Flashcards in Week 205 - Alcoholism and Hepatitis Deck (76)
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1
Week 205 - Alcoholism and Hepatitis: What is the metabolism pathway for alcohol?
• Ethanol is converted to Acetaldehyde - (Enzyme ADH)
• Acetaldehyde is converted into acetate - (Enzyme ALDH and reduction of NAD+ to NADH)
2
Week 205 - Alcoholism and Hepatitis: What are the risk factors for liver disease?
• Alcohol consumption
• Genetics, women>men + ethnicity
• BMI
• Diabetes
• Immune factors
3
Week 205 - Alcoholism and Hepatitis: What are the three degrees of alcoholic liver disease?
• Fatty liver
• Alcoholic hepatitis
• Hepatic fibrosis or cirrhosis.
4
Week 205 - Alcoholism and Hepatitis: What is the process of fatty deposition in the space of Disse in fatty liver disease?
• Decreased NAD+ (From increased use during alcohol metabolism)
• This results in decreased gluconeogenesis which results in an increase in fatty acids.
5
Week 205 - Alcoholism and Hepatitis: In which potential space are fatty acids deposited in the liver due to over consumption of alcohol?
Space of Disse, this is between hepatocytes and sinusoids.
6
Week 205 - Alcoholism and Hepatitis: What percentage of fatty livers develop into cirrhosis?
5-15%
7
Week 205 - Alcoholism and Hepatitis: What is the cause of alcoholic hepatitis?
This is from the toxic effect of acetaldehyde.
8
Week 205 - Alcoholism and Hepatitis: What are the signs and symptoms of alcoholic hepatitis?
Change in appetite, tiredness, weakness, fever, hepatomegaly, right upper quadrant pain, jaundice, nausea and vomitting.
9
Week 205 - Alcoholism and Hepatitis: What is the pathology of cirrhosis?
Inflammation and fibrosis that results in necrosis and tissue scarring.
10
Week 205 - Alcoholism and Hepatitis: What is the presentation of cirrhosis?
• S/S of alcoholic hepatitis - change in appetite, tiredness, weakness, fever, hepatomegaly, right upper quadrant pain, jaundice, nausea and vomiting.
• PLUS - oedema, ascites, bruising/bleeding, haematemesis, malaena.
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Week 205 - Alcoholism and Hepatitis: What are the percentage risk of alcoholics developing the triad of alcoholic liver disease?
• Fatty liver - 90%
• Alcoholic hepatitis - 10-35%
• Cirrhosis - 10-20%
12
Week 205 - Alcoholism and Hepatitis: What is the infective agent for hepatitis C?
• Hepatitis C Virus (HVC)
• A member of the Flaviviridae family.
13
Week 205 - Alcoholism and Hepatitis: Hepatitis C is commonly asymptomatic, but how can it present?
• Malaise
• Anorexia
• Weakness
14
Week 205 - Alcoholism and Hepatitis: What is the standard treatment for Hepatitis C?
• Ribivarin and Interferon.
15
Week 205 - Alcoholism and Hepatitis: Aside from alcoholic liver disease and Hepatitis C what is the other major cause of chronic liver disease?
Obesity
16
Week 205 - Alcoholism and Hepatitis: What are the routes of transmission for Hepatitis A-E
• Oral-faecal - A + E
• Parenteral - B + C (D in the presence of active B)
17
Week 205 - Alcoholism and Hepatitis: What is the prodrome of viral hepatitis?
Flu-like symptoms; anorexia, nausea and vomitting, fatigue, malaise, low-grade fever, myalgia and mild headache.
18
Week 205 - Alcoholism and Hepatitis: What are the signs of symptoms of viral hepatitis during the icteric phase?
Dark urine, pale stools, jaundice, abdominal pain, itch, arthralgia and skin rash.
19
Week 205 - Alcoholism and Hepatitis: Aside from Hep A-EE what other organisms can cause viral hepatitis?
Adenovirus, EBV, CMV, Herpes simplex
20
Week 205 - Alcoholism and Hepatitis: What is the management for viral hepatitis?
• Prevention - Vaccination A,B and E
• Post-exposure prophylaxis - HBIG for Hep. B
• Acute illness - supportive care, anti-viral B +C
• Chronic illness - anti-viral B + C
21
Week 205 - Alcoholism and Hepatitis: What is the geographic distribution of hepatitis E?
Roughly equatorial with china.
22
Week 205 - Alcoholism and Hepatitis: What are the clinical features of HEV?
• Cholestasis, jaundice, malaise, anorexia, nausea, vomitting, abdominal pain, fever, hepatomegaly.
• Less common features include diarrhoea, arthritis, pruritus, urticarial rash.
23
Week 205 - Alcoholism and Hepatitis: Hepatitis B can be found world wide, but in which areas of the world are suffering from an endemic?
• Sub-saharan africa
• China, Kazakstan, Mongolia
• Indonesia
24
Week 205 - Alcoholism and Hepatitis: What are the aims of HBV treatment?
• Loss of viral replication
• Normalisation of transaminases
• Improvement in liver histology
• Loss of e antigen
• Loss of surface antigen
25
Week 205 - Alcoholism and Hepatitis: What is the medical treatment of HBV?
• Peginterferon
• Entecavir
• Tenofovir
• Lamivudine
• Adefovir
• Telbivudine
26
Week 205 - Alcoholism and Hepatitis: What is the natural history of HCV infection?
• Exposure - 15% resolve, 85% become chronic
• Chronic - 80% stable, 20% develop cirrhosis
• Cirrhosis - 75% slowly progressive, 25% death/transplant
27
Week 205 - Alcoholism and Hepatitis: Interferon is used for the treatment of hepatitis, but is frequently in-tolerated due to its side effects, what are they?
Flu-like symptoms, injection site reactions, myalgia and arthralgia, neuropsychiatric, bone marrow suppression, thyroid dysfunction, exacerbation of auto-immune disease.
28
Week 205 - Alcoholism and Hepatitis: What are the adverse effects of Ribavirin?
Teratogenic, haemolytic anaemia, skin rash, cough, insomnia.
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Week 205 - Alcoholism and Hepatitis: What are the functions of the liver? (5)
• Storing glycogen
• Production of clotting factors
• Processing medication
• Helping to remove toxins from the body
• Production of bile
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