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Liver injury labs are as follows ammonia levels, INR, fibrinogen, glucose, and lactate. Other abs include Alanine transaminase (ALT): 0 to 55 units per liter (U/L) Aspartate transaminase (AST): 0 to 48 U/L. Alkaline phosphatase (ALP): 30 to 129 U/L. Gamma-glutamyltransferase (GGT): 8 to 61 U/L. Bilirubin: 0.1 to 1.2 milligrams per deciliter (mg/dL). Prothrombin time (PT): 10.9 to 12.5 seconds. Albumin: 3.5 to 5.0 grams per deciliter (g/dL). Total proteins: 6.3 to 7.9 g/dL. Once diagnosed liver injury the medications can be adjusted based on the lab results. Also discontinuing of any acetaminophen orders also any other nephrotoxic medications will also be recommended (2022). rising burden of liver disease is mainly a reflection of the three the most common causes: alcohol-related liver disease, non-alcoholic fatty liver disease and viral hepatitis, although autoimmune liver disease is also a significant contributor.4 The burden of liver disease in children differs from that in adults, as although non-alcoholic fatty liver disease (NAFLD) is seen in all ages, reflecting the rise in childhood obesity, disease associated with injecting drug use and alcohol are rarely encountered (Newsome et al., 2018). Acute hepatitis A virus (HAV) infection highly contagious. People who get hepatitis A may feel sick for a few weeks or several months but usually recover completely and do not have lasting liver damage. In rare cases, hepatitis A can cause liver failure and even death. This is more common in older people and in people with other serious health issues, such as chronic liver disease (2022).

           Hepatitis A virus (HAV) is one of the well-known viruses that cause hepatitis all around the globe. Although this illness has decreased in developed countries due to extensive immunization, numerous developing and under-developed countries are struggling with this virus, HAV can be contained and prevented with vaccination. HAV can spread through oral fecal contact and through contaminated foods and water. Acute viral hepatitis is a systemic illness that mainly affects the liver. Hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis D virus (HDV), and hepatitis E virus (HEV) are the viruses that cause almost all instances of acute viral hepatitis, Hepatitis can be present with little or no symptoms, although it frequently results in jaundice, anorexia, and malaise. Hepatitis infection is divided into two types: acute and chronic. Acute hepatitis remains for less than six months, whereas chronic hepatitis stays for an extended period (Torre et al, 2021). In conclusion, vaccination is key to control the spreading of the virus not only for HAV but for all other hepatitis viruses. Immunization has to be considered an important step, and this system will enable the early detection of epidemiologic transitions and the implementation of preventative efforts before HAV infection becomes a public health issue.

References

Newsome, P. N., Cramb, R., Davison, S. M., Dillon, J. F., Foulerton, M., Godfrey, E. M., Hall, R., Harrower, U., Hudson, M., Langford, A., Mackie, A., Mitchell-Thain, R., Sennett, K., Sheron, N. C., Verne, J., Walmsley, M., & Yeoman, A. (2018, January). Guidelines on the management of abnormal liver blood tests. Gut. https://pmc.ncbi.nlm.nih.gov/articles/PMC5754852/

https://my.clevelandclinic.org/health/diagnostics/17662-liver-function-tests. Liver Function Tests. (2022, November 9).

Hepatitis A basics | hepatitis A | CDC. (2025a, January 31). https://www.cdc.gov/hepatitis-a/about/index.html

Gholizadeh, O., Akbarzadeh, S., Ghazanfari Hashemi, M., Gholami, M., Amini, P., Yekanipour, Z., Tabatabaie, R., Yasamineh, S., Hosseini, P., & Poortahmasebi, V. (2023). Hepatitis A: Viral Structure, Classification, Life Cycle, Clinical Symptoms, Diagnosis Error, and Vaccination. The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale, 2023, 4263309. https://doi.org/10.1155/2023/4263309

Torre P., Aglitti A., Masarone M., Persico M., (2021) Viral hepatitis: milestones, unresolved issues, and future goals. World Journal of Gastroenterology.;27(28):4603–4638. doi: 10.3748/wjg. v27.i28.4603

Appropriate Blood Tests for Suspected Acute Liver Injury

     The liver plays a crucial role in maintaining homeostasis, and when acute injury occurs, a thorough evaluation is necessary to determine the extent of damage and underlying cause. Blood tests are essential in assessing liver function, hepatocellular integrity, and potential viral infections. The primary tests ordered for suspected acute liver injury include liver function tests (LFTs), coagulation studies, and viral serologies. Liver function tests provide insight into hepatocyte integrity and bile excretion. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are key markers of hepatocellular damage, often rising significantly in acute injury. In cases of acute hepatitis A virus (HAV) infection, ALT levels can exceed 1000 U/L, with AST also elevated but typically lower than ALT. Alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) assess biliary function, with ALP being mildly elevated in HAV cases. Additionally, total and direct bilirubin levels are crucial in evaluating bile processing and excretion, often presenting as hyperbilirubinemia in acute HAV, which correlates with jaundice. Albumin levels, while generally normal in acute liver injury, may decrease in severe hepatic dysfunction.

      Coagulation studies, including prothrombin time (PT) and international normalized ratio (INR), assess the liver’s synthetic function. Since the liver produces clotting factors, significant hepatic impairment can prolong PT/INR, indicating a decline in liver function. In mild cases of HAV, coagulation parameters remain normal, but in severe cases, PT may be prolonged. To confirm HAV infection, viral serologies are essential. The presence of HAV IgM antibodies indicates a recent or active infection, differentiating it from past exposure or vaccination. HAV IgG antibodies, on the other hand, suggest immunity from prior infection or immunization. The hallmark laboratory findings in acute HAV include markedly elevated ALT and AST, mild increases in ALP, hyperbilirubinemia, and a positive HAV IgM test, confirming acute infection.

References

Jameson, J. L., Fauci, A. S., Kasper, D. L., Hauser, S. L., Longo, D. L., & Loscalzo, J. (2022). Harrison’s Principles of Internal Medicine (21st ed.). McGraw-Hill Education.

Lee, W. M. (2020). Acute liver failure. The New England Journal of Medicine, 382(22), 2137-2145. https://doi.org/10.1056/NEJMra1917038

Schuppan, D., & Afdhal, N. H. (2021). Liver cirrhosis. The Lancet, 398(10308), 1359-1371. https://doi.org/10.1016/S0140-6736(21)01374-X

Recent milestones in the understanding of gastric acid secretion and treatment of acid-peptic disorders include the discovery of histamine H2-receptors and development of histamine H2-receptor antagonists, identification of H+K+-ATPase as the parietal cell proton pump and development of proton pump inhibitors, and identification of Helicobacter pylori as the major cause of duodenal ulcer and development of effective eradication regimens (Schubert et al. 2008). The stimuli for acid secretions are as follows, Acetylcholine, Gastrin and Histamine. When this acid secretion combines food can digest but also it can create different issues, for example, it can facilitate digestion of protein as well as the absorption of iron, calcium, and vitamin B12. When we take medication is these secretions are necessary for absorption of certain drugs however taking too much medicine or eating the wrong foods can lead to acid-related clinical conditions. Parietal cells secrete hydrochloric acid at a concentration of approximately 160 mmol/L or pH 0.8. Acid is thought to gain access to the lumen via channels in the mucus layer created by the relatively high intraglandular hydrostatic pressures generated during secretion, approximately 17 mm Hg (Johnsson et al, 2001). The acids facilitate the ingestion of protein and absorption of iron, calcium, and vitamin B-12 as well as prevent bacterial overgrowth and enteric infection. However, if the acid levels and pepsin increase a risk of ulcers can occur. The principal of acid secretion is histamine released from ECL cells (paracrine); gastrin, released from G cells (hormonal); and ACh, released from postganglionic enteric neurons (neurocrine) (Schubert et al. 2008).

Helicobacter pylori (H. pylori) attack the lining that protects your stomach. Many people have it and won’t have any issues with ulcers until the time is right for one to start causing issues. As the host starts showing symptoms of an ulcer, the H pylori make an enzyme called urease that makes the acid in the stomach less acidic while weakening the stomach lining, furthermore the host is at a greater risk of being hurt by acid and pepsin, strong digestive fluids. That can lead to sores or ulcers in your stomach or duodenum (2024). Helicobacter pylori is the first formally recognized bacterial carcinogen and is one of the most successful human pathogens, as over half of the world’s population is colonized with this gram-negative bacterium. Unless treated, colonization usually persists lifelong. H. pylori infection represents a key factor in the etiology of various gastrointestinal diseases, ranging from chronic active gastritis without clinical symptoms to peptic ulceration, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue lymphoma (Kusters et al., 2006). In conclusion H pylori is a bacteria that is found in all of us how it develops is how it is going to affect us, by taking simple precautions such as eating food that is cleaned thoroughly and cooked in a safe way and by drinking clean and potable water from a sanitary source that will not have bacteria. Lastly, good hand hygiene is the best way to effectively protect ourselves from these bacteria.

References

Schubert, Mitchell L. et al (2008). Control of Gastric Acid Secretion in Health and Disease

Gastroenterology, Volume 134, Issue 7, 1842 – 1860

Johansson, M. ∙ Synnerstad, I. ∙ Holm, L. (2001). Acid transport through channels in the mucous layer of rat stomach Gastroenterology; 119:1297-1304

Helicobacter pylori. Johns Hopkins Medicine. (2024, May 13). https://www.hopkinsmedicine.org/health/conditions-and-diseases/helicobacter-pylori

Kusters, J. G., van Vliet, A. H. M., & Kuipers, E. J. (2006, July). Pathogenesis of helicobacter pylori infection. Clinical microbiology reviews. https://pmc.ncbi.nlm.nih.gov/articles/PMC1539101/

Instructions:

This discussion will be completed in two parts and will give you an opportunity to reflect upon this week’s content and to interact with your classmates.

• Part 1 – Post your initial response to the discussion questions by Thursday at 11:59 pm
• Part 2 – Post substantive feedback to two (2) classmates by Sunday at 11:59 pm

Discuss the process you prefer to use when looking up codes from the imaging section of the ICD-10-PCS book. Do you find coding from the section easier than some of the previous sec

• You should respond by extending, refuting/correcting, or adding additional nuance to their posts. 
  • Your response should be at least 150 words.
• All replies must be constructive and use literature where possible. apa format with references

Reply to these post below seprately

1.Describe urinary tract infection, causes, symptoms and treatment

• A urinary tract infection encompasses multiple causes of urethral, bladder, or kidney inflammation. This inflammation is typically caused by yeast, bacteria, or chemical irritants.
• Women are 30x as likely as men to have a urinary tract infection. Women’s urethras are shorter than men’s, meaning there is less distance for bacteria to travel and the woman’s urethra is much closer to the anus than that of men, posing the risk of cross-contamination when wiping or during sexual intercourse. In men, the most common causes of urinary tract infections include having anal sex, the partner inserting their penis into another’s anus, and having an uncircumcised penis, as it traps bacteria.
• The most common symptoms associated with a urinary tract infection include urinary frequency, urinary urgency, and difficult or painful urination. Patients may also experience back or suprapubic pain. In patients with kidney infections, they may also experience flank pain, fever, nausea, and vomiting.
• Although around a quarter of uncomplicated urinary tract infections can resolve on their own, antibiotics are the treatment of choice. Antibiotics used to treat urinary tract infections include Bactrim, Trimpex, Macrobid, Cipro, Floxin, Levaquin, Noroxin, and Suprax. Urinary analgesics may also be prescribed to reduce pain, frequency, and urgency. These include Urised, Pyridium, and Urispas (Arcangelo, et al., 2017, pp. 1503-1522).
• Discuss treatment for benign prostatic hyperplasia
  • There are three main drug classes used to treat benign prostatic hyperplasia: A-Adrenergic antagonists, 5-A-reductase inhibitors, and PDE type 5 inhibitors.
  • A-adrenergic antagonists relax the prostate and bladder’s smooth muscle fibers. These drugs include tamsulosin, doxazosin, terazosin, alfuzosin and silodosin.
  • 5-A-reductase inhibitors, like finasteride and dutasteride, reduce the size of the prostate by up to 20-30% by decreasing intracellular DHT, which is the hormone that promotes prostate cell growth.
  • PDE5 inhibitors (tadalafil) is used when A-adrenergic antagonist use is unsuccessful or in men who also have erectile dysfunction. This drug regulates the prostate’s smooth muscle tone.
  • Alternative therapies can also be considered for benign prostatic hyperplasia even though there is no scientific proof to back them. Some men are choosing to take saw palmetto, Pygeum, and zinc to treat their BPH (Virginia Poole Arcangelo, Et Al., 2017, pp. 1543-1563)
• Describe overactive bladder, causes, symptoms and treatment 
  • Overactive bladder is a broad term, it encompasses urinary urgency, nocturia, frequency, and possibly incontinence, not caused by a UTI (Scarneciu et al., 2021).
  • Pinpointing the cause of overactive bladder is not always possible. Many physiologic, anatomic, and comorbidity-related factors can contribute to the development of overactive bladder. In most cases, the cause is idiopathic, while other causes are typically neurogenic or myogenic related.
  • Symptoms typically include urinary frequency, urinary urgency, nocturia, and incontinence. Patients may experience some or all of these symptoms.
• Treatment includes non-pharmacological and pharmacological interventions. Pelvic floor muscle exercises, bladder training, and weight loss are important treatments to aid in the reduction of symptoms. Medications used to treat overactive bladder include anticholinergics/antimuscarinics like oxybutynin or trospium, beta-3-adrenoreceptor agonists like Myrbetriq, OnabotulinumtoxinA better known as botox, serotonin norepinephrine reuptake inhibitors like duloxetine, alpha-adrenergic antagonists like tamsulosin or doxazosin, estradiol vaginal suppositories, estrogen ring, or desmopressin oral or intranasal spray (Virginia Poole Arcangelo, Et Al., 2017, pp. 1587-1626)
• Treatment options and recommendations for different STIs (Chlamydia, Gonorrhea and Syphilis)
  • For chlamydia, the treatment of choice is a one-time 1g dose of PO azithromycin or a 7-day 100mg BID regiment of doxycycline. If the patient is pregnant, they should not be prescribed doxycycline.
  • For gonorrhea, the treatment of choice is a one-time 250mg IM injection of ceftriaxone and either a one-time 1g PO dose of azithromycin or a 7-day 100mg BID regiment of doxycycline.
  • For genital herpes, the initial outbreak should be treated with acyclovir 400mg PO TID, acyclovir 200mg PO 5x daily, or valacyclovir 1g PO BID for 7-10 days. Recurrent treatments should be treated with acyclovir 400mg PO TID for 5 days, acyclovir 800mg BID for 5 days, acyclovir 800mg TID for 2 days, famciclovir 125mg PO BID for 5 days, famciclovir 100mg BID for 1 day, valacyclovir 500mg PO BID for 3 days or Valacyclovir 1g QD for 5 days. Suppressive treatment is also an option with acyclovir 400mg BID, famciclovir 250mg BID, Valacyclovir 500mg QD, or valacyclovir 1g QD.
• For Syphilis, treatment depends on when it is caught. If caught within the first year, regardless of it being primary, secondary, or latent syphilis, the adult dose is a one-time benzathine penicillin G 2.4 million U IM injection, child doses are weight based. For latent disease > one year, the same medication is given to adults, but instead of a one-time dose, they receive three doses one week apart. For children, the dose is weight based, but also done in 3 doses one week apart. If a patient is allergic to penicillin and not pregnant, they can be prescribed 14 days of 100mg PO doxycycline BID or tetracycline 500mg PO BID (Virginia Poole Arcangelo, Et Al., 2017, pp. 1630-1631).

References:

Virginia Poole Arcangelo, & Al, E. (2017). Pharmacotherapeutics for advanced practice : a practical approach (4th ed., pp. 1503-1522). Wolters Kluwer Health, Cop

Scarneciu, I., Lupu, S., Bratu, O., Teodorescu, A., Maxim, L., Brinza, A., Laculiceanu, A., Rotaru, R., Lupu, A.-M., & Scarneciu, C. (2021). Overactive bladder: A review and update. Experimental and Therapeutic Medicine, 22(6). https://doi.org/10.3892/etm.2021.10879

2.Describe urinary tract infection, causes, symptoms, and treatment

Urinary tract infection is a broad term encompassing a range of infectious syndromes, affecting areas from the urethra to the kidneys (Al Lawati et al., 2024). The infection occurs when bacteria colonize the urethra or periurethral space, migrate into the bladder, and trigger an inflammatory response (Al Lawati et al., 2024). The primary causative agents include Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis. The classic symptoms are dysuria, urinary frequency, urinary urgency, or suprapubic pain without systemic illness such as fever, rigors, or vomiting. It is confirmed with two main laboratory tests, a urinalysis and urine cultures, which show the presence of white blood cells in the urine.

Treatment includes proper hygiene, adequate hydration, and antibiotics. The first-line agent commonly used is nitrofurantoin 100 mg twice daily for five days. If the first-line agents are contraindicated, amoxicillin-clavulanic acid can also be used.

1. Discuss treatment for benign prostatic hyperplasia

Benign prostatic hyperplasia is a diagnosis that refers to the growth of glandular epithelial tissue and smooth muscle in the transitional zone of the prostate (Eitftu et al., 2024). The exact mechanism of BPH remains unclear; age-related changes leading to metabolic disturbances, hormonal changes, and chronic inflammation may play a role.

Some patients may choose conservative treatment methods, such as lifestyle modifications like losing weight, reducing evening fluid intake, and limiting overall fluid intake or the number of substances that irritate the bladder or have diuretic effects, including carbonated beverages like coffee, tea, and cola. Additionally, bladder management techniques should be considered, which include timed voiding every 2-3 hours and performing pelvic floor stretches or relaxation exercises. Pharmacotherapy includes alpha-blockers that relax the smooth muscles in the bladder neck and prostate, reduce constriction of the urinary channel, and lower resistance to urinary flow (Eitftu et al., 2024). These include second-generation terazosin and doxazosin and third-generation tamsulosin, alfuzosin, and silodosin.

1. Describe overactive bladder, causes, symptoms, and treatment 

Overactive bladder is a chronic condition that affects both men and women. It is characterized by a sudden, involuntary contraction of the bladder muscle, leading to an urgent need to urinate, frequent urination, and urge incontinence (Scarneciu et al., 2021). Common causes include neurological disorders, bladder abnormalities, and BPH.

The first line of treatment includes bladder training, which involves urinating at regular intervals, as well as control techniques, like pelvic floor muscle training, which can also be positive. Pharmacologic interventions include antimuscarinic drugs and beta-3 adrenergic agonists, which help relax the bladder muscle.

1. Treatment options and recommendations for different STIs (Chlamydia, Gonorrhea, and Syphilis)

Chlamydia infections can spontaneously clear. However, people with positive test results should always be treated. The treatment for non-pregnant people is doxycycline, 100 mg, twice a day for seven days. Patients can also be treated with a single 1-g dose of azithromycin or an alternative amoxicillin, 500 mg orally three times per day for seven days. Treatment for Gonococcal Infection includes higher doses of ceftriaxone, as azithromycin is no longer a recommended therapy for nonpregnant individuals (Yonke et al., 2022). Syphilis is primarily treated with penicillin G administered intramuscularly. The dosage and duration are based on the stage of the disease.

References

Al Lawati, H., Blair, B. M., & Larnard, J. (2024). Urinary tract infections: Core curriculum 2024. American Journal of Kidney Diseases, 83(1), 90–100. https://doi.org/10.1053/j.ajkd.2023.08.009Links to an external site.

Eiftu S. Haile, MD, Ayodeji E. Sotimehin, MD and Bradley C. Gill, MD, MS

Cleveland Clinic Journal of Medicine March 2024, 91 (3) 163-170; DOI: https://doi.org/10.3949/ccjm.91a.23027

Scarneciu, I., Lupu, S., Bratu, O. G., Teodorescu, A., Maxim, L. S., Brinza, A., Laculiceanu, A. G., Rotaru, R. M., Lupu, A. M., & Scarneciu, C. C. (2021). Overactive bladder: A review and update. Experimental and therapeutic medicine, 22(6), 1444. https://doi.org/10.3892/etm.2021.10879Links to an external site.

Yonke, N., Aragón, M., & Phillips, J. K. (2022). Chlamydial and Gonococcal Infections: Screening, Diagnosis, and Treatment. American family physician, 105(4), 388–396.

Instructions:

This discussion will be completed in two parts and will give you an opportunity to reflect upon this week’s content and to interact with your classmates.

• Part 1 – Post your initial response to the discussion questions by Thursday at 11:59 pm
• Part 2 – Post substantive feedback to two (2) classmates by Sunday at 11:59 pm

Discuss the process you prefer to use when looking up codes from the imaging section of the ICD-10-PCS book. Do you find coding from the section easier than some of the previous sec

Ten Heights : 61, 61, 62, 62, 64, 67, 68, 69, 70, 73