Gastroenterology and Hepatology

The Critical care nursing for liver diseases offers care to patients in potentially life-threatening conditions requiring life support system and other intensive medical interventions. The patients with liver disease or failure are admitted to a Critical Care Unit.

The goal of paediatric gastroenterology research is to reduce baby and child mortality rates, restrict the spread of infectious disease, promote healthy lifestyles for a long, disease-free life, and assist children and adolescents with their challenges. It is clear that understanding the major and primary subjects in gastroenterology will help you achieve this goal. It covers the treatments that are used to help children's gastrointestinal health.

The underlying pathophysiology of hepatitis begins in the liver. There are different types of viruses that cause hepatitis namely hepatitis A, B, C, D and E. The pathway begins when the virus enters the blood stream and spreads to the liver. The viral hepatitis doesn’t induce the apoptosis directly. They infect the hepatocytes and replicate to increase their number. After the infection of the hepatocytes the body’s innate and adaptive immunity systems activates leading to the inflammatory responses followed by the cell damage and death. Depending on the immune strength of the individual this can progress into acute or chronic infection. In case of poor immunity of individual then multiple cycles of inflammation, injury occurs leading to the scarring or fibrosis and hepatocellular carcinoma. In the hepatitis infection the function of the natural killer cells (NK cells belonging to the same family as T and B cells) is disturbed.

Liver is said to be the largest gland which plays a major role in the detoxification process. To detect the liver diseases there are many available liver function tests. The test mainly focuses on the levels of liver enzymes such as alanine transaminase, aspartame transaminase, serum proteins, serum albumins, partial thromboplastin time. Liver biopsy is another technique used to detect the liver damage. In this method a small piece of liver is collected and examined for extent of damage. In condition of liver damage the levels of coagulating factors and the anticoagulation factors are less because the damaged liver cannot synthesize them like before. Imaging techniques such as transient elastography, magnetic resonance imaging can be used to detect liver tissues and bile ducts.

Liver transplantation can also be called as hepatic transplantation. It is a surgery that replaces the injured or diseased liver with a healthy liver of another donor person. It is a suggestive option for irreversible and severe liver dysfunction.  The liver transplantation has a greater risk of graft rejection, biliary and vascular complications. The technique of liver transplantation includes the following steps of cooling, hepatic transplantation followed by post-transplant immunosuppression. However this hepatic transplantation is contraindicated in people with.

Liver is an organ that plays a major role in the detoxification, synthesizing of proteins and biochemical agents that are necessary for growth and digestion. The primary cells present in the liver are called as hepatocytes and the cancer developed at that site is named as hepatocellular cancer. This hepatic cancer is of two types. Primary hepatic malignancy starts developing in the liver whereas secondary hepatic malignancy starts developing in other parts of the body and spreads to the liver. The risk factors of hepatic cancer are cirrhosis, aflatoxin, obesity, smoking, alcohol abuse and genetic conditions. The most commonly seen hepatic cancer is hepatocellular cancer. Other types of cancers include

Pancreas is said to be second largest gland in the human body. It is a mixed gland which has both exocrine and endocrine functions. The exocrine function of the pancreas includes digestion by secreting digestive enzymes whereas the endocrine function includes secretion of the hormones. Pancreas is also called as the ductless glands since they secrete their products directly into the blood. The beta cells of the pancreas are responsible for the secretion of the insulin hormone which play a major role in the balancing the blood sugar levels. Diseases related to the pancreas can affect the entire human body. The most commonly seen pancreatic diseases include pancreatitis which is referred to the inflammation of the pancreas which left untreated may result in the onset of diabetes. Other common pancreatic diseases include

Till now few drugs are available for the treatment of hepatitis C disease. But now newer drug category is included which are direct acting antiviral agents. The mechanism of action of direct acting anti-viral drugs is they are the protein molecules that target specific stages in the hepatitis C virus lifecycle and disturbs the viral replication process there by inhibiting the infection. The drugs included under this category include.

This hepatitis A infection is more dominantly seen in children between the ages 5-14 whatever it is rarely seen in infants. Apart from adults who exhibit serious clinical symptoms the children infected with the Hepatitis A shows mild symptoms only. However Hepatitis A infection is said to impose greater risk to some population groups such as persons suffering from clotting disorders, chronic liver dieses, and persons administering clotting factors. Hepatitis B is most common type of viral Hepatitis seen all over the world. Hepatitis B virus is predominantly found in East Asia, African and sub-Saharan regions. This Hepatitis B infection imposes more risk to persons with intravenous drug administrations, health care workers and people with abnormal sexual behaviour. Hepatitis C virus has less prevalence which can be 30% of the world population. This Hepatitis C viral infection can lead to serious conditions like hepatocellular carcinoma and cirrhosis. Hepatitis D virus spreads through the syringe needles and other mode of contact with the infected person. The geographical regions including United States and northern Europe are more prone to this infection. Hepatitis E spreads by weakening the immune system and is responsible for nearly 55,000 deaths per annum.

Hepatitis A virus (HAV) belongs to the family Picornaviridae and genus Hepatovirus. It is usually spherical in shape and non-enveloped. HAV has a positive single stranded RNA which is enclosed inside a protein shell called as capsid. HAV is named as hepatogenous virus. It is said to have a poor internal ribosome entry site. Hepatitis B virus (HBV) belongs to the family of small DNA viruses. HBV undergoes replication in the hepatocytes of the host by reverse transcription of viral RNA. After the infection the virion DNA gets converted to nucleus and assembles to minichromosome forming a template for the viral mRNA synthesis. Hepatitis C virus (HCV) belongs to the genus Hepacivirus and the domestic Flaviviridae. HCV has an outermost covering of lipid membrane envelope. Two glycoproteins E1 and E2 are covalently embedded into the lipid membrane by means of the disulphide bridges. The genome of the HCV is positive sense single stranded RNA. E1 and E2 glycoproteins play a major role in the immune system interactions. Hepatitis D virus (HDV) is also called as hepatitis delta virus. It is spherical shaped enveloped virus. The genome of the HDV is negative sense single stranded closed and circular RNA.Hepatitis E is a single stranded RNA virus with a small envelope belonging to the family Hepeviridae.

Hepatitis is defined as the clinical condition characterized by the inflammation of the liver. Hepatitis is commonly caused by virus hence named as viral hepatitis.  Other common causes include alcohol abuse, administrations of certain medications, accumulation of certain toxins, other auto immune disorders, and non-alcoholic steatohepatitis. Even after the recovery from hepatitis that person can suffer from serious health risks such as destruction of the liver tissues, hepatic failure, hepatocellular carcinoma and even death in some cases. Hepatitis infection can be treated but cannot be cured completely and hence care should be taken to prevent the infection from attacking. Hepatitis infection can be prevented by immunization with the hepatitis vaccine within the day the child is born. There are available vaccines for Hepatitis A and Hepatitis B but not for Hepatitis C. Based on the fact that the hepatitis D infection occurs only if the person is suffering from the Hepatitis B infection vaccinating with Hepatitis B can protect against Hepatitis D infection. There exists no vaccine for hepatitis which is FDA approved. The risk factors associated with the hepatitis include unprotected sex, poor nutrition, alcohol abuse, long term dialysis and poor sanititation.

During hepatitis infection a high calorie diet is required along with moderate physical activity. The important step in the management of hepatitis is the intake of correct drug with correct dosage and frequency. Hepatitis A does not progress into chronic condition and hence the management requires supportive treatment such as intravenous administration of fluid and nutrition. In most cases hepatitis B results into chronic state and hence drug treatment is mandatory. The drugs used for the treatment of hepatitis B include interferon alpha, Pegylated interferon, Lamivudine, Adefovir dipivoxi, Telbivudine and Tenofovir. The drugs used in the management of hepatitis C include telaprevir, boceprevir, dasabuvir. The treatment of hepatitis D is difficult and lacks specific anti-viral drugs. The management of Hepatitis E includes bed rest along with supplementation of proper nutrition.

Liver cancer, otherwise called hepatic cancer, is the condition which occurs when the different types of cells in the liver forms into several types of malignant tumors. Liver cancer is generally of primary or secondary. Primary liver cancer begins in the liver whereas Secondary liver cancer also known as liver metastasis starts in another part of the body spreads to the liver. The main reason for liver cancer is cirrhosis because of hepatitis viruses B and C or alcohol. The other different causes include non-alcoholic fatty liver disease, aflatoxin, and liver flukes. Some of the most common symptoms of liver cancer are weight loss, easy bruising, yellowish skin, pain in the right side beneath the rib cage, loss of appetite and weakness. The generally recognized sorts are hepatocellular carcinoma (HCC), which makes up 80% of cases, and cholangiocarcinoma. Primary liver cancer is all around the 6th most frequent cancer (6%) and the second leading reason for death from cancer (9%).

Liver diseases that occurs during pregnancy is a present challenge for healthcare providers. Some certain liver diseases are uniquely associated with pregnancy, while some are unrelated. Liver diseases that have an impact during pregnancy may include acute fatty liver of pregnancy (AFLP), Intrahepatic cholestasis of pregnancy (ICP), Hyperemesis gravidarum and Hemolysis and Elevated Liver enzymes and Low Platelets (HELLP) syndrome. Both acute viral hepatitis and chronic viral hepatitis have an impact on pregnancy. Acute viral hepatitis can occur in pregnancy, and pregnancy may occur in patient suffering with chronic liver disease. It also includes patients with liver cirrhosis, portal hypertension, and the patients who have undergone liver transplantation.

Intestinal rehabilitation is the process of gradually restoring the intestine's ability to digest food and absorb nutrients. Generally, people with all types of gastrointestinal disorders may qualify for intestinal rehab without the need for transplant. This is done through recent advanced diet, medicines and surgery which greatly reduced the need for intestine organ transplants. Total Parenteral Nutrition (TPN) is a lifesaver for patients who are unable to absorb enough nutrition through their small intestine. TPN is the process where the nutrition is given into the blood through a vein (intravenously) by a central line placed in the child’s chest, neck or groin. Intestinal rehabilitation involves strategies and therapies designed to make the bowel to work better by giving nutritional support, nutritional rehabilitation, medical management and restorative surgery.

The current existing treatments eliminates the virus in only a little more than half of all patients. Those drugs may also have unwanted side effects which makes it difficult for patients to take them. In recent years, tremendous research advances are transforming on treatment of Hepatitis. This progress has occurred in just last three years with new and effective therapies transforming the trajectory of the disease for many patients. The scientific advances that are made by biopharmaceutical researchers have already begun to have a tangible impact on thousands of patients. In all these areas, rapid progress is being made and more new medicines are on the way. The Food and Drug Administration has approved a new drug named Harvoni, which combines sofosbuvir and ledipasvir which cures Hepatitis C virus in just eight weeks.

Liver fibrosis occurs when the healthy tissue of your liver becomes scarred by excessive accumulation of extracellular matrix proteins including collagen which makes the liver cannot work as well. Liver repairs damage through the deposition of new collagen, as the way the skin and different organs heal wounds through deposition of collagen and other grid constituents. Advanced liver fibrosis results in cirrhosis of the liver, in which the architectural organization of the functional units of the liver becomes disrupted. Over time this process can result in liver failure, liver cancer and portal hypertension and often requires liver transplantation. While some studies have shown that the potential for the liver to regenerate or heal itself, once liver damage is done in humans, the liver doesn’t usually heal. However, medications and lifestyle changes can help to keep fibrosis from getting worse.