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simon! hepatitis Flashcards

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1
Q

Where in the body might show signs of liver disease (6)

A

hands, face, chest, abdomen, legs, fever

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2
Q

Clinical signs of liver disease: hands

A

leukonychia
clubbing
palmar erythema
bruising

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3
Q

Clinical signs of liver disease: face

A

jaundice
scratch marks
spider naevi

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4
Q

Clinical signs of liver disease: chest

A

gynaecomastia
loss of body hair
spider naevi
bruising
pectoral muscle wasting

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5
Q

Clinical signs of liver disease: abdomen

A

hepatosplenomegaly
ascites
signs of portal HTN
testicular atrophy

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6
Q

Clinical signs of liver disease: legs

A

oedema
muscle wasting
bruising

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7
Q

Clinical signs of liver disease: fever

A

1/3 of advanced cirrhosis, or infected ascites

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8
Q

what is bilirubin

A

a yellow compound that occurs in the normal catabolic pathway that breaks down heme. There are two types, unconjugated and conjugated. Bilirubin is excreted in bile and urine and elevated levels may indicate certain diseases

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9
Q

Define portal hypertension

A

elevation of the hepatic venous pressure gradient to >5mmHg

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10
Q

What are some complications of portan hypertension? (7)

A
  • GI varices with haemorrhage
  • Ascites
  • Hypersplenism
  • Hepatic encephalopathy
  • Spontaneous bacterial peritonitis
  • Hepatorenal syndrome
  • Hepatocellular carcinoma
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11
Q

How can portal hypertension be investigated?

A
  • Blood tests
  • Liver function tests
  • Liver biochemistry
  • Viral markers
  • Additional blood tests, haematological, biochemical, immunological, markers of liver fibrosis and genetic analysis
  • urine tests
  • imaging (USS, CT, MRI, MRCP,ERCP)
  • liver biopsy for histology
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12
Q

What causes acute hepatitis

A
  • Viral hepatitis (hep A,B,C,D,E, EBV, CMV, coxsackievirus)
  • Alcohol
  • Drugs
  • Hypotension and ischemia
  • Biliary tract disease
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13
Q

What are some symptoms of acute hepatitis?

A
  • Malaise
  • Nausea
  • Vomiting
  • Diarrhoea
  • Low grade fever followed by dark urine, jaundice, hepatomegaly
  • elevation of aspartate and alanine aminotransferase (AST and ALT)
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14
Q

Describe hepatitis A infection

A
  • ssRNA genome
  • Faecal-oral transmission- food and water borne
  • Recover within 6-12 months
  • No clinical sequelae
  • Diagnosis-IgM anti-HAV in acute phase
  • After exposure: immune globulin within 2 weeks
  • Before exposure: inactivated HAV vaccine
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15
Q

Describe Hepatitis B infection

A
  • partially dsDNA
  • needle stick, sexual, perinatal transmission
  • Endemic in sub-saharan Africa and Southeast Asia (up to 20% of population)
  • Diagnosis: HBsAg in serum, IgM anti-HBc, HBV DNA in serum
  • individuals who remain HBsAg +ve for at least 6mo are considered hepb carriers
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16
Q

How can hepB be prevented

A
  • after exposure in unvaccinated: Hep B immune globulin
  • before exposure: recombinant hep B vaccine
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17
Q

Describe hepB outcomes

A
  • Recovery>90%
  • Fulminant hep <1%
  • Chronic hep or carrier state 1-2%, higher in neonates and immunocompromised/cirrhosis pts
  • Reactivation- immunosuppressed, esp. with rituximab
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18
Q

Describe hepC

A
  • RNA virus
  • 7-8 week incubation
  • clinically mild and fluctuating elevation of ALT
  • > 50% of chronicity
  • 20% cirrhosis
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19
Q

Describe hepC diagnosis, epidemiology, prevention

Study These Flashcards
A

diagnosis
- Anti-HCV in serum
- HCV RNA- most sensitive
epidemiology
>90% of transfusion associated hepatitis, >50% IV drug, little evidence for sexual or perinatal transmission
prevention
testing of donated blood

20
Q

Describe hepD

Study These Flashcards
A
  • RNA virus, requires HBV for its replication
  • coinfections or superinfections from a chronic HBV carrier
    diagnosis: Anti-HDV in serum
    prevention: hepB vaccine
21
Q

Describe hepE

Study These Flashcards
A

-ssRNA
- faecal oral route: water
- self-limiting illness with a high (10-20%) mortality rate in pregnant women

22
Q

Describe toxic and drug induced hepatitis

Study These Flashcards
A
  • dose dependent
    onset within 48hrs, predictable necrosis around terminal hepatic venule: paracetamol, carbon tetrachloride, benzene derivatives, mushroom poisoning
    micro-vesicular steatosis: tetracycline, valproic acid
23
Q

What might cause toxic/drug induced hepatitis

Study These Flashcards
A

paracetamol, carbon tetrachloride, benzene derivatives, mushroom poisoning

24
Q

How is toxic/drug induced hepatitis treated

Study These Flashcards
A
  • supportive as for viral hepatitis
  • withdraw suspected agent
  • gastric lavage
  • oral admin of charcoal
  • liver transplant
25
Describe paracetamol poisoning, cause and symptoms
cause: 150mg/kg or 12g (24x500mg) fatal in adults symptoms: vomiting, RUQ pain (early) jaundice, encephalopathy from liver damage and/or renal failure (later)
26
How is paracetamol poisoning managed?
- Lavage if >12g (or >150mg/kg) taken within 1hr - Activated charcoal if <1hr since ingestion - Monitor glucose, U&E, LFT, INR, ABG, HCO3 - Pt whose plasma:paracetamol conc above normal tx line should be given N-acetylcysteine by IV
27
Describe acute hepatic failure
Massive hepatic necrosis with impaired consciousness occuring within 8 weeks of the onset of illness
28
What are some causes of acute hepatic failure
- viral hep ABCDE, bacterial rickettsial, parasitic drugs and toxins, ischemia, acute Wilson's disease, acute fatty liver of pregnancy
29
What are some clinical manifestations of acute hepatic failure
neuropsychiatric changes - delerium, personality change, coma cerebral oedema - profuse sweating, haemodynamic instability, tachyarrythmia, tachypnea, fever, papilledema, jaundice, coagulopathy, bleeding, renal failure, acid-base disturbance, hypoglycaemia, infections
30
Describe chronic hepatitis
- Chronic inflammatory reaction in the liver for at least 6 months - hep BCD, drugs, autoimmune hep, wilson's disease, haemochromatosis - wide clinical spectrum
31
Describe autoimmune hepatitis
type 1 (classic): anti-smooth muscle and/or ANA type 2 anti-liver/kidney microsomal antibodies (anti-LKM) type 3 lack of ANA and anti-LKM, but AB react with hepatocyte cytokeratin, clinically similar to type 1
32
What are clinical and extrahepatic manifestations of autoimmune hepatitis
Acute onset, progressive jaundice, anorexia, hepatomegaly, abdominal pain, epistaxis, fever, fatigue, amenorrhea, rash, arthralgia, keratoconjunctivitis sicca, thyroditis, haemolytic anaemia, nephritis
33
How is autoimmune hepatitis diagnosed and treated
blood tests and biopsy steroid, azathioprine
34
Describe non-alcoholic fatty liver disease
- lead to cirrhosis (1%) and hepatocellular carcinoma - ranges from simple fatty change to fat and inflammation with or without fibrosis, to cirrhosis - oxidative stress injury and other factors lead to lipid peroxidation in the presence of fatty infiltration and inflammatory results - asymptomatic- obesity
35
How is non-alcoholic fatty liver disease diagnosed and managed?
Demonstration of a fatty liver by USS weight loss, exercise, strict control of HTN, diabetes, lipid level
36
What is cirrhosis
late stage of scarring (fibrosis) of the liver
37
what are common causes of cirrhosis
long-term alcohol abuse, hepatitis B & C infection, fatty liver disease, toxic metals, genetic diseases - hepB and C leading causes
38
what are common symptoms of cirrhosis
- anorexia - nausea - vomiting - diarrhoea - RUQ pain - fatigue - weakness - fever - jaundice
39
what are common signs of cirrhosis
- spider naevi, palmar erythema, jaundice, parotid and lacrimal gland enlargement, clubbing, hepatosplenomegaly, ascites, GI bleeding, hepatic encephalopathy
40
how can cirrhosis be tested for
labtests: bloods, liver function, viral markers, auto-AB, Ig, copper and caeruloplasmin, a1 antitrypsin imaging: USS, CT, MRI, Endoscopy (detection and tx of varices) biopsy: confirm both type and severity
41
Describe alcoholic liver disease
- excessive alcohol use-fatty liver, alcoholic hepatitis, cirrhosis - 40% deaths due to cirrhosis - Fatty liver: asymptomatic hepatomegaly and mild elevation of LFTs. Reverses on withdrawl of ethanol
42
Describe alcoholic hepatitis
- From asymptomatic to severe liver failure with jaundice, ascites, GI bleeding, encephalopathy
43
Describe management of alcoholic hepatitis
- daily multivitamin, thiamine, folic acid - correct NA, K, Mg, PO4 - monitor glucose
44
Describe primary biliary cirrhosis
- progressive - unknown - female median age 50 - prutitis, fatigue, jaundice, osteoporosis, portal vein HTN - Anti-mitochondrial AB in 90%; elevated ALP - liver biopsy - associated w/ sjogren's, thyroiditis, pernicious anaemia
45
What is necessary for liver transplant
- ABO compatible donor (HLA matching not necessary) - no sepsis, malignancy, HIV, HBV, HCV infection
46
What are risks of liver transplant
- rejection - acute/cellular rejection - chronic ductopenic rejection
47
What is the prognosis of a liver transplant
- 90% 1yr survival rate - 70-80% 5 year survival rate

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