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Flashcards in Hepatitis Deck (65):
1

What is hepatitis?

Inflammation of the liver

2

What is the difference between acute and chronic hepatitis?

Acute: less than 6 months, usually self limiting and liver returns to normal

Chronic: over 6 months, repeated attacks on liver takes a toll on it.

3

How does acute hepatitis present?

Can be asymptomatic

Malaise
GI upset
Myalgia
Abdominal pain
Jaundice
Dark urine + pale stools
Tender hepatomegaly

4

Causes of acute hepatitis?

Infection:
- viral
- bacterial
- parasitic

Alcohol
Drugs
Toxins
Pregnancy
Autoimmune
Genetic conditions

5

Which viruses can cause acute hepatitis?

Hepatitis A-E

Herpes viruses
- Epstein Barr virus
- Cytomegalovirus
- Varicella Zoster virus

6

Which bacteria can cause acute hepatitis?

Leptospirosis
Coxiella

7

Which parasite(s) can cause acute hepatitis?

Toxoplasmosis

8

How does chronic hepatitis present?

Asymptomatic

Jaundice
Ascites
Low albumin
Coagulopathy

Signs of chronic liver disease:
- Clubbing
- Palmar erythema
- Spider naevi
- Dupuytren's contracture

9

What is coagulopathy?

Impaired ability to clot blood, because the liver isn't producing enough of the proteins in the coagulation cascade

10

What is palmar erythema?

Red palms

11

What are spider naevi?

On the skin

A central red spot and reddish extensions which radiate outwards like a spider's web.

They are caused by swollen blood vessels

12

What is Dupuytren's contracture?

Fixed forward curvature of finger(s) caused by the development of fibrous tissue between finger tendons and on the skin of the palm

13

What happens in chronic hepatitis that means liver function is maintained?

Compensation

The body compensates for the problems, meaning chronic hepatitis can sometimes be asymptomatic

14

What are some complications of chronic hepatitis?

Chronic liver disease - fibrosis, cirrhosis

Hepatocellular carcinoma

Portal hypertension

Gastro-oesophageal varices

GI bleed

15

What causes chronic hepatitis?

Hepatitis B-D

Autoimmune hepatitis
Drugs
Alcohol
Genetic conditions

16

Describe the effect on acute hepatitis on the liver?

Damage to cells

Influx of neutrophils causes necrosis

Death of cells due to necrosis or apoptosis

17

Describe the effect of chronic hepatitis on the liver?

Damage and destruction of hepatocytes and other cells

The liver regenerates not in an orderly fashion

Damaged cells are replaced with scar tissue

Over time, there are only a few islands of hepatocytes left amongst the scar tissue

18

How would you distinguish autoimmune hepatitis from other types?

Blood tests:
Increased IgG levels
Antibodies against liver proteins

Biopsy: mononuclear infiltrate, you would see white blood cells in the liver

19

What causes autoimmune hepatitis?

Genetics

Sometimes viral infections (viral hepatitis or EBV)

20

How do patients with autoimmune hepatitis present?

Acute initially, but they will eventually become chronic


Fatigue
Anorexia
Weight loss
Amenorrhoea
Abdominal pain

Coagulopathy
Jaundice
Hepatomegaly
Ascites
Signs: Palmar erythema, spider naevi

21

How would you manage autoimmune hepatitis?

Immunosuppressants
- prednisolone
- non-steroids

Liver transplant

22

Name the hepatitis viruses.

A
B
C
D
E

23

How is hepatitis A spread?

Faecal-oral route

24

What type of virus is hepatitis A?

RNA virus

25

What food is hepatitis A commonly found in?

Shellfish

26

Does hepatitis A cause an acute or chronic illness?

Acute, it never progresses to chronic

It is a self-limiting infection

27

Do you acquire immunity to hepatitis A after an infection with it?

Yes
100% immunity

28

How long does a hep A infection usually last?

3-6 weeks

29

Management of hep A infection.

Supportive care

Monitor liver

Check close contacts and give them prophylaxis

30

What can you do to prevent hep A infection?

Vaccinate

HNIG - human normal immunoglobulin - provide someone with donor hep A antibodies

31

Summarise hep A!

A is Acquired by mouth for Anus, is Always cleared Acutely and only ever Appears once

32

How is hep E spread?

Faecal-oral route

Water or food-borne

33

What type of virus is hep E?

A small RNA virus

34

There are different genotypes of hep E, one of these is found in an animal, which animal?

Pigs
Virus can be found in some British sausages

35

Does hep E cause an acute or chronic infection?

Usually self-limiting acute infection

It can become chronic in the immunocompromised

36

Which people do you need to be extra concerned about if they get hep E?

Pregnant women: mortality is as high as 10-20%

Immunocompromised: can progress to chronic hepatitis

37

Summarise hep E!

E is Even in England and can be Eaten, if not always beaten

38

What is the link between hep B and D?

You can't be infected with D without having B too

39

What type of virus is hep B?

DNA virus

40

How is hep B spread?

Blood-borne
- needle stick
- tattoos
- sexual
- vertical

41

Is hep B an acute or chronic infection?

Acute
But can become chronic if the immune system can't right it off

42

Management of hep B?

Supportive care
Monitor liver function
Treat with drugs

Contacts: post-exposure prophylaxis, vaccination

43

What is a serious complication that can occur from hep B?

Fulminant liver failure

44

What 2 drug treatment options are there to treat hep B?

Describe them briefly

Pegasys
- stimulates the immune system to fight off infection better
- weekly subcut injection
- nasty side effects

Nucleoside analogues
- inhibit viral replication
- one tablet per day
- fewer side effects
- lifelong

45

What is fulminant liver failure?

Acute liver failure that results in encephalopathy within 8 weeks

46

What is encephalopathy?

Neurological symptoms: confusion, coma, can lead to death

47

What is the delta virus?

Hepatitis D

48

Why is it that hep D cannot infect without hep B?

The virus is a bit defective
It needs the hep B surface antigens to survive

49

Is it best to have hep B and D together or to have just hep B?

Best to have just hep B

Hep B and D together cause a faster rate of fibrosis of the liver

50

In an infection of hep B and D, which virus is dominant?

Hep D

51

Does hep D cause a chronic or acute infection?

Acute leading to chronic

52

Where is hep B virus found?

All over the place

53

Summarise hep B?

B is Blood-Borne and if not Beaten can be Bad

54

Summarise hep B and D?

B and D are DastarDly

55

What type of virus is hep C?

A flavivirus - RNA

56

How is hep C spread?

Blood-borne
Sexually transmitted
Mother to baby

57

What are the complications of a hep C infection?

Chronic hep C can lead to cirrhosis

Which can lead to Hepatocellular carcinoma

58

Is hep C a chronic or acute infection?

Acute that becomes chronic

59

Management of hep C?

Drug treatment: Pegasys + Ribvirin

Contacts: screen

60

How do you prevent hep C?

No vaccine

Take precautions: needle exchanges, condoms

61

Summarise hep C?

C is usually Chronic but Can be Cured at a Cost

62

How does hep A present?

Nausea
Anorexia
Jaundice
Dark urine + pale stools
Hepatomegaly
Skin rash
Lymphadenopathy

63

How does hep B present?

Skin rash
Arthralgia

Nausea
Anorexia
Jaundice
Dark urine + pale stools
Hepatomegaly
Lymphadenopathy

64

How does hep C present?

Mild symptoms, occasionally jaundice

Not usually picked up until infection is chronic

65

How does hep E present?

Nausea
Anorexia
Jaundice
Dark urine + pale stools
Hepatomegaly
Skin rash
Lymphadenopathy

Signs of chronic liver disease