Liver

Question 1

Hepatomegally. Normal size and causes

Answer 1

Normal size:

• 4.5-5 cm (1 week)
• 7-8 cm (12 years, male)
• 6-6.5 cm (12 years, female)

Causes:

1. Neonate
   - congenital infection
   - neonatal hepatitis
   - congenital HF
2. Infant
   - infection
   - PEM
   - congestive HF
   - tumour (hepatoblastoma)
3. Child
   - infection
   - drug & toxin
   - congestive HF
   - tumour (lymphoma)

Question 2

Type of hepatitis

Answer 2

1. Hepatotropic
   - A,B,C,D,E,F,G,H
2. Non-hepatotropic
   - Epstein-barr virus
   - cytomegalovirus
   - coxsackie

Question 3

Explain about hepatitis A.

Mode of transmission, ip, cp

Answer 3

MOT: feco- oral

IP: 15-45 days / 4 weeks

CP:

1. Prodromal (1-2 weeks)
   - headache, nausea, vomit
2. Icteric (2-4 weeks)
   - jaundice
   - dark urine
   - tender liver
   - abdominal pain
3. Convalescence (1-2 weeks)
   - become nearly normal

• May cause infection
• fever
• nausea, vomit
• like interic

Question 4

Explain about hepatitis A.

Diagnosis, treatment, complication

Answer 4

Diagnosis:

1. LFT
   - increase direct/ indirect bilirubin
   - dark urine
   - increase serun transaminase
   - increase alkaline phosphate
2. Presence IgM, IgG

Treatment:

• no specific treatment
• managment at home
• balanced diet: decrease fat
• HAV vaccine

Complication:

• acute fulminant hepatitis
• aplastic anemia
• prolonged cholestatic syndrome

Question 5

Explain about Hepatitis B.

Mode pf transmissiom, ip, cp

Answer 5

MOT:

• perinatal transmission
• paranteral
• child to child

IP: 45-160 days

CP:
1. Asymptomatic carrier
2. Infection
- longer than HAV
- like icteric
- hepatosplenomegally
- extra hepatic
>papular skin eruption
>arthalgia, polyarthritis
>GN
>aplastic anemia

• if chronic:
  > cirrhosis
  > chronic active hepatitis
  > hepatocellular carcinoma

Question 6

Explain about Hepatitis B.

Diagnosis, treatment, complication

Answer 6

Diagnosis:
1. LFT : increase serum transaminase

2. Hepatitis marker
   - HBsAg
   - HBcAb ( IgM, IgG)

Treatment:

• supportive treatment
• lnterferon alpha 2b
• liver transplant
• HBV vaccine

Complication

• persistent infection
• chronic hepatitis, then Cirrhosis
• Acute fulminant hepatitis
• Aplastic anemia
• hepaticellular carcinoma

Question 7

Hepatitis C. Mode of transmission, IP, CP

Answer 7

MOT:

• perinatal transmission
• parentral
• post transfussion

IP: 7-9 weeks

CP:
- similar infection
- mild
- may cause rapid liver failure with poor prognosis
- extra hepatic:
>cutaneous vasculitis
>peripheral neuropathy
>cerebritis
>GN (membrano-proliferate)
>nephrotic syndrome

Question 8

Hepatitis C. Diagnosis, treatment and complication

Answer 8

Diagnosis:

1. LFT
2. Serological
   - Ab of HCV antigen
   - PCR ( polymerase chain reaction)

Treatment:

• interferon alpha 2b
• combine with ribavirin

Complication:

• chronic hepatitis
• acute fulminant hepatitis
• hepatocellular carcinoma