Yellow Eyes

Yellow Eyes

1. Abdullah, 27 years old, Dentist

2. Jaundice?

   • Causes:
   • Ddx:
     • Viral infections
       • Hep A, B & C
     • Chronic alcohol abuse
     • Autoimmune disorders
     • Drugs
     • Pregnancy
   • Due to bilirubin accumulation
     • Heme Degradation & Bilirubin metabolism

3. Causes of liver cirrhosis:

   • Viral infection
     • Tumor
   • Drugs
   • alpha 1 antitrypsin def.
   • Alcohol abuse

4. Anatomy and Histology of GB

   • Embryology

5. Physiology of GB

   • Storage of bile
   • Release of Bile into the intestines in response to CCK
   • Abnormality?

6. Gallstones

   • Risk factors:
     • Female
     • >= 40 years old
     • Native or Mexican American
     • Overweight or obese
     • Sedentary
     • High-fat and Low-fiber diet
     • Family history
   • S&S
     • Sudden and rapidly intensifying pain in RUQ
     • Nausea or Vomiting
   • Types:
     • Cholesterol Gallstones
       • yellow undissolved cholesterol
     • Pigment Gallstones
       • when the bile contains too much bilirubin.
   • Why?
     • bile contains too much cholesterol.
     • the bile contains too much bilirubin.
     • the gallbladder doesn't empty correctly .
   • Investigations?
     • 1- Imaging
       • Ultrasound
       • CT Scan
     • 2- Bile tests:
       • HIDA, MRI and ERCP
     • 3- Blood tests:
       • To look for complications
     • Treatment and prevention: :
       • Surgery to remove the GB
       • Medications to dissolve the gallstones
       • Don't skip meals
       • Lose weight slowly
       • Maintain a healthy weight

7. Hepatitis

   • A "Picornavirus"
     • Acute only, RNA , IP: 2-6 weeks and feco-oral route
     • Most common S&S:
       • Fatigue
       • Nausea and vomiting
       • Fever
       • Hepatomegaly
       • jaundice
       • Dark urine
       • Anorexia
       • Rash
     • Prevention:
   • B "Hepadnavirus
     • DNA, in blood & saliva & serum & vaginal fluids, STD & parenteral and IP: 60 days
       • Prevention
     • Most common S&S:
       • Gradual onset of anorexia
       • Malaise
       • fatigue
       • Fever
       • Arthritis and arthralgias
       • Jaudice
       • Nausea and vomiting
     • Treatment
       • Lamivudine
       • Adefovir
       • Entacavir
       • Pegylated IFN
   • C "Flavivirus"
     • RNA, similar transmission as HepB, Chronic infection, IP: 15-150 days and diagnosed by HCV AB
     • Most common S&S:
       • During acute infection
         • similar to HepB
       • 80% are asymptomatic and do not develop icterus
     • Treatment
       • Ribavirin
       • Boceprevir
       • Telaprevir
       • Daclatsevir
       • Sofosbuvir
       • Pegylated IFN
       • NO VACCINE
   • D "Delta virus"
     • RNA, only multiple in a HBV infected cell >> co-infection, superinfection increases liver damage rate and IP: 35 days
     • Most common S&S:
       • severe acute hepatitis only in patients developing chronic superinfection
   • E "Calcivirus"
     • RNA, feco-oral route, IP: 5-6 weeks, severly affects pregnant women, no vaccines and diagnosis by HEV-specific IgM
     • Most common S&S:
       • Acute self-limited
       • No reports exists of chronic infection
   • Lab tests:
     • UCB
     • Mixed
     • CB
   • People at risk:
     • People not vaccinated for HAV and HBV
     • Poor sanitation
     • Drug Abuse
     • Travel history
     • High endemic areas for HBV and BDV
     • Unsafe intercourse

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