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Flashcards in Gastrointestinal Infections 2 Deck (17)
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Hepatitis

Inflammatory diseases of the liver
Most commonly viral but also autoimmune disorders, drug reactions, alcohol, leptospirosis, brucellosis, liver abscesses, amoebic, pyogenic

1

Clinical features of hepatitis

Preicteric:
Malaise
Anorexia
Nausea
Abdo pain
Fever
Icteric:
Pale stool/ dark urine
Jaundice

2

Hepatitis A

Viral cause of hepatitis
RNA Enterovirus
Faecal oral transmission
Contaminated food or water
2-4 weeks incubation
Can be asymptomatic
-> fever, malaise, anorexia, jaundice-> acute icteric hepatitis
Doesn't cause chronic hepatitis
Infection confers subsequent immunity
Vaccination

3

Hepatitis B

Viral cause of hepatitis
DNA virus of hepadna group
300 million carries
Transmitted in blood, semen, and saliva
Self limiting in most patients
Rise in serum HBsAg, IgM anti-HBc
Vaccinate

4

Five clinical patterns of hep B

Acute self limited hepatitis-> patients recover after jaundice, malaise and anorexia with immunity. 25%
Fulminant acute hepatitis-> necrosis of liver cells. Rare
Chronic hepatitis-> 5-10% May progress to cirrhosis or recover
Asymptomatic carrier state-> may later develop hepatitis
Sub clinical infection-> asymptomatic inapparent infection. 75% May become carrier or progress to chronic hepatitis.

5

Chronic hep B

Failure to eliminate virus from liver
HBsAg positive for more than 6 months
Either
-> chronic carrier state with no active viral replication-> anti-HBe positive-> low infectivity and low risk of inflammatory liver disease
->chronic liver disease with active viral replication-> HBeAg positive-> high infectivity and high risk of inflammatory livery disease

6

Hepatitis E

Clinically similar to hep A
RNA virus
Fecal oral spread
Contaminated water
Acute self limiting hepatitis-> mild infection associated with jaundice
Incubation 1 month
No progression to chronic
Higher morality than HAV
Usually associated with travel abroad

7

Hepatitis C

Clinically similar to hep B
RNA flavivirus
Six subtypes with different geographic incidence
Quasi species-> swam of closely related sequences within an individual
May result in false negative
Blood, semen and saliva transmission
Incubation is 2 months
Acute hepatitis with fever, malaise, anorexia and jaundice

8

Diagnosis of hep c

Antiviral HCV detection
HCV RNA detection -> current infection->infectious

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Outcomes of hep C

Acute infection-> very rarely symptomatic
Chronic hepatitis-> 70-80%
most develop active chronic hepatitis-> many progress to cirrhosis and increased risk of hepatocellular carcinoma
Predisposing factors to chronic-> male, old, increased alcohol intake
Extra hepatic manifestations-> arthritis, agrannulocytosis

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A,B,C,D,E hepatitis can cause

Asymptomatic hepatitis
Acute hepatitis without jaundice
Acute hepatitis with jaundice-> icteric
Massive necrosis of liver

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B,C,D

One of the forms of chronic hepatitis
Chronic carrier state

12

Cholecystisis

Acute inflammation of the gall bladder
Usually secondary to gall stones
Abdo pain and tenderness, fever, vomiting
Often obstruction of cystic bile duct
Secondary infection may develop with enteric organisms-> anaerobes, coli forms

13

Cholongitis

Infection of the biliary tree
Usually secondary to obstruction-> inflammation
Secondary infection with gut organisms
Clinically similar to Cholecystisis but also fever, rigors, jaundice

14

Splenomegally

Infectious causes
-> bacterial-> TB, typhoid, brucellosis,infective endocarditis
->vival-> infectious mononucleosis
-> protozoal-> malaria, leishmaniasis, trypanosomiaisis, toxoplasmosis
Also vascular, neoplasticism, hematilogical, immunological, metabolic disorders
Rarely splenic abceses arise

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Pancreatitis

Usually dues to gall stones
Secondary bacterial infection

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Peritonitis

Inflammation of the peritoneal cavity
Usually a secondary complication to other intra abdo pathology with perforation->intra intestinal organisms release in to the perineum
Often poly microbial
Life threatening

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