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Abdo Medicine > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

What is the definition of hepatitis

A

Injury to the liver characterised by inflammatory cells in the tissue

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2
Q

What are the causes of hepatitis

A 
Viral:-
Hep A
Hep B
Hep C
Hep D
Hep E
EBV
CMV

Drugs and toxins:-
Alcohol
Paracetamol
NSAIDs

Autoimmune
Ischaemia

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3
Q

What is the commonest cause worldwide of liver damage

A

Viral hepatitis

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4
Q

How is Hep A spread

A

Faeco-oral route

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5
Q

How is Hep B spread

A

Haematogenous spread
Sexually
Vertical transmission

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6
Q

How is Hep C spread

A

Haematogenous spread
Sexually
Vertical transmission

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7
Q

How is Hep D spread

A

Only co-infects/superinfects with Hep B

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8
Q

How is Hep E spread

A

Faeco-oral route

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9
Q

How can acute viral hepatitis present

A 
Prodromal flu-like illness
Anorexia
Jaundice
Tender hepatomegaly
Lymphadenopathy
Splenomegaly
Acute liver failure
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10
Q

What are the complications of chronice Hep B and C hepatitis

A

Hepatocellular carcinoma

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11
Q

What would you expect to find on LFTs in a patient with viral hepatitis

A

Very high transaminases

May reach over 10,000 units

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12
Q

What medications would you give to a patient with chronic viral hepatitis (B)

A

Peginterferon alpha-2a - first line (Not for use in pregnant women)
Tenofovir - second line

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13
Q

How does the presentation of alcoholic hepatitis differ from that of viral hepatitis

A

Rarely RUQ pain

Symptoms of withdrawal - Delirium tremens

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14
Q

How can you differ between viral and alcoholic hepatitis on investigation

A

Transaminases usually raised to less than 200 and no over 400 in alcoholic
Signs of cirrhosis in alcoholic - reduced albumin, anaemia, thrombocytopaenia, prolonged PT
AST normally greater than ALT in alcoholic

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15
Q

What other drugs can cause hepatitis

A

Paracetamol
Anti-TB drugs
Antibiotics - sulphonamides, coamoxiclav, nitrofurantoin
Antiretrovirals - zidovudine
Antiepileptics - phenytoin, carbamazepine
Immune suppression - azathioprine, methotrexate
NSAIDs
Allopurinol
Amiodarone

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16
Q

What is the cause of autoimmune hepatitis

A

Unknown aetiology

Cell-mediated immune response producing autoantibodies against hepatocytes

17
Q

Who is more likely to get autoimmune hepatitis

A

Females

18
Q

What diseases are associated with autoimmune hepatitis

A 
Autoimmune thyroiditis
Autoimmune haemolytic anaemia
Pernicious anaemia
Fibrosing alveolitis
Ulcerative colitis
Glomerulonephritis
19
Q

How can identify autoimmune hepatitis on investigation

A

Elevated transaminases - higher than in alcoholic but less than viral hepatitis

Viral > Autoimmune > Alcoholic

Positive autoantibodies - ANA, SMA
Increased globulins

20
Q

What diagnostic test would you do to confirm autoimmune hepatitis

A

Liver biopsy - chronic inflammatory cell infiltrates, predominately plasma cells

21
Q

What medication do you give for autoimmune hepatitis

A

Steroids

Azathioprine

22
Q

What is ischaemic hepatitis

A

Occurs when there is decreased blood supply to the liver due to significant hypotension or hepatic arterial occlusion

23
Q

What are some causes of hepatic arterial occlusion

A

Sickle cell crisis

Thrombosis

24
Q

How does ischaemic hepatitis present

A

Few liver signs/symptoms
Hypotension - low urine production
RUQ pain

Abdo Medicine (14 decks)

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