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Lecture 15: Infections Causing Jaundice Flashcards

1
Q

3 ways that infectious diseases can cause jaundice

A
  • obstructive jaundice
  • hyperbilirubinaemia –> inflammation of hepatocytes –> hepatitis
  • haemolysis –> RBC destruction –> excess Hb metabolism –> bilirubin end product
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2
Q

what way does malaria cause jaundice

A

haemolysis

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3
Q

what is a notifiable disease

A

disease that have potential risks to populations or public health and must be reported to public health authorities

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4
Q

name two viral infections that can cause hepatitis

A
  • Epstein Barr Virus (EBV)

- Cytomegalovirus (CMV)

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5
Q

what is the most notable bacterial pathogen to cause bacterial hepatitis

A

leptospirosis

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6
Q

how are the different hep viruses spread

A
  • A and E are faecal oral

- B C and D are blood borne spread by sexual contact, blood contaminated equipment or vertical transmission

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7
Q

which hep virus is a worldwide endemic

A

Hep A

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8
Q

how is Hep A transmitted

A
  • faecal-oral
  • food borne
  • person to person in crowded circumstances
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9
Q

how is Hep A/Hep E diagnosed

A
  • serological tests looking for HAV/HEV specific IgM
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10
Q

how is the spread of Hep A controlled

A
  • improved sanitation

- vaccination

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11
Q

where in the world is Hep E more prevalent

A

Asian countries

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12
Q

how can Hep E be transmitted

A
  • faecal-oral

- water borne

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13
Q

which people are particularly at risk of developing more severe hepatitis or persistent infection from Hep E

A
  • pregnant women particularly at the end of pregnancy

- immunocompromised patients

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14
Q

how is Hep E treated

A
  • no specific treatment

- no licensed

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15
Q

how is Hep C transmitted

A
  • spread through blood

- blood contaminated equipment

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16
Q

what type of virus is Hep C and Hep A

A

RNA

  • C –> enveloped RNA
  • A –> single stranded RNA
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17
Q

why do many patients not know they are infected with Hep C/ infectious

A

Hep C causes notable jaundice in around 25% of ACUTE infections, and most people go on to have CHRONIC HCV infection

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18
Q

how is Hep C diagnosed

A
  • serological w/ assays for both HCV antigens and antibodies
  • HCV RNA can also be detected using PCR
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19
Q

how is Hep C treated

A
  • treatment aims to reduce viral RNA detection in blood which reduces long term sequelae of chronic infection
  • treatment still developing and is dependent on serotype patient is infected with
  • pegylated interferon alpha sometimes used as part of primary treatment for HCV
  • range of direct acting antiviral (DAA) drugs that target HCV specific enzymes e.g. viral protease
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20
Q

what type of virus is Hep B

A

double stranded DNA virus w/ reverse polymerase

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21
Q

how is Hep B transmitted

A
  • blood borne
  • vertical transmission (majority)
  • sexual contact
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22
Q

what is the most prominent symptom of acute Hep B

A

jaundice –> occurs in 90% of people

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23
Q

how is Hep B capable of chronic carrier condition

A

has reverse transcriptase enzyme that allows integration of viral DNA unto human genome

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24
Q

what are the 3 important antigens of HBV

A
  • HBsAg
  • HBcAg
  • HBeAg
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25
what is looked for when doing blood tests for HBV
- 3 important antigens - antibodies raised against antigens - HBV DNA tested by PCR
26
what does the presence of HBsAg indicate
confirms infection and indicates infectivity of blood
27
what does presence of HBeAg indicate
signifies high infectivity and maybe be seen in acute infection or chronic carriers
28
what indicates successful vaccination against HBV
presence of HBsAb - seen in patients who have recovered from acute infection and cleared virus from body
29
when does HBcAb develop
shortly after acute infection and persist in all patients
30
how is HBV prevented
- vaccination of at risk groups - using single-use instruments e.g. needles - decontamination of multiple use instruments - screening pregnant women for HBsAg - babies born to HBsAg +ve moms given prophylaxis w/ HBV immune globulin (passive immunisation)
31
how is HBV treated
- supportive and symptom relief measures - pegylated interferon alpha - nucleoside analogue drugs e.g. Entacavir and reverse transcriptase inhibitors e.g. Tenovovir
32
what is the aim of HBV treatment
prevention of liver cirrhosis + failure and hepatocellular carcinoma
33
how can HDV cause infection
can only replicate in cells already infected with HBV - requires shell of HBsAg in order to bud from infected hepatocytes
34
how is HDV spread
- blood borne (same as B and C)
35
what does the presence of HDV in HBV infected patients indicate
disease is more severe
36
what type of jaundice occurs with biliary tree infection
obstructive jaundice
37
what makes the biliary tree vulnerable to infection
anatomy: gall bladder attached to duodenum which has a rich microbiome
38
what can cause obstruction of flow of bile
- gall stones - intrinsic narrowing of biliary draining ducts - extrinsic narrowing of biliary tree - bile stasis --> bile does not flow or becomes thickened --> could occur in response to stress responses seen in sepsis/starvation/burns/trauma/major surgery
39
what organisms are most commonly seen assc. w/ biliary tree infection
- enterobacteriaceae e.g. E.coli - enteric gram +ves e.g. enterococcus species - anaerobes incl. bacteriodes species
40
how can biliary tree infection present as a public health risk
- salmonella (specific enterobacteriaceae) can colonise biliary tree - may lead to chronic carrier states of salmonella species - salmonella typhi (cause of typhoid fever) can be one
41
define cholecystitis
inflammation of gallbladder
42
define cholangitis
inflammation of biliary tract
43
give 2 clinical presentations of biliary tract infection
- cholecystitis | - cholangitis
44
give some risk factors for gallstones in biliary sepsis
- older age - female - low fibre diet - obesity
45
name some characteristic symptoms of biliary infection
- pain localising to right upper quadrant - pain may be severe and radiate to the back - referred pain to right shoulder tip - nausea and vomiting - fever - abdominal tenderness - local peritonitis --> both reflex guarding and rebound tenderness - Murphy's sign --> patient can't breathe in comfortably when examiner's hand placed along right costal margin (suggests cholecystitis)
46
management of biliary tract infection
- source control - endoscopic retrograde cholangio-pancreatography (ERCP) - antibiotics e.g. beta-lactam/ beta-lactase inhibitor combinations are first line treatment --> Co-amoxiclav and Piperacillin inhibitor - Piperacillin-tazobactam reserved for more severe presentations - vancomycin, aztreonam, and metronidazole may be used for penicillin-allergic patients
47
define abscess
destruction of normal tissue structure due to infection, and replacement of normal structure with pus and necrotic tissue
48
why can antibiotics not reach therapeutic level within abscess collections
collections are relatively avascular and tend to have low pH
49
name 3 infective aetiologies that can cause liver abscess
- bacteria --> when infection drains into liver via portal system - amoeba --> food/water borne - helminths --> worms e.g. dog tapeworm
50
liver abscess management
- management follows aetiology - source control - drainage - polymicrobial infection without drainage needs long course of high dose broad spectrum antibiotics - amoeba treated w/ metronidazole
51
why does drainage of hydatid cysts require specialist management
contents can lead to anaphylaxis and death
52
define zoonosis/zoonotic
infectious disease that is transmissible from animals to humans e.g. anthrax, brucellosis
53
define vector
a living intermediary that carries an agent from reservoir to a susceptible host e.g. mosquitoes, fleas or ticks
54
name some key vector borne diseases and zoonoses
- malaria - dengue - lyme - plague - q-fever (caused by Coxiella Burnetti) - brucellosis (caused by brucella species, notably brucella abortus) - leptospirosis (most common bacterial cause of primary jaundice)
55
how does leptospirosis cause human infection
- assc. w/ contaminated water/food --> water contaminated w/ rat urine - organisms enter through skin breaks or mucosae
56
clinical infection of leptospirosis
- 'bi-phasic illness' - pyrexial or flu-like illness - more severe cases involve immune mediated haemorrhagic complications --> Weil's disease --> haemorrhagic complications due to low platelets, kidney and liver failure --> hepatitis, jaundice, haemorrhage, meningitis
57
how to diagnose leptospirosis
serology
58
leptospirosis treatment
doxycycline | penicillins also effective
59
Weil's disease triad
- thrombocytopenia - jaundice - renal failure
60
what kind of diseases are notifiable
- those w/ epidemic potential - food-borne threats - rare, serious and imported infections

GERR (46 decks)

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