Introduction: Hepatitis X
Hepatitis X: Some cases of viral hepatitis cannot be attributed to the hepatitis A, B, C, D, or E viruses. This is called non A...E hepatitis or hepatitis X. Scientists ... more about Hepatitis X.
Hepatitis X: Hepatitis infection by an unknown virus not classified as HepA/B/C/D/E. More detailed information about the symptoms, causes, and treatments of Hepatitis X is available below.
List of symptoms of Hepatitis X:
The list of signs and symptoms mentioned in various sources for Hepatitis X includes the 11 symptoms listed below:
- Flu-like symptoms
- Fever
- Fatigue
- Nausea
- Vomiting
- Loss of appetite
- Abdominal pain
- Diarrhea
- Jaundice
- Yellow eyes
- Yellow skin
Note that Hepatitis X symptoms usually refers to various symptoms known to a patient, but the phrase Hepatitis X signs may refer to those signs only noticable by a doctor.
More ways to research these symptoms: To research other symptoms use the symptom center, or to research causes of more than one symptom in combination, try our multi-symptom search.
Causes of Hepatitis X: Online Medical Books
16 MEDICAL BOOKS ONLINE! Review the full text of medical books online, free, without registration, for more information about the causes of Hepatitis X.
Hepatomegaly: Differential Diagnosis
(In a Page: Signs and Symptoms)
- Inflammatory disorders, resulting in tender hepatomegaly
–Hepatitis (viral or drug-induced): Associated with jaundice, fever, nausea, vomiting, fatigue, diarrhea, weight loss
–Alcoholic liver disease: Associated with liver failure and portal hypertension (e.g., caput medusae, spider angiomata, hemorrhoids, testicular atrophy, ALT is more than two times higher than AST) - Infiltrative disorders
–Fatty liver (NASH): Predisposing factors include middle age, obesity, female gender, diabetes, and hyperlipidemia
–Sarcoidosis: Associated with cough, hilar lymphadenopathy; more common in blacks, women, ages 30–40
–Hemochromatosis: Iron overload resulting in bronzed skin color, diabetes, abnormal iron panel
–Wilson's disease: Copper excess resulting in liver failure, lenticular degeneration, and Kayser-Fleischer rings in cornea - Neoplasms present with focal enlargement, arterial bruit and/or hepatic rub, and constitutional symptoms (e.g., fever, night sweats, weight loss)
–Metastatic cancer is more common than primary liver cancers (colon, lung, breast)
–Hepatocellular carcinoma is most common primary liver cancer (often due to chronic hepatitis or cirrhosis)
–Hepatic adenoma or hepatic cysts
–Leukemia/lymphoma
- Liver abscess
- Less common causes (“zebras”) include tricuspid regurgitation, Budd-Chiari syndrome, schistosomiasis, amyloidosis, kala-azar (visceral leishmaniasis), and HIV/AIDS
Jaundice: Differential Diagnosis
(In a Page: Signs and Symptoms)
- Viral hepatitis
–Fatigue, anorexia, fever, nausea, vomiting, dark urine, light-colored (acholic) loose stools, RUQ pain, hepatomegaly, and/or pruritis
- Alcoholic hepatitis
–Associated with fever, leukocytosis, and AST:ALT ratio >2
- Nonalcoholic steatohepatitis or nonalchoholic fatty liver disease
–Associated with obesity, diabetes, hyperlipidemia and medications
- Cholecystitis
–RUQ pain, fever, leukocytosis
–Female, fertile, fat, forty
–Murphy's sign: Pain upon palpation of the
gallbladder while taking a deep breath
- Drugs and toxins
–Acetaminophen, alcohol, estrogens, isoniazid, chlorpromazine, erythromycin, nitrofurantoin, rifampin
- Gilbert's syndrome
–Decreased conjugation of bilirubin, especially with dehydration, fasting, infection
- Liver infiltration
–Amyloidosis, lymphoma, sarcoidosis, tuberculosis
- Cholangitis
–Charcot's triad of fever, RUQ pain, and jaundice
–Chronic hemolysis, hepatic dysfunction
- Autoimmune hepatitis
–May mimic viral hepatitis
–Females >> males, often 10–30 years old
–Associated with autoimmune disease
(e.g., RA, UC, Sjögren's syndrome, thyroiditis)
–Pruritus in third trimester
–Resolves after delivery
Hepatomegaly: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Inflammation
–Most common infections: EBV; hepatitis A, B, C; CMV; TORCH
–Less common infections: HIV, malaria, amebiasis, tuberculosis, toxocariasis, Borrelia burgdorferi
–Drugs: Acetaminophen (commonly used in overdoses among adolescents), NSAIDs, isoniazid, sodium valproate, propothiouracil, halothane
–Toxins: Tyrosinemia, galactosemia, vitamin A toxicity
–Autoimmune hepatitis
–Systemic lupus erythematosus
- Inappropriate storage
–Glycogen storage diseases I–V
–Lipids: Gaucher disease, Wolman disease, Niemann-Pick disease
–Fat: Fatty acid oxidation defects, mucopolysaccharidoses
–Metals: Wilson disease (copper), hemochromatosis (iron)
–Abnormal proteins: α-1 antitrypsin deficiency (store abnormal protein product)
–Peroxisomal disease: Zellweger
–Mucopolysaccharidoses, types I–IV
- Infiltration
–Hepatoblastoma
–Hepatocellular carcinoma
–Hemangioma
–Histiocytosis
–Extramedullary hematopoiesis
–Chronic granulomatous disease - Vascular congestion
–Congestive heart failure
–Budd-Chiari syndrome
–Veno-occlusive disease
–Suprahepatic web - Biliary obstruction
–Biliary atresia represents the most common cause of pediatric liver transplantation
–Alagille syndrome
–Cystic fibrosis
–Primary sclerosing cholangitis
–Inspissated bile syndrome - Miscellaneous
–Reye syndrome, bile acid synthetic disorder
Jaundice in Infants – Direct: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Bile duct obstruction
–Biliary atresia: Represents the most frequent cause for liver transplantation in the pediatric patient; prompt diagnosis is crucial, as patient outcome is better if intervention comes before 60 days of life
–Choledochal cyst
–Common bile duct gallstone
–Choledochocele
–Bile duct stricture
–Alagille syndrome
–Caroli disease
–Congenital hepatic fibrosis
- Neonatal hepatitis
–Idiopathic hepatitis: Diagnosis of exclusion that should be made only when other causes are excluded; accounts for 60% of patients with neonatal cholestasis
–Infections: TORCH, hepatitis B, HIV, E. coli, adenovirus, enterovirus, parvovirus B16, tuberculosis, listeriosis, malaria
- Metabolic disorders
–α-1 antitrypsin deficiency
–Cystic fibrosis
–Hypothyroidism
–Neonatal iron storage disease
–Amino acids: tyrosinemia
–Carbohydrates: Galactosemia, fructosemia
–Lipids: Niemann-Pick, Gaucher, Wolman, cholesterol ester storage disease
–Mitochondropathies
–Bile acid synthetic disorders
–Peroxisomal: Zellweger syndrome
–Urea cycle defects - Toxins
–Total parenteral nutrition
–Drugs: Trimethaprim-sulfamethoxazole, anticonvulsants - Miscellaneous
–Sepsis/hypoperfusion
–Erythrophagocytic lymphohistiocytosis
–Extracorporeal membrane oxygenation
–Trisomy 17, 18, 21
–Neonatal lupus erythematosus
–Donohue syndrome
–Rotor syndrome
–Dubin-Johnson syndrome
–Byler disease (PFIC type 1)
–Cholestasis of North-American Indians
–Nielsen syndrome
Jaundice in Infants – Indirect: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Icterus neonatorum (physiologic jaundice)
–The most common form of indirect jaundice in infants under 14 days of age
–Caused by increased bilirubin production with transient limited conjugation abilities - Breast-feeding jaundice
–Occurs in first week of life in 13% of breast-fed infants
–Secondary to poor volume intake - Breast-milk jaundice
–Occurs in about 2% of breast-fed infants after day 7 of life
–Secondary to glucuronidase in breast milk - Hematologic: Hemolysis increases bili load
–Rh incompatability
–ABO incompatability
–Glucose-6-phosphate dehydrogenase (G6PD) deficiency
–Pyruvate kinase deficiency
–Hereditary spherocytosis
–Elliptocytosis
–Thalassemia
–Polycythemia - Extravascular blood
–Cephalohematoma
–Trauma
–Swallowed maternal blood - Endocrinologic
–Hypothyroidism
–Maternal diabetes - Sepsis
- Metabolic
–Crigler-Najjar I
–Crigler-Najjar II (Arias syndrome)
–Crigler-Najjar III - Cardiopulmonary
–Congestive heart failure
–Patent ductus arteriosus
–Portal vein thrombosis - Anatomic
–Pyloric stenosis
–Duodenal atresia/stenosis
–Duodenal web - Drugs
–Oxytocin
–Sulfonamides
–Ceftriaxone
–Chuen-Lin - Lucey-Driscoll syndrome
Treatments of Hepatitis X: Online Medical Books
16 MEDICAL BOOKS ONLINE! Review the full text of medical books online, free, without registration, for more information about the treatments of Hepatitis X.
Hepatomegaly: Treatment
(In a Page: Signs and Symptoms)
- Heart failure: Diuretics, inotropes, and afterload reduction
- Viral hepatitis: Supportive care and antivirals in some chronic cases
- Alcoholic liver disease: Abstinence from alcohol, steroids in severe cases, and possible transplant
- Fatty liver: Treat underlying obesity, diabetes, hyperlipidemia
- Sarcoidosis: Steroids
- Hemochromatosis: Iron removal by weekly phlebotomy for 2–3 years and/or deferoxamine chelation
- Wilson's disease: Copper chelation with D-penicillamine or trientine; may require liver transplantation
- Neoplasms: Resection and chemotherapy
- Abscess or cyst: Antimicrobials, percutaneous drainage, and/or surgical resection
- Amyloidosis: Prednisone and alkylating agents
Jaundice: Treatment
(In a Page: Signs and Symptoms)
- Discontinue and avoid potentially hepatotoxic medications
- Supportive care for viral hepatitis
- Rehydrate/refeed for Gilbert's syndrome
- Consider steroids in fulminant alcoholic hepatitis
- Cholecystectomy or ERCP with stone removal for obstructing gallstones
- Treat underlying causes of hemolysis or other disorders
- Antibiotics for cholangitis, sepsis
- Hydroxyurea and folate for sickle cell disease, prevent crises by adequate hydration, vaccinating against diseases, and try to prevent other infections
Hepatomegaly: Treatment
(In A Page: Pediatric Signs and Symptoms)
- Geared towards specific disease
- Cholestasis
–Ursodeoxycholic acid
–Supplemental fat soluble vitamins A, D, E, K - Infections
–Consider interferon for hepatitis B
–Consider interferon and ribaviron for hepatitis C - Toxins
–Use of NTBC for tyrosinemia - Metabolic disease
–Metabolism consultation
–Often requires specific restricted formulas - Surgical repair for biliary atresia
–Kasai portoenterostomy has better outcome if done before 60 days of age - Mucomyst for acute acetaminophen toxicity
- Immune suppression for autoimmune hepatitis
Jaundice in Infants – Direct: Treatment
(In A Page: Pediatric Signs and Symptoms)
- Varies by specific disorder
- General medication principles of cholestasis include
–Promoting bile flow with ursodeoxycholic acid
–Consider phenobarbital (increases bile excretion)
–Fat-soluble vitamins including K, D, E
–Vitamin A is a relative contraindication given hepatotoxicity at high levels
–Kasai portoenterostomy for biliary atresia
–Surgical repair of choledochal cyst
–Special formulas for tyrosinemia
–Lactose free formula for galactosemia (e.g., soy based)
–Remove toxic exposures
–Treat infections
–Treat hypothyroidism
Jaundice in Infants – Indirect: Treatment
(In A Page: Pediatric Signs and Symptoms)
- Treatment options vary based on level of bilirubin, age of presentation, and cause
–Goal is prevent levels high enough to cause kernicterus - Phototherapy involves the use of photon energy to change the structure of bilirubin and permit excretion without glucuronidation
–Decisions for use are age-based
–Considered when serum level above 14 mg/dL - Exchange transfusion should be considered with serum levels above 25 mg/dL
- IVF or breast-feed more frequently to increase volume
-
- Correct endocrine abnormality
- Improve perfusion if cardiac problem
- Correct anatomic abnormality
- Consider enteral binding agents
–Cholestyramine, charcoal, calcium phosphate - Crigler-Najjar: Phenobarbital, may need liver transplantation
Jaundice [Icterus]: Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))
Encourage the patient with a hepatic disorder to decrease his protein intake sharply and increase his intake of carbohydrates. If he has obstructive jaundice, encourage a nutritious, balanced diet (avoiding high-fat foods) and frequent small meals.
Hepatomegaly: Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Instruct the patient to avoid alcohol. Explain the importance of following the treatment plan to correct or control the underlying disorder as needed. Tell the patient to avoid exposure to people with infections and to maintain good personal hygiene. Explain the importance of pacing activities and having frequent rest periods.
Jaundice: Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Encourage the patient with a hepatic disorder to decrease his protein intake sharply and increase his intake of carbohydrates. If he has obstructive jaundice, encourage a nutritious, balanced diet (avoiding high-fat foods) and frequent small meals. Teach the patient ways to reduce pruritus.
Hepatomegaly: Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Prepare the patient for liver enzyme, alkaline phosphatase, bilirubin, albumin, and globulin studies to evaluate liver function and for X-rays, a liver scan, celiac arteriography, a computed tomography scan, and ultrasonography to confirm hepatomegaly.
▪ Provide bed rest, relief from stress, and adequate nutrition to help protect liver cells from further damage and to allow the liver to regenerate functioning cells.
▪ Monitor and restrict dietary protein as needed.
▪ Give hepatotoxic drugs or drugs metabolized by the liver in very small doses, if at all.
TopPatient teaching
▪ Explain the underlying disorder and its treatments.
▪ Stress the importance of avoiding alcohol and people with infections.
▪ Discuss the importance of pacing activities and rest periods.
Jaundice [Icterus]: Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ To decrease pruritus, frequently bathe the patient; apply an antipruritic lotion, such as calamine; and administer diphenhydramine or hydroxyzine.
▪ Prepare the patient for diagnostic tests to evaluate biliary and hepatic function, including laboratory studies (such as urine and fecal urobilinogen, serum bilirubin, liver enzyme, and cholesterol levels; prothrombin time; and a complete blood count), computed tomography, ultrasonography, cholangiography, liver biopsy, and exploratory laparotomy.
TopPatient teaching
▪ Teach the patient appropriate dietary changes.
▪ Discuss ways to reduce pruritis.
▪ Review with the patient prescribed medications and their possible adverse effects.
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