hepatitis and liver disease Flashcards
(24 cards)
HBsAg surface antigen is first marker to rise
when is it detectable
virus is actively present
Anti-HBsAg is human antibody against HBsAg what does this imply
this implies immuniy either via vaccination or recovered from infection
Anti-HBc is the core antibody - when is it only made
in response to an infection, not a vaccine.
anti-HBC is divided into what two anitbodies and what does this tell us
It is divided into IgG and IgM – the IgM is only detectable in acute infection whereas the IgG is detectable for life
what would an acute infection show
positive for
HbsAg
anti-igM Hbc
anti-IgG HBc
what would a chronic infection show
HbsAg
Anti-IgG Hbc
vaccinated
Anti-HbsAG positive
recovered
Anti-IgG Hbc
anti-HbsAg
how do you manage heb b infections
Antiviral therapy – pegylated interferon and nucleoside analogues
what type of hepatitis follows tis pattern
typically produces a flu-like prodrome before signs of acute hepatitis (tender hepatomegaly and jaundice) but does not typically cause chronic disease.
hep A
f hep c is left untreated what could it led to
liver cirrhosis with a high risk of hepatocellular carcinoma.
Transient elastography uses ultrasound vibrations to measure what
liver stiffness - chronic liver failuree
NAFLD is the most common cause of
ld
Its aetiology is thought to be associated with increased insulin resistance.
There is a build-up of fat in hepatocytes (steatosis) which leads to inflammation called steatohepatitis. Over time, it slowly progresses to liver cirrhosis.
It is associated with metabolic factors e.g., type 2 diabetes and hyperlipidemia.
how does the serum ascites albumin gradient SAAG tell us whether the ascites has been caused by liver diseasee or not
If > 11 g/L, indicative of liver disease (as it suggests it is due to increased hydrostatic pressure secondary to portal hypertension)
If < 11 g/L, this suggest the cause is not liver related, e.g., malignancy, TB, trauma
mx of ascites
Fluid restriction
Diuretics such as spironolactone
Drainage if very large
Spontaneous Bacterial Peritonitis is what
infection of the ascitic fluid, despite the absence of a clear infection source.
secondary to E. coli bacterial translocation from the bowel, usually as a complication of ascites secondary to liver cirrhosis.
how is SBP dx
This leads to a triad of ascites, abdominal pain and fever.
It is diagnosed by an ascitic tap which can be sent for cytology and culture.
Paracentesis (ascitic tap) and check for raised neutrophils
mx of SBP
Prophylactic antibiotics (e.g., norfloxacin) are given to patients who have a fluid protein less than 15 g/L or a previous episode of SBP
Treatment involves antibiotics (e.g., cefotaxime)
what is hepatic encephalopathy
The liver is unable to remove ammonia from the blood, due to decreased function.
This allows ammonia to enter the systemic circulation and reach the brain.
It is theorized that neurotoxic substances, including ammonia and manganese, may gain entry into the brain in the setting of liver failure. These neurotoxic substances may then contribute to morphologic changes in the astrocytes. In cirrhosis, astrocytes may undergo Alzheimer type II astrocytosis
Ammonia is neurotoxic and can result in central nervous system dysfunction.
This ranges from mild confusion to asterixis and decreased consciousness.
sx of hepatic encephalopathy
Gives altered GCS, and asterixis (liver flap) and constructional apraxia (can’t draw a star)
Stage 1 (irritability)
Stage 2 (confusion)
Stage 3 (Incoherent)
Stage 4 (coma)
management of hepatic encephalopathy
1st line is lactulose (a laxative which flushes out ammonia producing gut bacteria)
Other options include rifaximin, an antibiotic which kills ammonia producing bacteria
3 major complications of liver failure
heaptic encephalopathy
SBP
ascites
