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(Finals) GI > Liver disease > Flashcards

Liver disease Flashcards

diagnosing and managing hepatic disease processes

1
Q

Causes ACUTE hepatitis

A

Circulatory Insufficiency -> Ischaemic hepatitis

Viral infection-

  • Hep A, B, C, E, D
  • EBV, Yellowfever, CMV

Bacterial infection: Q fever, toxoplasma, leprosy

Alcohol

Drug induced- isoniazid, disulfiram, fenafibrate,

Poison- mushroom, alfatoxin, green tea

Pregnancy

Wilsons Disease

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2
Q

Causes CHRONIC hepatitis

A
  • Infectious
    HEP C
    also B + D
  • Autoimmuity
    post infectous, as part of systemic disease, IBD
  • Toxins
    Methyldopa, isoniazid, nitrofurantoin
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3
Q

Pathophysiology of acute hepatitis

A
  1. Hepatocyctes Degenerate
    Swell, increase in granularity and form vaculoes
  2. Hepatocytes necrose
    become shrunken and eosinophilic
  3. Dead hepatocytes removed by immune system, leaving inflammatory mass
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4
Q

Progression of acute Hepatitis

A

Pre-iteric “prodromal” phase of general illness

followed by hepatic localising symptoms

eventually late stage and complications is not cured eg. encephalopathy

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5
Q

Presentation of acute hepatitis

A

Fatigue, Fever, malaise, muscle pain, loss of appetite, weight loss

N&V

Abdominal pain

Jaundice

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6
Q

Investigations Acute Hepatitis

A
  • Bloods
    LFTs,+Albumin, Coagulation, BM, ESR, Viral Markers (antigens + antibodies) Alpha-fetoprotein, Toxicology
  • Imaging
    US Liver, (CT, MRI abdo) EEG
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7
Q

Management Acute Hepatitis

A
  1. Suppotive care
  2. Identify aetiology and treat cause
  3. Antivirals useful only in extrahepatic complications
  4. Early treatment of acute hepatitis C with interferon alfa [unlicensed indication] may reduce the risk of chronic infection.
  5. post-exposure prophilaxis is available for HepA and HepB
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8
Q

Hepatitis A specifics

A

Always self limiting
Very low risk of fulminant hepatic failure (usually in those with pre-existing liver disease)

Picornaviridae

Fecal-Oral transmission

Poor Hygeine and sanitatin are biggest RF
Shellfish
Africa, South Asia

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9
Q

Hep B specifics

A

Hepadnaviridae

Bodily fluid transmission- usually sexual or parenteral but also perinatal and horizontal (biting, scratching etc)

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10
Q

Hep C specifics

A

Flaviviridae

incubation period 7 weeks

Blood borne virus

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11
Q

Hepititis D specifics

A

Deltaviridae

ONLY occurs as co-infection with Hep B
Increases risk of FHF

Meditaranian and Far East Asia

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12
Q

Hep E specifics

A

Caliciviridae

Self-limiting, 40days incubation

Fecal-Oral transmission; usually contaminated drinking water

Asia, Africa, Mexico

Very low mortality except amongst pregnant women

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13
Q

Definition Chronic Hepatitis

A

>6months infection.

Can be from unresolved viral Hep or other acute causes
Can be ongoing disease process that always develops seperately

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14
Q

Pathophysiology Chronic Hepatitis

A
  1. Inflamatory cell infiltrates build up in portal tract
    Leukocytes
    Lymphocytes
    Lymphoid Follicles
  2. Apoptosis and necrosis
  3. Lobular change
  4. Fibrosis
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15
Q

Staging and Grading CHRONIC hepatitis

A

STAGING: severity of the fibrosis/chirrosis resulting from Hepatitis

GRADING: Spread of inflammation in liver

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16
Q

Liver disease states and their relation to one another

A
17
Q

Hepatotoxic agents that can cause PROGRESSIVE liver disease

A
  • Hep C
  • Untreated Hep B
  • Drugs
  • Alcohol
  • Metabolic Syndrome (Obesity, DM, HTN, Hyperlipideamia)
  • Idiopathic
18
Q

2 processes by which normal liver becomes cirrhotic

A

Fibrosis

Nodular Regeneration

19
Q

Which Cells are damaged by local inflammation and activate cells around them

A

Kupffer Cells

20
Q

Which cells are in the Space of Disse and are activated by local inflammation and other cells to proliferate and break down collegen

A

Stellate Cells

21
Q

Kupffer Cells

A

are damaged by local inflammation and activate cells around them

22
Q

Stellate Cells

A

are in the Space of Disse

activated by local inflammation and Kuppfer cells to proliferate and break down collegen

(Finals) GI (5 decks)

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