Yellow Eyes

Abdullah, 27 years old, Dentist
Jaundice?
1. Causes:
2. Ddx:
  1. Viral infections
    1. Hep A, B & C
  2. Chronic alcohol abuse
  3. Autoimmune disorders
  4. Drugs
  5. Pregnancy
3. Due to bilirubin accumulation
  1. Heme Degradation & Bilirubin metabolism
Causes of liver cirrhosis:
1. Viral infection
  1. Tumor
2. Drugs
3. alpha 1 antitrypsin def.
4. Alcohol abuse
Anatomy and Histology of GB
4. Embryology
Physiology of GB
1. Storage of bile
2. Release of Bile into the intestines in response to CCK
4. Abnormality?
Gallstones
1. Risk factors:
  1. Female
  2. >= 40 years old
  3. Native or Mexican American
  4. Overweight or obese
  5. Sedentary
  6. High-fat and Low-fiber diet
  7. Family history
2. S&S
  1. Sudden and rapidly intensifying pain in RUQ
  2. Nausea or Vomiting
3. Types:
  1. Cholesterol Gallstones
    1. yellow undissolved cholesterol
  2. Pigment Gallstones
    1. when the bile contains too much bilirubin.
4. Why?
  1. bile contains too much cholesterol.
  2. the bile contains too much bilirubin.
  3. the gallbladder doesn't empty correctly .
5. Investigations?
  1. 1- Imaging
    1. Ultrasound
    2. CT Scan
  2. 2- Bile tests:
    1. HIDA, MRI and ERCP
  3. 3- Blood tests:
    1. To look for complications
  4. Treatment and prevention: :
    1. Surgery to remove the GB
    2. Medications to dissolve the gallstones
    3. Don't skip meals
    4. Lose weight slowly
    5. Maintain a healthy weight
Hepatitis
1. A "Picornavirus"
  1. Acute only, RNA , IP: 2-6 weeks and feco-oral route
  2. Most common S&S:
    1. Fatigue
    2. Nausea and vomiting
    3. Fever
    4. Hepatomegaly
    5. jaundice
    6. Dark urine
    7. Anorexia
    8. Rash
  3. Prevention:
2. B "Hepadnavirus
  1. DNA, in blood & saliva & serum & vaginal fluids, STD & parenteral and IP: 60 days
    1. Prevention
  2. Most common S&S:
    1. Gradual onset of anorexia
    2. Malaise
    3. fatigue
    4. Fever
    5. Arthritis and arthralgias
    6. Jaudice
    7. Nausea and vomiting
  3. Treatment
    1. Lamivudine
    2. Adefovir
    3. Entacavir
    4. Pegylated IFN
3. C "Flavivirus"
  1. RNA, similar transmission as HepB, Chronic infection, IP: 15-150 days and diagnosed by HCV AB
  2. Most common S&S:
    1. During acute infection
      1. similar to HepB
    2. 80% are asymptomatic and do not develop icterus
  3. Treatment
    1. Ribavirin
    2. Boceprevir
    3. Telaprevir
    4. Daclatsevir
    5. Sofosbuvir
    6. Pegylated IFN
    7. NO VACCINE
4. D "Delta virus"
  1. RNA, only multiple in a HBV infected cell >> co-infection, superinfection increases liver damage rate and IP: 35 days
  2. Most common S&S:
    1. severe acute hepatitis only in patients developing chronic superinfection
5. E "Calcivirus"
  1. RNA, feco-oral route, IP: 5-6 weeks, severly affects pregnant women, no vaccines and diagnosis by HEV-specific IgM
  2. Most common S&S:
    1. Acute self-limited
    2. No reports exists of chronic infection
7. Lab tests:
  1. UCB
  2. Mixed
  3. CB
8. People at risk:
  1. People not vaccinated for HAV and HBV
  2. Poor sanitation
  3. Drug Abuse
  4. Travel history
  5. High endemic areas for HBV and BDV
  6. Unsafe intercourse

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