git 2 part 2 ( hepatitis ) upload.pdf

GIT Dr. Shaf3y

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G.I.T.

152013

Fulminant Hepatic Failure diseases Liver

8 weeks

infection hepatitis yellow fever

drugs paracetamol

paracetamol poisoning suicidal

Halothane

halothane general anesthesia

fulminant hepatic failure

As an allergic manifestationsdose fulminant hepatic failure

allergy dose

intoxication high dose

hypersensitivity

dose manifestations

intoxication dose

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Halothane Hypersensitivity

INH

INH T.B.

T.B. hepatotoxic

Hypersensitivity

drugs

toxins fulminant hepatic failure

Alcohol

ethyl alcohol

methanol

Methanol

ethyl alcohol

ethyl alcohol

Methanol toxic

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Anyway



toxins

300400

poisoning


Poisoning material

alcohol poisoning carbon tetra chloride

Carbon tetra chloride

fulminant Infection Drugs

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Toxins

Budd Chiari occlusion of 4 hepatic veins

Reye’s syndrome viral infection

fatty liver of pregnancy


clinical pictures


hepatic encephalopathy


hepatic encephalopathy

mechanism encephalopathy

amino acids ammonia

fulminant hepatic failure chronic liver cell failure

edema brain

Massive edema


Hepatic encephalopathymechanism ammonia

cerebral edema

chronic liver cell failure

cerebral edema

cerebral edema so massive

brain herniation

brain herniation jaundice

Hepatic encephalopathy Jaundice

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hepatic encephalopathy Jaundice

Liver

investigations liver


Missed diagnosis

neurological problem

Miss diagnosisneurological problem

jaundice

treatment

investigation Liver function

Hepatic encephalopathy

foetor hepaticus

jaundice

spider navei Plamer erythema ascites

cause of death

HypoglycemiaD.I.C. ARDS

Hepato renal syndrome

Investigations

investigations fulminant hepatic failure

Liver function test

Liver function test

Enzymes

enzymes

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SGOT <<normally

40

7,000 4,000

Liver enzymes

liver enzymes fulminant

follow up

enzymes

Liver has been exhausted

enzymes liver exhausted

Liver enzymes

Prognosis

Liver enzymes Investigations

Albumin

Normal

acute liver diseases

albumin Normal

Prothrombin time Prolonged

Prognosis

prothrombin time

prothrombin time

bilirubin

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bilirubin

biphasic

Prognosis

bilirubin

Prognosis

prothrombin time bilirubin

enzymes << diagnosis

Prognosis << prothrombin time bilirubin

blood glucose

arterial blood gases

X ray

CT brain edema

coagulation profile detect affected organs

investigations for the cause

Hepatitis markers

treatment

ICU

cause

paracetamol poisoning N acetyl cystiene

Hepatitis

ICU

ICU care of comatosed

care of comatosed

care of skin care of respiration care of bowel

GIT Dr. Shaf3y

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hypoglycemic

hepato renal syndrome dialysis

ARDS << ventilator

D.I.C.<<plasma platelets

Just symptomatic

95 %

survival 5 %

5 % Liver

proliferation replacement Liver has been damaged

Liver transplantation

liver transplantation

95 %

ICU

fulminant

equipment available

ICU

transplantation

Patient list transplant

fulminant

ICU

ICU transplantation

list transplant

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maximum

immune suppression

complications

Normal

95 %

criteria

95 %

recovery

fulminant

Prothrombin time

100

Prognostic marker


Prothrombin time

100

Prothrombin time 100

34

Prothrombin time 50

Age40

hepatic encephalopathy Not improving bilirubin 300

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criteria

fulminant

hepatitis

Hepatitis acute hepatitis

hepatitis

Inflammation of the liver

acute

Acute hepatitis Is inflammation of the liver less than 6 months

acute hepatitis

inflammation Liver

acute hepatitis

hepatitis A, B, C, D, E, G viruses

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acute

yellow fever virus

Epstein-Barr virus

cytomegalo virus

acute hepatitis

acute hepatitis

hepatitis viruses

A, B, C, D, E

Hepatitis A virus

RNARNA B virus DNA

hepatitis A virus

RNA

Mode of transmission

Feco-oral

blood

blood infection

Infection viremia

virus

Infection

incubation period

Manifestations

blood bank screening hepatitis A

hepatitis A

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viremia

feco oral

feco oral

children young adults

sporadic epidemic

hepatitis A

500

Hepatitis

salmonella

AnywayHepatitis A sporadic epidemic

acute attack

mild

acute attack Mild

without jaundice

acute hepatitis A

Just abdominal pain diarrhea

jaundice

abdominal pain diarrhea

Hepatitis

gastroenteritis

hepatitis A

gastroenteritis

Hepatitis A

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Immune hepatitis A

complications

acute complications


chronic complications


Incubation period

6

Hepatitis E

typical A

E A << typical

2727

E A

E


20 %

E


20 %

fulminant

Fulminant hepatic failure

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3

playstation

playstation

hepatitis E Hepatitis A

fulminant

Hepatitis B

DNA virus

mode of transmission

blood transfusion

Vertical transmission from the mother to the baby

Sexual transmissionNeedles

Dialysis machinesMode of transmission

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High risk group

Doctors and nursing

Homosexual Prostitutes Drug addicts

doctors and nurses

Homosexual Prostitutes

Drug addicts

Hemolytic anemia

dialysis

High risk group

sporadic epidemic

epidemic

epidemic in certain population

epidemic dialysis

dialysis hepatitis B 60 70

epidemic

Dialysis population

Incubation period

acute attack

always severe

jaundice

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A jaundice

jaundice

Hepatitis B

acute attack severe

jaundice

complications

acute chronic

fulminant cirrhosis

acutechronic complications

Hepatitis B

Hepatitis DDtypical B

D B

D << is incomplete virus

infection

D << as incomplete virus

infection

capsule

capsule B

B

D infection

B

co-infection B on-top D super infection

Hepatitis C

C virus RNA

Typical BC B

GIT Dr. Shaf3y

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C RNA virus

D DNA

acute C acute C mild

jaundice

hepatitis C

Jaundice

cirrhosis

hepatitis marker

C

Hepatitis C

attack anicteric jaundice

anicteric

Hepatitis C

complications

Acute and chronic

Hepatitis Csexual transmission doubt

hepatitis B

sexual transmission

Hepatitis C doubt

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30 % Hepatitis C

hepatitis C

tartar emetic

hepatitis C

theory

hepatitis C

hepatitis markers

hepatitis C

Whatever

study

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infection

infection

fresh

infection

dentist

dentist fungus

fungus dentist

dentist << regularly

dentist

insurance dentist

dentist

it covers the dentist

My job covers the dentist

dentist infection

pain

GIT Dr. Shaf3y

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dentist

hepatitis C 30 %

hepatitis G virus

G

G

hepatitis G virus C

D B

G C

G C virus

G damage Liver

We cannot tellC damage

G C

hepatitis G virus damage liver

G A, B, C, D, E, F

F

F G

F fulminant hepatic failure

hepatitis A virus

F

complicated fulminant

already F

fulminant

viruses

G

etiology

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pathology

virusLiver

virus

virus proliferation

virus proliferate

virus hepatocyte proliferation

virus proliferate

proteins

virus dormant non proliferating

proteins

proteins surface cells

immune system hepatocytes

virus not proliferating

surface

hepatocytes antigens

immune system

viral infection

Lymphocytic infiltration

Lymphocyte is infiltrating Organ

virus virus

proteins surface

virus Proliferating

Hepatocyte

Hepatic lobule

Portal area

Portal area hepatic artery Portal vein bile duct

GIT Dr. Shaf3y

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central vein Hepatocyte

damage viral infection

center

central zone

viral infection

Portal area infiltrated Lymphocytes

Pathology viral hepatitis

liver kidney

bone marrow

pleura

hepatitis viruses liver

Which is not true

Kidney

bone marrow pleura

Clinical pictures

clinical pictures

Hepatitis

icteric type anicteric type

complications

clinical pictures

icteric anicteric

anicteric

jaundice

anicteric jaundice

Hepatitis A, E, C

GIT Dr. Shaf3y

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A E

C

A anicteric

A jaundice

jaundice

anicteric

fever diarrhea abdominal colics

typhoid

hepatitis

undiagnosed

hepatitis C cirrhosis

C anicteric

cirrhosis

icteric type 3

Pre icteric phase Icteric Post icteric

Pre ictericicteric Post icteric

Pre icteric

jaundice

jaundice

Feverabdominal pain << specially

right hypochondrium

anorexia nausea vomiting Especially toward cigarettes

We have no idea

GIT Dr. Shaf3y

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icteric 3

Pre icteric Icteric Post icteric convalescence recovery

pre icteric

fever abdominal pain anorexia nausea vomiting

Especially towards cigarettes

fever

Relative bradycardiarelative bradycardia

3940heart rate 80

heart rate 110120

heart rate 15

403

45

heart rate << 115 -120

Heart rate 80

relative bradycardia


heart rate expected for fever


abdominal rash

spleen

enlarged tender liver

jaundice

manifestations

jaundice

manifestations

fever

anorexia nausea

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clay colored stool dark urine

jaundice

hepatocellular

stercobilinogen

stool clay colored

direct bilirubin urine

urine << dark

splenomegaly

spleen just in 20 % of patient

splenomegaly

just palpable spleen

spleen

20

convalescence

presentation

complications

complications hepatitis

complications

complications

Hepatic Extra hepatic

complications Hepatic

extra hepatic

hepatic complications

Acute chronic

acute chronic

GIT Dr. Shaf3y

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acute complications


fulminant viruses

fulminant

post hepatitis cholestasis

Post hepatitis cholestasis

viral infection

Liver

edema

compression bile ductules

hepatocyte Columns

bile ductules

viral infection

hepatocytes swelling

compression bile ductules

obstructive jaundice

edema

jaundice


corticosteroids

edema

corticosteroids edema

flaring virus

edema 828

jaundice

jaundice 828

GIT Dr. Shaf3y

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Post hepatitis syndrome

Post hepatitis syndrome

hepatitis

infection chest infection sputum

unresolved pneumonia

bronchogenic carcinoma

chest pain Pleurisy

Pain myocardial infarction

deny

Myocardial infarction myocardial infarction

cardiologist Infarction

esophageal spasm Heart burn

Anywayhepatitis

He covered

complications virus

virus

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enzymes

enzymes

enzymes enzymes

father of hepatology

hepatology science

female

spasm copula of the diaphragm

hepatitis

spasm copula of the diaphragm

spasm pain

compression dome Liver copula Liver

damage

enzymes

relapse

Relapse

hepatitis

super infection B D on top

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virus dormant activation

relapse

chemical clinical

Chemical

Liver enzymes

Clinical

jaundice


chronic complications Cs

Cirrhosis Carcinoma Carrier Chronic hepatitis

Extra hepatic complications A, P, C, G

A << aplastic anemiaarthritis P << Poly arteritis nodosa C<< cryoglobinemia G << glomerulonephritis

G.I.T.

15162013

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git 2 part 2 ( hepatitis ) upload.pdf

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