asymptomatic stage of liver cirrhosis is known as compensated cirrhosis. At this stage, the liver is able to perform its normal functions despite the fact that it the liver may be scarred or may have developed fibrosis. The lack of symptoms however is not associated with a better prognosis and both patients with compensated and decompensate cirrhosis require treatment (European Association for the Study of the Liver, 2018). If left untreated, compensated cirrhosis can develop into severe cirrhosis with worse symptoms such as jaundice, inflammatory bowel disease, and patients may also develop rheumatoid arthritis.
Explain why each of the following events occur
Excessive bleeding from trauma
Excessive bleeding due to trauma in liver cirrhosis patients can be caused by poor or incorrect diet. Hard foods, spicy foods and hot beverages can lead to damage of the varicose veins, gastric mucus, or other impairments of the gastrointestinal tract. These damages eventually lead to gastrointestinal bleeding. Overworking can also lead to trauma bleeding (Liu et al., 2016).
When the patients over works, their blood pressure will rise resulting to the bleeding of the damaged varicose veins. Patients should therefore unsure that they have adequate rest to reduce fatigue and improve blood circulation in the liver.
Increased abdominal pressure can lead to trauma those results in bleeding in patients with liver cirrhosis. Excessive diarrhea, vomiting, coughing , heavy lifting, excessive sneezing are some of the factors that lead to abdominal pressure. The increase in abdominal pressure can lead to rapture of the weakened varicose veins (European Association for the Study of the Liver, 2018).
Changes in mood swings can lead to an increase in blood pressure resulting in bleeding. The increased secretion of adrenaline due to mood changes leads to blood pressure increase. Increase in sympathetic activity in the brain and an elevated portal pressure can also result in increased blood pressure leading to the bleeding.
Respiratory tract infections can also lead to trauma bleeding in liver cirrhosis patients. Fever and persistent coughing elevates blood pressure resulting inn increased portal pressure. The increased blood pressure can lead to bleeding of the gastrointestinal tract due to weakened veins and damaged mucus membranes.
Increased serum ammonia levels
One of the functions of the liver is to detoxify the body of ammonia that collects in the blood. When the liver is damaged, there is a disruption of the detoxification process leading to an increase in ammonia levels in the blood. Patients with liver cirrhosis are advised to reduce their protein and carbohydrates consumption. These foods contain amino acids, which when metabolized to produce energy, removes nitrogen from the ammonia. (Dasarathy et al., 2017). A healthy liver is capable of converting the ammonia to urea, but due to liver damage, the ammonia builds up in the blood.
Hand-flapping tremors and confusion.
Hand flapping tremors and confusion can occur due to Hepatic encephalopathy is which is the altered consciousness due to liver failure. Metabolic encephalopathy can also lead to confusion and hand tremors. Metabolic encephalopathy is a disorder of the cerebral function due to toxins in the body as a result of liver damage. Acute hepatic failure can also lead to hand tremors and confusion (Wijdicks, 2016). Acute hepatic failure refers to an acute failure of the liver functions due to drug overdose, excessive alcohol use, hepatitis B infection as well as reactions to some medications such as tetracycline.
References
Dasarathy, S., Mookerjee, R. P., Rackayova, V., Thrane, V. R., Vairappan, B., Ott, P., & Rose, C. F. (2017). Ammonia toxicity: from head to toe?. Metabolic brain disease, 32(2), 529-538.
European Association for the Study of the Liver. (2018). EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. Journal of hepatology, 69(2), 406-460.
Liu, J., Han, L., Zhu, L., & Yu, Y. (2016). Free fatty acids, not triglycerides, are associated with non-alcoholic liver injury progression in high fat diet induced obese rats. Lipids in health and disease, 15(1), 1-9.
Terrault, N. A., Bzowej, N. H., Chang, K. M., Hwang, J. P., Jonas, M. M., & Murad, M. H. (2016). AASLD guidelines for treatment of chronic hepatitis B. Hepatology (Baltimore, Md.), 63(1), 261.
Wijdicks, E. F. (2016). Hepatic encephalopathy. New England Journal of Medicine, 375(17), 1660-1670.