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8/13/2019 GIT 3 Part 1( Hepatitis
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GIT Dr. Shaf3y
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G.I.T.
24162013
acute hepatitisinflammation of the liver less than 6 months
virusesacute hepatitis
A, B, C, D, E and G viruses
pathology
clinical pictures
clinical pictures
Ictericanicteric
complications
complications
hepatic
extra hepatic
Hepatic
acutechronic
investigations
investigationsacute hepatitis
Liver functions
Liver functions
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liver enzymes
albumin
Normal
globulins
bilirubin
biphasic
sonarLiver
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Leucopeniabone marrow
It is a leucopenia with relative lymphocytosis
inflammationLiver
Inflammationhepatitis ABCDEHepatitis markers
Hepatitis markers
Hepatitis A virushepatitis E virushepatitis D virus
markerIg MIg G
hepatitis A , E and D viruses
markerIg MIg G
acute infection
Ig M
Old infection
Ig G
hepatitis markersHepatitis A virusHepatitis E virushepatitis D virus
Ig MIg G
Ig Macute infection
Ig Gold infection
hepatitis A virus
virusstool
first week
viremia
detectionvirusstool
RT PCR
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PCR
Polymerase chain reaction
RT
Reversed transcriptase
virusRNA
PCR
PCRcopiesDNA
reversed transcriptase
RNADNA
PCR
Hepatitis A virus
Hepatitis D virus
D virusHepatitis B markers
hepatitis B surface antigen
D virus
Is incomplete virus
infection
B
hepatitis B marker
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hepatitis B marker
Hepatitis B surface antigen
Hepatitis AED
Hepatitis B virus
Hepatitis B virus
B virus
HBs Ag
Hepatitis B surface antigen
HBc Ag)hepatitis B core antigen
DNA
hepatitis B surface antigen
DNA
DNAprotein
hepatitis B core antigen
Proteinse antigen
antigensantibodies
antigens
antibodies
hepatitis B surface antigen
6-3-6
Hepatitis B surface antigen
6-3-6
6
3
6
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hepatitis B surface antibody
3persist for life
3Persist for life
hepatitis B surface antigen
63-6
carrier
antibody
And persist for life
vaccinehepatitis B
hepatitis B surface antigen
vaccine
Hepatitis B vaccineinfection
vaccineinfection
hepatitis B surface antigen
infection
genetic engineering
virus
Hepatitis B virusKilled virus
genetic engineering
riskinfection
Which is very strange
Infection
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vaccination
antibodies
infection natural
antibodiesprotection for lifehepatitis B
vaccination
Protection 5 years
booster dose
Hepatitis B surface antigen
antibody
hepatitis B core antigen
core antigen
hepatitis B core antigenLiver biopsy
Hepatitis B core antigen
Liver biopsy
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hepatitis B e antigen
virus
Is rapidly replicating
proliferate
virusIs rapidly replicating
virus
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Mutationhepatitis B virus
Interferonvaccine
Mutationvirus B
e antigen
e antibody
DNA
DNA
Hepatitis B core antigen
DNA
DNAvirus
core antigen
core antigen
DNA
DNAhepatitis B core antigen
DNA
Partiallye antigen
e antigencore antigenDNA
core antigen
Partiallye antigen
virusDNA
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virus
virusDNA
virus
e antigen
virusrapidly proliferating
DNA
e antigenrapidly replication virus
virusDNA
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surface antigenantibody
e antigenantibody
hepatitis B core antigenLiver biopsy
hepatitis B
Core Ig M
serological gap
Hepatitis B
core Ig M
Most recent
hepatitis B
PCR
PCRhepatitis B virus
viruses
quantitative
PCRvirus
viruses
Hepatitis C virus
Hepatitis C virus
detectionantibodies
Hepatitis C virus
antibodies4
detectionELISA technique
ELISA techniqueantibody
Against hepatitis C virus
Positive
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false positiveELISA technique
ELISAnegative
hepatitis
ELISApositive
Hepatitis
false positive
Positiveconfirmdiagnosis
Detection of antibody by RIBA technique
(Recombinant immune blot assay)
ELISA
Pulmonary edema
lasix
digitalis
target
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Hepatitis C virus
detectionantibodies
4Infection
detectionELISA technique
ELISAnegative
hepatitis C
ELISApositive
confirmdiagnosisRIBA technique
And finally
RT PCR
For diagnosis of hepatitis C virus
RT PCR
RNA
hepatitis B
PCR
Hepatitis B
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vaccine
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hepatitis
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hepatitis C
hepatitis C
hepatitis B and C
Hepatitis B and C
Hepatitis
category
vaccine
vaccine
Hepatitis B surface antigen protein
genetic engineering
vaccine0 1 6
0 1 6
zero
6
protection
5
5You have to measure the serum antibodies
serum antibodies
booster dose
How to protect against hepatitis C virus
vaccine
How to protect against hepatitis D virus
By protecting against B
Pre exposure prophylaxis
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hepatitis B
Pre exposurevaccine
Disposable syringes
Disposable needles
dialysis
Screening of blood donorScreening of organ transplant
Hepatitis B virus
How to prevent
surgeon
abdomen
hepatitis B
hepatitis B
immune globulinsImmune globulinswithin two days
From exposure
Hepatitis A
within two weeks
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hepatitis B virus
immune globulins
Within two days from exposure
actually
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bilirubinNormal
clearancesclera
bilirubin1.5jaundice
diet
excess carbohydrates
proteinsLiver cell failure
fat
fat
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Liver CirrhosisLiver cirrhosis
liver cirrhosis
hepatic lobule
central vein
Portal area
hepatic arteryportal veinbile duct
central vein
Liver
columns
columns
sinusoid
hepatic arteryPortal vein
sinusoid
central vein
Liver
Proliferatereplacement
One of the cellsLiver
proliferatereplacement
proliferate
sinusoids
sinusoids
ischemic
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Proliferation
replacement
Proliferation
columns
Nodules
Nodulessinusoid
ischemic
fibrosis
regeneration
nodules
Nodulesfibrosis
cirrhosis
cirrhosis
degeneration
regeneration
fibrosis
degenerationregenerationfibrosis
Liver
Loss of hepatic architecture
Liver cirrhosis
Definition
Liver cirrhosis is degeneration of the liver cells which is associated by regeneration and formation of
nodules which surround by fibrosis and this will lead to loss hepatic architecture
Liver
definitioncirrhosis
Etiology
etiologiescirrhosis
Morphology
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definition
specific pathology
definition
specific pathology
cirrhosispathology
definition
specific
clinical pictures
manifestations of liver cell failure
damage2/3Liver
cirrhosisLiver
cirrhosisLiver
cirrhosisLiver
cirrhosis
asymptomatic
cirrhosisLiver
asymptomatic
accidently
accidently
examinationshrunken liver
Hepatomegaly
splenomegaly
cirrhosis
Liver
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health insurance
examination
examinationhepatomegaly
shrunken livershrunken liversplenomegaly
cirrhosis
asymptomatic
cirrhosis2/3Liver
cirrhosis2/3Liver
symptomatic
manifestations of liver cell failure
for example
spider naveiplamar erythemaasciteshepatic encephalopathy
manifestations
portal hypertension manifestations
for example
hematemesis, caput medosa, piles
clinical pictures of the cause
complicated by hepatocellular carcinoma
cirrhosis
Investigationsliver function test
liver function test
Liver function testmanifestationschronic liver cell failure
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chronic liver cell failure
SGOTSGPTalkaline phosphatase
bilirubinbiphasic
Prothrombin timeProlonged
albumin
globulin
alpha feto proteinhepatocellular carcinoma
CT
Liver biopsy
Investigationsliver function
Liver function test
chronic liver cell failure
Investigations of portal hypertension
Endoscopy
Investigations for the cause
treatment
treatment of liver cell failure
chronic liver cell failure
look above
treatment of portal hypertension
Injection sclerotherapy
band ligation
Treatment of the cause
Liver transplantation
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cirrhosis
cirrhosispost hepatitis Cirrhosis
Post hepatitis cirrhosis
definition
Degeneration, regeneration, fibrosisLoss of hepatic architecture
Due to hepatitis
etiology
Hepatitis B, C ,D
AE
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History of hepatitis
Cacute attackjaundice
complicatedhepatocellular carcinoma
Investigations
investigations
Liver function test
Investigations
Portal hypertension
Investigations of the cause
investigations of the cause
markers
treatment
Liver cell failure
Portal hypertension
cause
causecause
hepatitis
Hepatitis
liver transplantation
cirrhotic phase
chronic hepatitis
Post hepatitis cirrhosis
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Haemochromatosisdefinition
Degeneration, regeneration, fibrosis
Loss of hepatic architecture
Due to deposition of iron in liver
definition
etiology
etiologyhaemochromatosis
Primary
Secondary
secondary
irontissues
Hemolytic anemiarepeated blood transfusionparentral iron therapy
of course
acidic
iron
primary haemochromatosis
primary haemochromatosisgenetic
chromosome 6
iron
1
mucosal block theory
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primary haemochromatosis
defectMucosal block
mucosal block
iron
haemochromatosis
primary haemochromatosis
mucosal block theory
Which means
iron
ironhaemochromatosis
6
Pathology
Degeneration, regeneration, fibrosis
Loss of hepatic architecture
specific
ironHepatocytes
clinical pictures
Asymptomatic
hepatomegalyshrunken livershrunken liver and splenomegaly
Symptomatic
Manifestations of liver cell failure
Manifestations of portal hypertension
Clinical pictures of the cause
cause
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clinical pictures of the cause
blood
bloodhemolytic anemia
extravascular hemolysis
RBCs
heme
heme
Iron
Protoporphyrin
irontissue
C.N.S.
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Investigation for the cause
Investigation for the cause
Serum iron
total iron binding capacity
transferrin saturation
ferrtin
iron
MRI
ironLiver
MRIiron
magnetic resonance imaging
reflection
ironreflection
MRI
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DNA analysis
genetic defectprimary haemochromatosis
Liver cell failurePortal hypertension
Iron chelating agentdesferrioxamine
vene section
250Iron
serum ironNormal
34
primary haemochromatosis
Hemolytic anemia
haemochromatosis
vene section
Hemolytic anemia
hemolytic anemia
Liver transplantation
Wilson disease
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Wilson disease
Hepatolenticular degeneration
Wilson disease
Hepatolenticular degeneration
cupper
diet
cupper
dietabsorptionintestine
liver
Liverceruloplasmin
ceruloplasmincupper
ceruloplasmin
ceruloplasmincupper
ceruloplasmincupper
spot diagnosis
nauseating
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ceruloplasmincupper
diseaseWilson diseaseHepatolenticular degeneration
defect13
Liverceruloplasmin
Liver
ceruloplasmin
cupperintestine
LiverceruloplasminLiver
cupperalbumin
albumincupper
Loose attachement
albumincupper
Loose attachement
cupperalbumintissues
cupperalbuminUrine
cupper
urinealbumin
urine
albumin
cupper
cupper
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albumin
urine
cupper
tissues
etiologypathology
This is a hereditary disease
Where there is defect in chromosome 13
Which is responsible for the synthesis of ceruloplasmin
According the patient has not ceruloplasmin to attach to cupper
So cupper will be loosely attached to albumin
cupper is easily precipitated in tissueAnd lost in urine
pathology
Degeneration, regeneration, fibrosis
Loss of hepatic architecture
Due to cupper in the hepatocytes
clinical picturesAsymptomatic
Symptomatic
Manifestations of liver cell failure
Portal hypertension
Clinical pictures of the cause
diseasehepatolenticular degeneration
lenticular
Lenticular
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Lentiform nucleusbasal gangliaparkinsonism
disease
hepatolenticular degeneration
hepatocirrhosis
lenticularlentiform nucleusbasal gangliaparkinsonismchoreadystonia
snake like movement of the handinvoluntary
dystoniasnake like movement of the trunk
lenticularlens
lenscupper
sun flower cataract
cornea
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clinical pictures
Hepatocellular carcinoma
is rare
Which is very strange
haemochromatosishepatocellular carcinoma incidence
Is high
Wilson
Is low
cupperprotection against cancer
We have no idea
cancer
cancerhepatocellular carcinomaWilson
Is very rare
Investigations
Liver function testportal hypertension
investigations for the cause
Investigations for the cause
cupper
cupper
cupper
cupper
tissues
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cupper
Urine
Ceruloplasmin
DNA analysis
the mother of this patient
the mother of this patient
Liver cell failure
Portal hypertension
cause
cause
Cupper chelating agent
Penicillamine
liver transplantation
general rules
Alcoholic Cirrhosisalcoholcirrhosis
30alcoholmale
female20
30male
20female
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30
alcohol30
7 %11 %4 %
4 %
1004alcohol
4 %
1007alcohol
Stella
7 %
Which means30alcohol
400400
cirrhosis
70 %
70100
40
40 %
addict
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alcoholcirrhosis30
30alcohol
20
30male20female
alcoholdamageLiver
alcoholdamagehepatocytes
direct toxic effect
alcoholmetabolismLiverenzymealcohol dehydrogenase
Metabolismtoxicalcoholtoxic
Metabolism
metabolismtoxic material
toxic materialLiver
alcoholantigenic structure
surface of hepatocytes
antigenswallhepatocytes
Immune systemHepatocytes
alcoholdamageLiver
direct toxic
Metabolismtoxic material
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antigenic structureHepatocyteImmunogenicImmune system
Orallyparentral nutrition
OrallyparentralOral
Liver
detoxication
detoxication
Intravenoustoxication
OrallyLiver
stimulateLiver
Hepatotropic factors
Total parentral nutrition
resectionintestine
cirrhosis
sepsis
Liveractivateliver
hepatotropic factors
stimulationLiver
hepatotropic factors
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hepatotropic factor
alcoholics
alcoholicscalories
alcoholcalories
alcoholic
go and buy a meal
go and buy a meal
4
alcoholic
Liverstimulated
degeneration by time
alcoholLiver
direct toxic effect
metabolites
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Mallory bodies
bodies
alcoholismalcoholics
Hepatocytes
actin filaments
actinMyocinMuscles
intra cellularactin filaments
actin filaments
Organellescells
ribosomes
actin filaments
actincontract
package
package
actin filaments
contraction
relaxtion
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alcohol
damageactin filaments
Mallory bodies
Mallory bodies
clinical pictures
Asymptomatic
Symptomaticmanifestation of liver cell failure-Portal hypertension
Clinical pictures of the cause
clinical pictures of the cause
Alcoholics
C.N.S.
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brain
EpilepsyKorsakoff syndromeCerebellar ataxiaperipheral neuritis
Heart
Dilated cardiomyopathy
Pancreatitisalcoholpancreatitis
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And finally
Liver transplantation
alcoholLiver
alcoholcirrhosis
alcoholfulminant hepatic failure
alcohol
fulminant hepatic failure
alcoholfatty liver
diseasesalcoholLiver
fatty liver
fulminant hepatic failure
cirrhosis
acute hepatitis
metabolized
Liver
inflammationLiver
painright hypochondirumnauseavomiting
even jaundice
Hepatitis
Acute alcoholic hepatitis
alcoholic cirrhosis
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Congestive Cirrhosiscongestive cirrhosis
Prolonged hepatic congestion
Livercongested
Liverbranchesviens
4 hepatic veins
Inferior vena cava
inferior vena cava
inferior vena cava
right atrium
right atriumright ventricle
tricuspid
congestionLiver
venous drainage
brancheshepatic veins
veno occlusive
hepatic veins
Budd Chiari
inferior vena cava
inferior vena caval thrombosis
heart
Constrictive pericarditistricuspid stenosistricuspid regurgeright ventricular failure
congestive cirrhosis
veno occlusive
Budd Chiari
inferior vena caval occlusion
right sided lesion
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congestive cirrhosis
cirrhosis
Liverenlarged and tender
cirrhosis
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hypercoagulable state
CS
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investigations
Liver function test
Investigations for portal hypertension
Investigations for the cause
investigations for the causeECHO
( Dopplerveins
Venographyocclusion
MRAvenous phaseMRA
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etiology
idiopathic
veno occlusiveetiologyidiopathic
disease
3
3
disease
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GIT Dr. Shaf3y
thrombosisbranchesHepatic veins
tea
veno occlusive
Budd Chiari
Cirrhosisbiliary cirrhosis
G.I.T.
53
162013
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