Conditions of the Liver Flashcards

Question

What is the serology in Hep B?

Answer 1

``` Hepatitis B serology • Acute - EARLY RISE in anti-core IgM • Chronic ◦ Persistent HbsAg > 6/12 months ◦ HbeAg positive = immunotolerant ‣ High viral levels = infectious ‣ Normal LFTs ‣ Few liver problems ◦ HbeAb positive = immunoreactive ‣ Low viral levels = less infectious ‣ ALT raised ‣ Often fibrotic/cirrhotic ```

Answer 2

``` Blood borne Medical IVDU - main cause in UK Sexual Vertical transmission ```

Answer 3

1 in 4 fights off the virus and makes a full recovery 3 in 4 it becomes chronic -> increasing fibrosis -> cirrhosis Complications: liver cirrhosis and associated complications and hepatocellular carcinoma

Answer 4

No vaccine Curable with direct acting antiviral (Ribavirin) medication Interferon

Answer 5

Hepatitis C antibody is the screening test Hepatitis C RNA testing is used to confirm the diagnosis of hepatitis C, calculate viral load and assess for the individual genotype

Answer 6

Hepatitis D is an RNA virus It can only survive in patients who also have a hepatitis B infection - It attaches itself to the HBsAg to survive and cannot survive without this protein Worsens prognosis of Hep B

Answer 7

Treat hepatitis B - interferon

Answer 8

Hepatitis E is an RNA virus. It is transmitted by the faecal oral route Normally it produces only a mild illness, the virus is cleared within a month and no treatment is required Similar to Hep A

Answer 9

Primary biliary cirrhosis is a condition where the immune system attacks the small bile ducts within the liver The first parts to be affected are the intralobar ducts, also known as the Canals of Hering. This causes obstruction of the outflow of bile, which is called cholestasis The back-pressure of the bile obstruction and the overall disease process ultimately leads to fibrosis, cirrhosis and liver failure

Answer 10

Ursodeoxycholic acid reduces the intestinal absorption of cholesterol Colestyramine is a bile acid sequestrate in that it binds to bile acids to prevent absorption in the gut and can help with pruritus due to raised bile acids

Answer 11

Primary sclerosing cholangitis is a condition where the intrahepatic or extrahepatic ducts become strictured and fibrotic This causes an obstruction to the flow of bile out of the liver and into the intestines. Sclerosis refers to the stiffening and hardening of the bile ducts, and cholangitis is inflammation of the bile ducts Chronic bile obstruction eventually leads to liver inflammation (hepatitis), fibrosis and cirrhosis.

Answer 12

ERCP can be used to dilate and stent any strictures Ursodeoxycholic acid is used and may slow disease progression Colestyramine is a bile acid sequestrate in that it binds to bile acids to prevent absorption in the gut and can help with pruritus due to raised bile acids

Answer 13

1) Alcohol related fatty liver - drinking leads to a build-up of fat in the liver. If drinking stops this process reverses in around 2 weeks 2) Alcoholic hepatitis 3) Cirrhosis

Answer 14

C - cutting down A - annoyed (Do you get annoyed at others commenting on your drinking?) G - guilt (ever feel guilty about drinking?) E - eye opener (ever drink in the morning to help your hangover/nerves?)

Answer 15

``` Alcoholic Liver Disease Cirrhosis and the complications of cirrhosis including hepatocellular carcinoma Alcohol Dependence and Withdrawal Wernicke-Korsakoff Syndrome (WKS) Pancreatitis Alcoholic Cardiomyopathy ```

Answer 16

FBC – raised MCV LFTs – elevated ALT and AST (transaminases) and particularly raised gamma-GT - ALP will be elevated later in the disease - Low albumin due to reduced “synthetic function” of the liver - Elevated bilirubin in cirrhosis Clotting – elevated prothrombin time due to reduced “synthetic function” of the liver U+Es may be deranged in hepatorenal syndrome.

Answer 17

Ultrasound FibroScan Endoscopy - assess for and treat oesophageal varices when portal hypertension is suspected CT and MRI scans Liver biopsy - should be considered in those undergoing steroid treatment

Answer 18

``` Stop drinking alcohol permanently Corticosteroid treatment (if they have severe alcohol-related hepatitis) - Only effective in improving survival in short term (1 month) ```

Answer 19

An acute confusional state which results when someone who drinks excess alcohol daily, suddenly stops drinking * Untreated it results in seizures and even death * This is why patients are advised to reduce their drinking gradually, which allows receptors in the brain to adapt, or they are started on detoxification regimens.

Answer 20

Offer benzodiazepine (e.g. Chlordiazepoxide) or carbamazepine Clomethiazole may be offered as an alternative - CAUTION when used - only in inpatient settings

Answer 21

Offer oral lorazepam as 1st line treatment If symptoms persists off parenteral (non-oral) lorazepam Seizures: quick-acting benzodiazepines (e.g. lorazepam)

Answer 22

Alcohol excess leads to thiamine (vitamin B1) deficiency. Thiamine is poorly absorbed in the presence of alcohol and alcoholics tend to have poor diets and rely on the alcohol for their calories. Wernicke’s encephalopathy comes before Korsakoffs syndrome. These result from thiamine deficiency

Answer 23

Wernickes encephalopathy: - Confusion - Oculomotor disturbances (disturbances of eye movements) - Ataxia (difficulties with coordinated movements) Korsakoffs syndrome - Memory impairment (retrograde and anterograde) - Behavioural changes