On the Trail

Out to accomplish one of the biggest personal goals of his life, Sam is half done hiking the mountain range spanning multiple states. He makes occasional stops to gather supplies and take a shower, but these last few weeks on the trail have been challenging. His resources are dwindling, and he is having difficulty finding clean water supplies. 

Now that summer is in its prime, the scorching sun is slowing Sam down and making him incredibly thirsty. He forgoes all of his precautionary measures to purify the water from any contaminants or infectious debris. Since he has run out of water cleansing tablets and is too thirsty to boil the water prior to drinking it, he sticks his face in the stream and has his fill. Within a few weeks, Sam begins to feel ill as if he has the flu. He is barely able to make it into a public health clinic to find the cause of his symptoms. 

What is Hepatitis A?

Stumbling into the clinic, it is clear that Sam does not feel well. Blood work is drawn and the staff determined that he is in a state of liver failure caused by the Hepatitis A Virus (HAV). Known to cause inflammation or swelling and irritation to the liver, HAV can have a significant impact on a person’s energy levels and ability to regulate blood clotting. 

Hepatitis A is transferred when individuals come into contact with infected feces or solid waste carrying the virus. Rarely, by blood transfusion ( viremia – during late intubation period)

While HAV itself is rarely life-threatening, the virus can lead to complete liver failure and cause death in rare cases. 

Symptoms of HAV

The blood work identifying the presence of HAV along with Sam’s symptoms confirm the diagnosis. Once someone contracts HAV, symptoms may or may not appear. Common symptoms of this virus include: 

• Flu-like symptoms – achiness, stiffness, fever 
• Jaundiced appearance, or yellowing of the skin, typically indicating liver disease 
• Children- Asymtomatic
• Adults- when seen, its severe hepatitis
• Mild disease in children can occur as anicteric hepatitis
• Relapsing Hepatitis (sometimes)- Normal monophasic HAV

Sam learns that symptoms begin to develop about 2-4 weeks after exposure. Symptom management may last a period of up to 6 months until an individual can expect them to completely resolve. 

Risk Factors

The nurse teaches Sam common ways that HAV is transmitted: 

• Contaminated water: dirty or unfiltered drinking water contaminated with infected feces 
• Unsanitary sewage: unregulated or undermanaged disposal of waste 
• Dirty fruits and vegetables 
• Intimate contact with an infected individual through sex or caregiving 

Prevention

Curious to know how she could have prevented the infection, he learns that he could have received a vaccine before he left the country. The vaccine, or medication that can boost immunity to the virus, is usually given to people over the age of 1 year and comes in the form of 2 injections administered 6 months apart. Children should be vaccinated between 1 to 2 years of age but can receive the vaccine later in life as well. 

Serology

IgM Anti HAV = Acute Hep A (<6months)

IgG Anti HAV = Immune (>6months)

• Virus is active (doesn’t cause chronic infection)
• Natural Immune – Recovered with proper bed rest and diet
• Artificial Immune – Post infection Vaccine for HAV

Other than all of the things that I just mentioned the liver is important for, it’s also important for the production of something known as bile. This is a greenish liquid produced in the liver and stored in the gallbladder, which facilitates the digestion of fat. 

Bile, among other things, contains something known as bilirubin. Bilirubin is an orange-yellow pigment formed from the breakdown of red blood cells. Bilirubin is converted into other substances that eventually give urine its yellow color and feces its yellow-brown color. Who knew physiology could be so colorful and yet so disgusting? 

When red blood cells break down due to age or destruction, then something known as unconjugated or indirect or water-insoluble bilirubin is released into the bloodstream. Once this unconjugated bilirubin enters the liver, the liver converts it into conjugated or direct or water-soluble bilirubin by tacking on a compound known as glucuronic acid; this is what makes bilirubin water soluble. 

This newly water-soluble bilirubin is then secreted into the watery bile and, from there, into the intestines. 

If all of this is making your head spin, don’t worry; we can simplify it even more. Your liver is like a giant factory. Through one end, raw ingredients come in by the truckload. In our case, that’s crates and crates of raw, hard, and unprocessed indirect bilirubin. Once inside the factory, the workers take a piece of unconjugated bilirubin and stick another ingredient right onto it, thereby making an entirely new concoction, called conjugated bilirubin. This conjugated bilirubin isn’t hard like unconjugated bilirubin; it’s slushy and can dissolve easily in water instead.

SOURCE – NISHA GARG TEXTBOOK

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SOURCE – NISHA GARG TEXTBOOK

SOURCE – NISHA GARG TEXTBOOK

SOURCE – NISHA GARG TEXTBOOK