GIT 3 Part 1( Hepatitis

8/13/2019 GIT 3 Part 1( Hepatitis

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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


HBc Ag)hepatitis B core antigen

DNA


DNA

DNAprotein

hepatitis B core antigen

Proteinse antigen

antigensantibodies

antigens

antibodies


6-3-6


6-3-6

6

3

6


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hepatitis B surface antibody

3persist for life

3Persist for life


63-6

carrier

antibody

And persist for life

vaccinehepatitis B


vaccine

Hepatitis B vaccineinfection

vaccineinfection


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


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


Investigations of portal hypertension

Endoscopy

Investigations for the cause

treatment

treatment of 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


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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defectMucosal block

mucosal block

iron

haemochromatosis


mucosal block theory

Which means

iron

ironhaemochromatosis

6

Pathology



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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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


Hemolytic anemia

haemochromatosis

vene section

Hemolytic anemia

hemolytic anemia


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



Due to cupper in the hepatocytes

clinical picturesAsymptomatic

Symptomatic

Manifestations of liver cell failure

Portal hypertension


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


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



Alcoholics

C.N.S.


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brain

EpilepsyKorsakoff syndromeCerebellar ataxiaperipheral neuritis

Heart

Dilated cardiomyopathy

Pancreatitisalcoholpancreatitis


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And finally


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 causeECHO

( Dopplerveins

Venographyocclusion

MRAvenous phaseMRA


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etiology

idiopathic

veno occlusiveetiologyidiopathic

disease

3

3

disease


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thrombosisbranchesHepatic veins

tea

veno occlusive

Budd Chiari

Cirrhosisbiliary cirrhosis

G.I.T.

53

162013

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Documents

GIT 3 Part 1( Hepatitis