NUR 660 Week 12 Discussion 1 Case Study Discussion Team C: Hepatitis B and Cirrhosis

NUR 660 Week 12 Discussion 1 Case Study Discussion Team C: Hepatitis B and Cirrhosis

NUR 660 Week 12 Discussion 1 Case Study Discussion Team C: Hepatitis B and Cirrhosis

Describe the pathophysiology of acute hepatitis B infection. How is this different from chronic hepatitis B infection?

            Hepatitis is a group of different viruses that attack the liver cells called hepatocytes. In hepatitis B, the cells become damaged through a cell-mediated immune response to the virus. The antigens of this virus include HBcAg, HBeAg, and HBsAg. Recognizing these antigens in the blood is important for diagnosis and further monitoring the course of Hepatitis B.  If these antigens continually stay in the blood, especially HBsAg, then the individual is at a higher risk of chronic hepatitis B. If the antigens rise and then fall, it is most likely acute (Hubert & VanMeter, 2018, p. 461).

If J.B. had known about his exposure at the time, could any treatment measures have been undertaken at the time?

            There is no direct treatment that can fully destroy the virus even in the early stages. However, immune therapy (Gamma globulin) can be given to boost the patient’s immune system and help fight the disease. This treatment works best if given immediately, within 7-14 days of exposure.

Describe two signs of the preicteric stage and three signs of the icteric stage of acute hepatitis B infection. In which of the stages could J.B. transmit the virus? Be sure to include discussion of the mode of transmission.

            Acute hepatitis has three stages: preicteric, icteric, and posticteric. The first stage, preicteric, is subtle may only show signs of elevated AST/ALT (liver enzymes), fever, and muscle aches (Hubert & VanMeter, 2018, p. 462). When the inflammation of the liver persists, the bile duct becomes blocked and leads to a backup of waste including bilirubin. The following phase, the icteric stage, is marked by jaundice due to the increase in bilirubin. Three common signs of the icteric stage include light colored stools, dark urine, and itchy skin (Hubert & VanMeter, 2018, p. 462). J.B. can transmit the virus from the preinteric stage even if asymptomatic. It can be transmitted through blood and other body fluids. Examples of transmission include birth, sex, drug use through a needle, sharing toothbrushes & razors, various medical equipment, or hemodialysis (CDC, 2020).

What serum markers remain high when chronic hepatitis B is present?

            HBsAg is a hallmark serum marker of hepatitis. If this antigen consistently remains in the blood after six months, it implies chronic hepatitis B. The presence of anti-HBc is also another marker of chronic infection (Hubert & VanMeter, 2018, p. 462)..

Explain how cirrhosis develops from chronic hepatitis B. Why is the early stage of cirrhosis relatively asymptomatic?

            In chronic hepatitis B, the hepatocytes are constantly being inflamed leading to necrosis. As these cells die, fibrous scar tissue forms on the liver leading to obstruction and decreased blood supply causing permanent damage and cirrhosis. The early stages are often asymptomatic and may only have vague mild signs of fatigue, anorexia, weight loss, and diarrhea (Hubert & VanMeter, 2018, p. 458).

Explain why each of the following events occur: (1) excessive bleeding from trauma, (2) increased serum ammonia levels, and (3) hand-flapping tremors and confusion.

            As the liver becomes cirrhotic, its function severely decreases. It cannot produce enough clotting factors or absorb and store iron and vitamin B12 leading to anemia and increased bleeding. Ammonia is a waste product of protein and is metabolized by the liver to be further excreted by the kidneys in urine. When the cirrhotic liver cannot remove the waste, ammonia builds up in the blood causing hepatic encephalopathy leading to muscle twitching and confusion (Eberhardt & Topka, 2017).

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Resources:

Centers for Disease Control and Prevention (CDC). (2020, July 28). Hepatitis B Questions and Answers for Health Professionals. https://www.cdc.gov/hepatitis/hbv/hbvfaq.htm

Eberhardt, O., & Topka, H. (2017). Myoclonic Disorders. Brain sciences, 7(8), 103. https://doi.org/10.3390/brainsci7080103

Hubert, R. J., & VanMeter, K. C. (2018). Pathophysiology Online for Gould’s Pathophysiology for the Health Professions(6th ed.). Elsevier

Team C: Hepatitis B and Cirrhosis

Week 12 Discussion Team C Worksheet

You are caring for J.B., age 35, who has had chronic hepatitis B for nine years. The origin of his acute infection was never ascertained. He is not married, lives alone, and sometimes has trouble managing his disease.

  • Describe the pathophysiology of acute hepatitis B infection. How is this different from chronic hepatitis B infection?
  • If J.B. had known about his exposure at the time, could any treatment measures have been undertaken at the time?
  • Describe two signs of the preicteric stage and three signs of the icteric stage of acute hepatitis B infection. In which of the stages could J.B. transmit the virus? Be sure to include discussion of the mode of transmission.
  • What serum markers remain high when chronic hepatitis B is present?
  • Explain how cirrhosis develops from chronic hepatitis B. Why is the early stage of cirrhosis relatively asymptomatic?

J.B.’s cirrhosis is now well advanced. He has developed ascites, edema in the legs and feet, and esophageal varices. His appetite is poor, he is fatigued, and he has frequent respiratory and skin infections. Jaundice is noticeable. He has been admitted with hematemesis and shock resulting from ruptured esophageal varices.

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  • Explain why each of the following events occur: (1) excessive bleeding from trauma, (2) increased serum ammonia levels, and (3) hand-flapping tremors and confusion.

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You are caring for J.B., age 35, who has had chronic hepatitis B for nine years. The origin of his acute infection was never ascertained. He is not married, lives alone, and sometimes has trouble managing his disease.
1. Describe the pathophysiology of acute hepatitis B infection. How is this different from chronic hepatitis B infection?Hepatitis is inflammation to the liver and can be caused from a few different factors. Acute Hepatitis B is a result of contact with infectious body fluids that target hepatocytes. The liver cells are damaged in two ways either by direct action of the virus or by cell-mediated immune responses of the virus, such as in Hepatitis B (Hubert, R. J., & VanMeter, K. C., 2018).2. If J.B. had known about his exposure at the time, could any treatment measures have been undertaken at the time?According to Hubert, R. J., & VanMeter, K. C., (2018), there is no current treatment for Hepatitis at this time. There is a Gamma globulin that can be given early on in the course of the virus.

3. Describe two signs of the preicteric stage and three signs of the icteric stage of acute hepatitis B infection. In which of the stages could J.B. transmit the virus? Be sure to include discussion of the mode of transmission.

1. malaise

2. anorexia

1. stools become clay colored

2. jaundice occurs

3. urine darkens

When looking at the stages and which stage can J.B. transmit the virus would be the preicteric stage. These are marked with nonspecific symptoms that can be easily masked with other diseases or illnesses that also cause anorexia and malaise. Transmissions of Hepatitis B can occur through childbirth, hemodialysis, sexual activity, tattooing, or even body piercing exposes an individual for transmission (Hubert, R. J., & VanMeter, K. C., 2018)

4. What serum markers remain high when chronic hepatitis B is present?

HBsAg anti-HBs, HBcAb IgM, HBcAb IgG, HBeAg, and HBeAb (Hubert, R. J., & VanMeter, K. C., 2018)

5. Explain how cirrhosis develops from chronic hepatitis B. Why is the early stage of cirrhosis relatively asymptomatic?

Cirrhosis develops when there is progressive destruction of liver tissue that eventually will lead to liver failure. With this there is extensive damage to diffuse fibrosus and loss of lobar organization. (Hubert, R. J., & VanMeter, K. C., 2018). The early stages of cirrhosis is usually silent because when liver function starts to decline, your body will feel sluggish; you will feel tired and lose your appetite. Typically, we do not recognize these early symptoms as issues with our liver. When symptoms such as jaundice become apparent, the disorder will have already reached an advanced stage (Otsuka Pharmaceutical Co., n.d.).

J.B.’s cirrhosis is now well advanced. He has developed ascites, edema in the legs and feet, and esophageal varices. His appetite is poor, he is fatigued, and he has frequent respiratory and skin infections. Jaundice is noticeable. He has been admitted with hematemesis and shock resulting from ruptured esophageal varices.

6. Explain why each of the following events occur:

(1) excessive bleeding from trauma— The gastric veins have several points of channels that join with the gastric veins. With this increase of pressure of blood then it extends into esophageal veins. This creates large, distended and distorted veins and can be easily torn from something as simple as food passing though. (2) increased serum ammonia levels— With this there is a metabolic dysfunction in which the body is unable to remove ammonia from protein metabolism. There is too much crossing the blood-brain barrier.  (Hubert, R. J., & VanMeter, K. C., 2018). (3) hand-flapping tremors and confusion— But when the liver is impaired for any reason, it may not remove toxins efficiently. Consequently, they can build up in the blood and enter the brain, where they disrupt brain function (Healthline, 2018).

Healthline. (2018). Asterixis: Causes, treatment, relation to the liver, and more. https://www.healthline.com/health/asterixis

Hubert, R. J., & VanMeter, K. C. (2018). Gould’s Pathophysiology for the Health Professions (6th ed.). Elsevier.

Otsuka Pharmaceutical Co. (n.d.). Early detection of “silent” liver cirrhosis | otsuka pharmaceutical co., ltd. Otsuka Pharmaceutical Co., Ltd.. https://www.otsuka.co.jp/en/health-and-illness/liver-cirrhosis-nutritional-therapy/early-detection/

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