Hepatitis, PSC and PBC Flashcards
(105 cards)
1
Q
Viral hepatitis presents with?
A
Nausea Vomiting Fatigue RUQ pain Change in sense of smell or taste
2
Q
How is Hep A spread?
A
Faecal oral
Poor hygiene
Contaminated food
3
Q
Hep A presents as an?
A
Acute heptatitis
4
Q
Hep A is common in?
A
MSM and PWIDs
5
Q
Hep A is excreted in ___ then _____
A
Bile
Faeces
6
Q
Hep A has a ____ incubation period
A
short
7
Q
Epidemiologically, Hep A infections are?
A
Sporadic/endemic
8
Q
Does Hep A have a carrier state?
A
No, it is directly cytophatic
9
Q
How severe is Hep A illness?
A
Mild - usually full recovery
10
Q
What are blood test features of the prodromal stage of Hep A?
A
Bilirubinuria, raised AST or ALT
11
Q
What are symptomatic features of the prodromal stage of Hep A?
A
Anorexia, nausea, vomiting, alterations in case, arthralgia, malaise, fatigue, urticaria and pruritis
12
Q
What is arthralgia?
A
joint pain
13
Q
What is urticaria?
A
hives
14
Q
What is pruritus?
A
itching without a rash
15
Q
What are blood test features of the icteric stage of Hep A?
A
Serum bilirubin
Serum AS
Serum ALP is normal
16
Q
What are symptomatic features of the icteric stage of Hep A?
A
Dark urine, followed by pale-coloured stools
GI symptoms + malaise
May develop RUQ pain with hepatomegaly
17
Q
What are histopathological features of Hep A?
A
Predominantly lobular inflammation and hepatocyte necrosis
18
Q
What are investigations for Hep A?
A
PT increased
Anti IgM = acute infection
Bloot test for Hep A IgM antibody
19
Q
What are treatment options for Hep A?
A
None
20
Q
What are prevention methods for Hep A?
A
Vaccine
Boil all water
EBV is a big cause
21
Q
How does Hep B spread?
A
Sex, mother to child, blood
22
Q
Chronic infection from hep B is more likely if?
A
First exposure is in childhood
23
Q
What are possible outcomes from Hep B infection?
A
Fulminant acute infection (death) Chronic hepatitis Cirrhosis HCC Asymptomatic (carrier)
24
Q
What causes liver damage in Hep B?
A
Antiviral immune response
25
For Hep B, Th1 indicates?
Viral clearance
26
For Hep B, Th2 indicates?
Chronic infection
27
Hep B is the only virus containing?
DNA (rest contain RNA)
28
What is the blood test for Hep B?
Hep B surface antigen (HBsAg)
29
If the surface antigen test for Hep B is positive you do a?
Full viral profile
30
What is the marker of acute Hep B infection?
Anti-HBc
31
What is the marker for recent infection with Hep B`
Hep B IgM
32
What is the marker for highly infectious individuals?
HepBeAg and DNA in high titre
33
What is the marker for immunity to Hep B?
Anti-HB
34
How do you treat Hep B?
Symptomatically
| Monitor markers
35
How can you control Hep B spread?
Minimise exposure (safe blood, sex, needle exchange, screen pregnant, vaccination and post-exposure prophylaxis)
36
What are post-exposure prophylaxis measures for Hep B?
Vaccine
| hyperimmune Hep B immunoglobulin (HBIG)
37
How do you treat chronic viral hepatitis?
Adefovir and entecavir
Infection control
Decrease alcohol
Screening
38
What do you give for chronic viral hepatitis if cirrhotic?
Influenza penumococcal
39
Hep C is more common in?
Indian and Pakistani
40
How is Hep C transmitted?
Like Hep B but less via sex
| Blood - blood
41
Hep C is chronic in ___% of cases
75
42
What are blood features of Hep C?
Elevated ALT
43
What are extra hepatic features of Hep C?
Arthritis
44
Symptom-wise, Hep C is often?
Asymptomatic
45
How do you prevent Hep C?
Minimise exposure (no vaccine)
46
How do you test for HCV?
Antibody test
Look for virus by PCR
often diagnosis by exclusion
47
What are microscopic features of chronic HCV?
Dense portal chronic inflammation
Piecemeal necrosis
Lobular inflammation
Small amounts of steatosis (fatty liver), fibrosis
48
What are outcomes of HCV?
Tends to become chronic
| Cirrhosis
49
What are treatment options for HCV?
peg interferon and ribacvarin
| Th2 - fibrotic
50
Hep D is ____ in the UK
Rare
51
Hep D can only occur if?
In conjunction with Hep B
52
Why can Hep D only coexist with hep B?
Incomplete RNA particle - can't replicate on its own
53
How does Hep E spread?
Faecal oral
| Animals (pigs, deer, rabbit)
54
Hep E is more common where?
Tropic (Travellers)
55
Is there a vaccine for Hep E?
No
56
Which viral hepatitis patients do you treat?
Antibody present
| Risk of complications
57
When do you treat viral hepatitis?
Before complications
| Evidence of inflammation
58
What is peginterferon (IFN-a)?
Human protein component of viral immune response made by genetic engineering
59
What are side effects of IFN-a?
Makes you feel ill as if you have the flu
| Can get thyroid, autoimmune and psychiatric disease
60
What is Ribavirin?
An antiviral given alongside IFN-a
61
What are side effects of ribavirin?
Anaemia
62
What are treatment options for Hep B?
IFN-a
Suppressive antiviral drug
reduce progression of liver disease
63
What are examples of suppressive antiviral drugs?
Enteclavir
| Tenofovir
64
What is the effect of suppressive antiviral drugs?
Suppress only don't cure
| Resistance can develop
65
How do you treat hep C?
Remove RNA from blood
| Antivirals
66
Relapse from Hep C is?
Rare
67
Progress of Hep C treatment is measured by?
SVR (sustained virological response)
68
Which Hep C types are most common in Tayside?
Type 3 and 1a
69
Autoimmune hepatitis is more common in?
Women
70
For PH, viral hepatitis is a?
Notifiable disease
71
What are histology features of AI hepatitis from a biopsy?
Piecemeal necrosis
Interface hepatitis
Excess of plasma cells
72
Features of type I AI hepatitis?
Adult (associated with extra-hepatic manifestations like Grave's)
73
Features of type II AI hepatitis?
Children/young adults
74
AI hepatitis may have some triggers including some?
Drugs
75
How does AI hepatitis present?
Hepatomegaly, jaundice stigmata of chronic liver disease, splenomegaly
76
What are blood marker features of AI hepatitis?
```
ALT 100-800
Increased AST
Increased PT
ASMA ++
Increased IgG
Serum Immunoglobulins
```
77
What are non-specific features of AI Hepatitis?
```
Malaise
Fatigue
Lethargy
Nausea
Abdo pain
Anorexia
```
78
How do you diagnose AI Hepatitis?
Presence of autoimmune antibodies
| Liver biopsy
79
How do you treat Autoimmune Hepatitis?
Prednisolone (acute)
| Azathioprine (steroid-sparing - lon-term)
80
What does PBC stand for?
Primary Biliary Cirrhosis/Cholangitis
81
What is PBC?
Rare autoimmune condition of unknown origin
Destruction of the bile ducts by immunological mechanisms leading to damage of hepatocytes, subsequent fibrosis with hepatocyte regeneration leading to cirrhosis
82
What is the autoimmune component of PBC?
T-cell mediated
| CD4 cells react to M2 target
83
What is found on histopathology of PBC?
Chronic portal inflammation
| Bile ducts inflamed
84
PBC is more common in?
Females
85
How does PBC present?
Usually asymptomatic
| Fatigue, itch without rash, xanthelasma/xantheloma
86
How do you investigate PBC?
2/3 have +ve AMA (anti-mitochondrial antibody)
Cholestatic LFTs
Liver biopsy
87
What does ASMA stand for?
Autoantibodies to smooth muscle
88
What is Liver biopsy used for in the investigation of PBC?
Stage disease
89
How do you treat PBC?
Ursodeoxycholic acid
90
What is a common side effects of ursodeoxycholic acid?
Diarrhoea
91
What are rare side effects of ursodeoxycholic acid?
Abdominal pain
Gallstone calcification
Urticaria
Nausea, vomiting, pruritus
92
What is PSC?
Autoimmune destruction of medium and large sized bile ducts
93
PSC is more common in?
females
94
PSC stands for?
Primary sclerosis cholangitis
95
PSC is associated with which condition?
Ulcerative Colitis
96
PSC is a chronic inflammatory process affecting?
Intra and extra-hepatic bile ducts
97
PSC leads to?
Periductal fibrosis (onion skinning), duct destruction, jaundice and fibrosis
98
PSC causes an increased risk of?
Malignancy in bile ducts and the colon
99
How does PSC present?
Recurrent cholangitis
100
How do you investigate PSC?
ERCP/MRCP
101
How do you manage PSC?
Maintain bile flow
| Monitor for cholangiocarcinoma and CRC
102
Chronic Drug induced hepatitis has similar features to?
All other types of chronic hepatitis
103
Chronic Drug induced hepatitis can be does related or?
Idiosyncratic
104
Chronic Drug-induced hepatitis may trigger?
Autoimmune hepatitis
105
What is seen microscopically for chronic drug-induced hepatitis?
Chronic active process: granuloma, fibrosis, necrosis, failure, cholestasis +/- cirrhosis
