Types of hepatitis in terms of etiology, Symptoms, treatment and prevention

Viral infections of the liver which are categorized as hepatitis are A, B, C, D, and E. Hepatitis A is an acute, short-term viral infection caused by hepatitis A virus (HAV). It is spread through fecal-oral route is the transmission route by means of close contact with infected person or ingestion of contaminated water and food. about 1400,000 new global HAV infections are reported annually (World Health Organization, 2012). Hepatitis B is caused by hepatitis B virus (HBV). It is spread via exposure to infectious body fluids and through sex and mother to infant during birth (Center for Disease Control and Prevention, 2020). Hepatitis C is caused by hepatitis C virus (HCV). It is transmitted through direct percutaneous exposure to infectious blood. HCV infects 150 million people every year (WHO, 2012).   Hepatitis D is caused by hepatitis D virus (HDV). A person contract HDV via direct contact with infected blood. It occurs together with HBV infection. Hepatitis E is caused by hepatitis E virus (HEV). It is a waterborne infection that result from ingesting infected feces that contaminates water supply (Zelman, et al., 2014). About 20 million new global HEV infections are reported annually. It is associated with increased morbidity and mortality.

Symptoms of viral hepatitis are the same irrespective of the type of hepatitis one has and can include fever, jaundice, loss of appetite, fatigue, vomiting, nausea, joint pain, abdominal pain, diarrhea, clay-colored stool and dark urine (Zelman, et al., 2014).

No medication is available for treatment of HAV and acute HBV. Thus they are best addressed via supportive management. However, antiviral drugs are available for chronic HBV. avoiding alcohol is advised as it worsens liver disease. Both acute and chronic HCV are treated with antiviral drug therapies. Liver transplant is considered the last resort if HCV progresses to liver cirrhosis. HAV, HBV and HEV can be prevented through vaccinations. Safe and effective vaccines are available. Proper sanitation and hygiene are also recommended. HCV can be prevented through proper implementation of blood safety strategies, such as safe injection practices, safe sex practices and quality-assured screening of donated blood. Because HCV can spread via sex, people in heterogamous relationships are advised to always use condoms (WHO, 2012).

Etiology and Symptoms of Cholelithiasis and Cholecystitis

Cholelithiasis is a gallstone disease characterized by the presence of hardened gallstones in the common bile duct (Terrie, 2020). Gallstones are formed from hardened bilirubin, cholesterol, or both. They vary in composition, size and shape. Cholesterol stones, black pigment stones and brown pigment stones are the main types of gallstones. Chronic gallstones lead to progressive fibrosis and loss of the gallbladder’s motor function, resulting in cholecytitis. Cholecytitis is characterized by the inflammation of the gall bladder. Cholecystitis occur as a result of gallstones get stuck at the opening of gall bladder. Other than gallstones getting stuck in the gallbladder, cholecytitis can also result from immunodeficiency, critical illness or trauma. Cholecytitis causes the thickening and edema of the gallbladder wall.  Patients with chronic cholelithiasis can develop cholecytitis.  Cholelithiasis is implicated in 90-95% of cholecytitis cases (Lindenmeyer, 2020). Patients with cholelithiasis present with symptoms of severe abdominal pain, blockage of bile duct, abdominal tenderness, fever, jaundice, abdominal swelling, clay-colored stool, nausea and vomiting. symptoms of cholelithiasis include gallstone pain. The commonest clinical presentation of cholecytitis is biliary pain. This pain begins abruptly in the right upper or center abdomen and radiates to the back and right shoulder (Terrie, 2020). Nausea and vomiting accompany the pain, which occur due to gallbladder distension or as a result of an obstruction of a stone via the cystic duct. other symptoms include fever and abdominal tenderness.

Severe gallstones can block the flow of digestive fluids and substances into the small intestine, resulting in pancreatitis or pancreatic inflammation. Digestive fluids and enzymes from the pancreas, liver and gall bladder are blocked from entering the small intestine and instead build up in the pancreas. The blockage of bile ducts can inflict severe harm to the liver, pancreas and gallbladder, which can be deadly.

It is possible to survive without a pancreas but at a cost. The pancreas secretes insulin and other chemical substances that regulate the body blood sugar. Without the pancreas, one becomes dependent on insulin therapy and is at higher risk of developing diabetes.

Diabetes associated with Chronic Renal Disease and End Stage Renal Disease

Diabetes is characterized by insufficient insulin in the body or inability of the body to utilize insulin amounts properly (Zelman, et al., 2014). High blood sugar levels in the body can injure blood vessels in the kidney and heart rendering the kidney incapable of cleaning blood properly (Ghaderian, Hayati, Shayanpour, & Beladi Mousavi, 2015). Salt, water, waste material will accumulate in blood and cause edema, weight gain, m and proteinuria. The damage to the nerves also makes it difficult for the bladder to empty. The full bladder causes blood pressure to build up and damage the kidneys. The kidneys maintain the water-electrolyte balance, and remove waste via urine production and keep blood pressure under control. The damage of kidneys by diabetes makes it impossible for kidneys to perform their function leading to chronic kidney disease. Chronic renal disease can progress to end-stage renal disease (Zelman, et al., 2014).

The major treatment options for renal disease include lifestyle changes, dialysis to replicate kidney’s functions and medications to control high blood pressure and cholesterol. There are five stages of chronic renal disease and treatment at earlier is recommended to keep the disease from worsening. Patients with diabetes and hypertension can avoid developing or delay onset of chronic renal disease by making lifestyle changes like controlling their blood sugar level, keeping blood pressure under normal level, adhering to prescribed medication, following diabetic diet, avoiding smoking and alcohol, and getting regular exercise.

Dialysis is a procedure that filters and cleans the blood utilizing a machine (National Kidney foundation, 2021). The purpose of dialysis is to filter and remove extra fluid and waste from the blood in people with damaged kidneys. Both hemodialysis and peritoneal dialysis involve filtering and elimination of extra fluid and waste from the body. Hemodialysis involves pumping of blood to artificial kidney machine for purification, after which it is returned to the body through tubes connected to the machine. On the other hand, in peritoneal dialysis, waste and extra fluid are filtered in the abdomen. Hemodialysis is used in patients whose kidneys are functioning to some extent while peritoneal dialysis is used in patient with kidney failure.

  1. Acute Kidney Injury Case Study of Zach


The main symptom implicated in a kidney bruise is pain in the flank and abdominal areas. Other symptoms of kidney bruise include discoloration of skin, tenderness, pain, vomiting, nausea, blood in urine and muscle spasms (Anthony, 2018). Since the ribcage and back muscles protect the kidneys, they may also get injured when the kidneys become injured. An injured kidney is a serious injury that may result in severe health complications if not treated.

Diagnostic Tests

Imaging test may be ordered to confirm or rule out further injury and internal bleeding. Imaging such as X-rays or CT scan can tell how bad the kidney injury is. Urinalysis can also be ordered to detect blood in urine (Wedro, 2021). A dipstick test is often used to detect microscopic hematuria.


A kidney injury is a serious condition that requires immediate attention. Even a minor kidney injury can develop into severe complications and lead to death. Treatment of acute kidney injury depends on the extent of kidney injury and whether there are injuries to other organs. For a stable patient with no injury to other body organs, surgery is out of question. The patient will take bed rest and monitored closely until the urine is clear of blood (Anthony, 2018). The patient is also monitored for bleeding. After discharge, the patient is monitored for high blood pressure and late bleeding. A minor kidney injury should take two to three weeks to heal on its own. the kidney maintains water-electrolyte balance and excretes waste from the body. A damaged kidney thus can be a life-threatening. In case of unstable patient who is losing much blood, surgery is considered necessary. The purpose of surgery is to repair and fix the injured kidney. Advancement in medical technology has made it possible to invasively handle invasively kidney injuries without surgery. For example, angiographic embolization is a method that can be used to reach blood vessels of the kidney to halt bleeding.


Anthony, K. (2018). Bruised Kidney (Kidney Contusion). Healthline. Reviewed July 7, 2021 from https://www.healthline.com/health/bruised-kidney#symptoms

Center for Disease Control and Prevention. (2020). The ABCs of Hepatitis – for Health Professionals. https://www.cdc.gov/hepatitis/resources/professionals/pdfs/abctable.pdf

Ghaderian, S. B., Hayati, F., Shayanpour, S., & Beladi Mousavi, S. S. (2015). Diabetes and end-stage renal disease; a review article on new concepts. Journal of renal injury prevention, 4(2), 28–33. https://doi.org/10.12861/jrip.2015.07

Lindenmeyer, C. (2020). Acute cholecystitis. Merck Manual Professional Edition Online. Reviewed July 7, 2021 from www.merckmanuals.com/professional/hepatic-and-biliary-disorders/gallbladder-and-bile-duct-disorders/acute-cholecystitis?query=Cholecystitis.

National Kidney foundation. (2021). Peritoneal Dialysis: What You Need to Know. Reviewed July 7, 2021 from https://www.kidney.org/atoz/content/peritoneal

Terrie, Y.C. (2020). A Review of Cholelithiasis and Cholecystitis for Pharmacists. US Pharmacy 45(12): HS-2-HS-10

Wedro, B. (2021). Lacerated Kidney Symptoms, Treatment, and Recovery Time. MedicineNet. Reviewed July 7, 2021 from https://www.medicinenet.com/lacerated_kidney_symptoms_treatment_and_recovery/views.htm

World Health Organization. (2012). Prevention & Control of Viral Hepatitis Infection: Framework for Global. Reviewed July 7, 2021 from Actionhttps://apps.who.int/iris/bitstream/handle/10665/130012/WHO_HSE_PED_HIP_GHP_2012.1_eng.pdf;jsessionid=9988D5AC32ACB13234B8B0A4BBD59E84?sequence=1

Zelman, M. et al (2014). Human Diseases: A Systematic Approach, 8/e. P

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