Session 8 Flashcards

Question

What are LFTs?

Answer 1

Liver function test • Bilirubin * Liver transaminases * Alanine transaminase (ALT) * Aspartate aminotransferase (AST) * Hepatocyte damage / cellular integrity • Alkaline phosphatase (ALP) • Biliary tract cell damage / cholestasis suggests gall stone rather than liver damage. • Albumin • a protein synthesised in liver seen low in chronic liver damage, when low can see oedema ``` • Tests of coagulation • clotting factors are synthesised in liver • INR (International Normalised Ratio) • Prothrombin time (PT) these are altered in liver damage. ```

Answer 2

* Vertical transmission (75% cases globally) * Perinatal transmission in pts from highly endemic areas * Sexual contact * People who inject drugs * Close household contacts * Significant blood exposure * Health care workers via needlestick injuries

Answer 3

•Jaundice •Fatigue •Abdominal pain •Anorexia/Nausea/Vomiting •Arthralgia (joint pain)

Answer 4

* Incubation 6wks - 6 months. * AST/ALT in 1000s * Up to 50% - no/vague symptoms * Clear infection within 6 months * <1% - fulminant hepatic failure * Becomes chronic in <10% if infected as adult * 90% if infected in infancy (Asia/China)

Answer 5

``` Antigen - Antibody • HBsAg  HBsAb (surface) • HBeAg  HBeAb (E) • (HBcAg) not detected in blood.  (Core) HBcAb: IgM and IgG ``` Can look at HBV DNA through PCR.

Answer 6

1) Surface antigen first 1) Within 6/52; Rise in ALT / DNA 2) Followed by e-antigen 1) Highly infectious when present with surface antigen 3) Core antibody (IgM) 1) First antibody to appear 4) Followed by e-antibody 1) Heralds disappearance of e-antigen so less infectivity 5) Surface antibody 1) Last antibody to appear 2) Clearance of virus/recovery 6) Core antibody (IgG) 1) Persists for life

Answer 7

Definition - Persistence of HBsAg after 6 months. | • 25% chronic infection leads to cirrhosis and ~5% will develop hepatocellular carcinoma

Answer 8

* NO CURE – integrates into host genome * Life-long anti-virals to suppress viral replication * Not required for everyone (e.g. “inactive” carrier) * Low VL / normal LFTs / no liver damage

Answer 9

* Genetically engineered surface antigen * 3 doses + boosters if required * Effective in most people * Produces surface antibody response * >10 adequate •>100 long-term protection

Answer 10

* People who inject drugs (“Intravenous drug users”) >90% of those with Hep C in UK - IV Heroin / crack / methamphetamines - Crack or heroin smokers * Sexual contact (<1% but higher if HIV co-infected) * Infants born to HCV positive mothers (<5%) * Blood transfusion prior to 1991. * Needlestick injuries to healthcare workers etc.

Answer 11

* ~80% become chronically infected * Of these some will develop chronic liver disease/cirrhosis. Resulting in: * Decompensated liver disease * Hepatocellular carcinoma (primary liver cancer) * Transplant * Death

Answer 12

``` •80% have no symptoms (acute or chronic) •20% have vague symptoms –Fatigue –Anorexia –Nausea –Abdominal pain (RUQ) ```

Answer 13

* Serology – anti-Hep C antibody only (doesn't tell you if they currently have had it or if they've cleared it) * Remains positive life-long, even after clearance / cure * Not protective, can get re-infected * Viral PCR * If positive, confirms on-going / chronic infection

Answer 14

* CAN BE CURED! * Directly acting antiviral drug combo * 8-12 weeks * >90% chance of cure * Expensive * Can get re-infected * No vaccine

Answer 15

•HIV - 1/300 - Much lower if patient is on ARVs / VL undetectable •Hep C - 1/30 •Hep B - 1/3 -Much lower if recipient has been vaccinated

Answer 16

* First aid – bleed and wash wound * Collect blood from patient (with consent) and from med student * Inform Occupational Health * Check med student’s Hep B vaccination status * Assess risk and need for immediate HIV PEP

Answer 17

* Early initiation of ARVs reduces dissemination and replication of HIV in tissue and bodily fluid * Evidence limited (animal studies / observational human studies) * Assess risk * Give x3 ARVs for 28 days * Start ASAP, max up to 72 hours * HIV test at baseline, 1 month and 3 months

Answer 18

* Possible for Hep B booster * HIV PEP required for 28 days * Counselling and follow-up required * Advise to use condoms while at risk * No PEP available for Hep C * Repeat HIV and Hep C tests at 12 weeks

Answer 19

Acute infection - Prevention - Outcome of infection (untreated) - Treatment HIV - Flu-like symptoms / nil - Condoms, PEP - AIDS Life-long anti-viral therapy Hep B - Jaundice / abdo pain / anorexia - Vaccination - •Cure (majority) •Chronic infection (minority) - Nil OR Lifelong antiviral drug Hep C - Usually nil Risk avoidance only - Chronic infection (majority) - 8-12 weeks of anti-viral drugs

Session 8 Flashcards

(43 cards)