Liver Flashcards
(33 cards)
What are the different causes of hepatitis?
Non-alcoholic fatty liver disease Alcoholic liver disease Autoimmune hepatitis Viral hepatitis Drug induced hepatitis e.g. paracetamol overdose
Symptoms of hepatitis
Abdominal pain Fatigue Jaundice Pruritus (bile salt accumulation) Muscle & joint aches Nausea and vomiting Fever (viral)
** can be asymptomatic
Hepatitis & LFTs
AST and ALT high, proportionally smaller rise in ALP
High bilirubin
What are transaminases?
Liver enzymes that are released into the blood as a result of inflammation of hepatocytes
What is Hepatitis A, how is it spread?
RNA virus, incubation period 2-4 weeks
Transmitted via the faecal-oral route usually by contaminated water or food (eating raw shellfish e.g. oysters)
Symptoms of HVA
Flu like prodrome RUQ pain Nausea, vomiting, anorexia Tender hepatomegaly Jaundice Cholestasis (dark urine, pale stools)
Management of HVA
Basic analgesia, it resolves without treatment in 1-3 months
Notifiable disease, public health need to be told
Vaccination is available to reduce the chance of developing infection
Management of HVA
Basic analgesia, it resolves without treatment in 1-3 months
Notifiable disease, public health need to be told
Vaccination is available to reduce the chance of developing infection
Transmission of HVB
Direct contact with blood or bodily fluids e.g. sexual intercourse, needles with IV drug use or tattoos, sharing household products e.g. toothbrushes, vertical transmission during pregnancy and delivery
What happens to babies born to mothers with chronic HVB infection or acute infection during pregnancy?
Should receive a complete course of vaccination and hep B immunoglobulins
Little evidence to suggest C-section reduces vertical transmission
Can HVB be spread through breastfeeding?
No
HIV can
What is hepatitis B and its features
DNA virus
Incubation period 6-20 weeks
Fever, jaundice, elevated transaminases
Interpretation of HBV serology
HbsAg is the surface antigen, signifying active infection
Normally implies acute disease, if present >6 months this implies chronic disease (i.e. infective)
Anti-HBs implies immunity, either through exposure or immunisation. It is negative in chronic disease
Anti-HBc implies previous (or current) infection. IgM anti-HBc appears during acute or recent hepatitis B infection and is present for about 6 months. IgG anti-HBc persists and indicates a past infection where the HBsAg is negative
HbeAg results from breakdown of core antigen from infected liver cells as is, therefore, a marker of infectivity. Marker of HBV replication and infectivity.
*** when screening, test HbcAB for previous infection and HBsAg for active infection, and if positive do further testing for HbeAg
anti-HbC = caught, negative if immunised
Complications of HBV infection
Chronic hepatitis (ground glass hepatocytes might be seen on light microscopy) Hepatocellular carcinoma Fulminant liver failure Glomerulonephritis Polyarteritis nodosa Cryoglobulinaemia
When do children get HBV vaccine?
Who else should get it?
2,3, and 4 months
Healthcare workers, IV drug users, CKD who may require renal replacement therapy, chronic liver disease, prisoners, sex workers, people receiving blood transfusions
HbsAg is checked 1-4 months after immunisation in healthcare workers and patients with CKD
Interpretation of anti-has
> 100 = adequate response, booster in 5 years
10-100 = suboptimal response, give additional vaccine dose. If immunocompetent, no further testing required
< 10 = non-responser, check for current or past infection. Give 3 doses of vaccine again and if doesn’t respond will need HBV immunoglobulins if comes into contact
Management of HBV
Screen for other BBVs and STIs Notify public health Stop smoking and alcohol Education about reducing transmission Test for complications e.g. cirrhosis, hepatocellular carcinoma
Pegylated interferon first line, a better response is predicted by being female, < 50 years old, low HBV DNA levels, non-Asian, HIV negative, high degree of inflammation on liver biopsy
Tenofovir, entecavir and telbivudine (a synthetic thymidine nucleoside analogue)
Procedure for children born to HVB + mothers
Within 24 hours of birth given hepatitis B vaccine and immunoglobulin infusion
Given an additional HVB vaccine at 1 and 12 months of age, receiving the hepatitis B vaccine as part of the normal 6 in 1 vaccine given to all infants at 2,3,4 months
Tested at 1 year for HbsAg to see if they have contracted the virus
What is HVC, how is it spread?
RNA virus, spread by blood and body fluids
Incubation period 6-9 weeks
No vaccine is available, but it is now curable with direct acting antiviral medications
1 in 4 fights off the virus and makes a full recovery, 3 in 4 becomes chronic
Complications of HVC
Liver cirrhosis and hepatocellular carcinoma
What is the testing done for HVC
HCV RNA is the investigation of choice for acute diagnosis
Need to calculate the viral load and assess for the individual genotype (direct acting antivirals tailored to the specific viral genotype - typically taken for 8-12 weeks)
Features of HVC
Only 30% will develop features:
Fever
Elevated transaminases/jaundice
Arthralgia
Potential complications of chronic HVC
Arthralgia, arthritis
Sjogren’s syndrome
Cirrhosis, hepatocellular carcinoma
cryoglobulinaemia, typically type II (mixed monoclonal and polyclonal)
porphyria cutanea tarda (PCT): it is increasingly recognised that PCT may develop in patients with hepatitis C, especially if there are other factors such as alcohol abuse
membranoproliferative glomerulonephritis
What is the management of chronic HCV
Aim of treatment is sustained virological response = undetectable serum HCV RNA six months after the end of therapy
Combination of protease inhibitors e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir with or without ribavirin
Based on viral genotype
