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Lucy Knox - Year 2 > 205 - Hepatitis > Flashcards

205 - Hepatitis Flashcards

1
Q

What are the 2 phases of viral hepatitis?

A

Prodrome - flu-like

Icteric Phase

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2
Q

What symptoms are seen in the icteric phase of viral hep?

A 
Dark urine
Jaundice
Pale Stools
Abdo pain
Itching
Arthralgia
Skin rash
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3
Q

What is another word for jaundice?

A

Scleral Icterus

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4
Q

Of the 5 types of viral hepatitis, which have a vaccine available?

A

A
B
E

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5
Q

Which viral hep. has a post-exposure prophylaxis available?

A

B - HBIG surface antibody

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6
Q

Which viral heps are transmitted oral-faecally?

A

A

E

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7
Q

Which viral heps can be transmitted sexually?

A

B
C (MSM)
D

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8
Q

Which viral heps can be transmitted paraenteraly?

A

B

D

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9
Q

Which viral heps would IVDU (iv drug users) be at risk of?

A

B

C

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10
Q

Which viral hep can contaminate blood products?

A

C

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11
Q

Needle exchange is used in which viral heps as a preventative?

A

B

C

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12
Q

Better sanitation would reduce the transmission of which viral heps?

A

A

E

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13
Q

Which viral heps have vertical transmission? (Mother-baby)

A

B

C

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14
Q

A newborn baby is given a vaccination to prevent transmission of a viral hep from its mother, which hep?

A

B

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15
Q

Treatment is available for which viral heps?

A

B
C
E (post transplant/supportive)

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16
Q

What are the treatment options for Hep B?

A

PEG-IFN - to try reduce viral load - £20,000/course
Tenofovir - antiviral
Entercavir - antiviral

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17
Q

What are the treatment options for Hep C?

A

PEG-INF - £20,000/course
Ribavarin
DAAs - Direct acting antivirals, eg. daclatasvir

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18
Q

Which viral hep is dependant on the presence of another active hep?

A

D - only in presence of hep B

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19
Q

Which viral heps can cause chronic disease?

A

B
C
E - in solid organ transplant patients

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20
Q

Which is the most common viral hep?

A

B - 2 billion infected, most cleared

1 million die a year worldwide

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21
Q

In the UK, in what population do we find 95% of the cases of Hep B?

A

Migrant communities

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22
Q

When would you choose to treat someone with Hep B?

A

Chronic
High viral load
Liver disease

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23
Q

Of those who are infected with Hep C, how many become chronic, and how many progress?

A

85% chronic
20% develop cirrhosis
25% of those get HCC - cancer

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24
Q

What type of virus is Hep E?

A

RNA virus

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25
Q

What are the 5 key functions of the liver?

A 
Storage of glycogen
Production of clotting factors
Drug metabolism
Removal of toxins
Production of bile
26
Q

What are the 3 major causes of chronic liver disease?

A

Alcoholic liver disease
Chronic viral Hep
Obestiy

27
Q

Describe drug metabolism steps in the liver

A

A lipophilic drug is processed by P450 in phase 1 (a heamoprotein), the drug is broken down into smaller products which through phase 2 undergo conjunction to form water soluble metabolites - these are then secreted via bile or urine

28
Q

How is a small amount alcohol metabolised?

A

In low concentrations it is dealt with by 1st pass metabolism - by alcohol dehydrogenase

Ethanol -> acetaldehyde -> Acetyl CoA
(NAD+ is converted to NADH in each step)

29
Q

When a large amount of alcohol is consumed, how is it metabolised?

A

A smaller amount is dealt with by 1st pass metabolism

The rest by 2nd pass - using MDOS (Drug metabolising system) and MEOS (ethanol oxidising system)

30
Q

Why is taking drugs and drinking excess alcohol dangerous?

A

Alcohol is metabolised by MDOS - drug metabolising system when at high quantities, so the drug metabolism is impaired, so there is less/slower removal of the drug - toxic risk

31
Q

What is the consequence of alcohol metabolism?

A

The NAD+ : NADH ratio is upset - this lack of NAD+ causes less gluconeogenesis - so blood glucose falls - hypoglycaemia

This can starve the brain + cause hypothermia if extreme

32
Q

What effect does alcohol have on the CNS?

A

It is a depressant

33
Q

What are the stages in alcoholic liver disease?

A

Alcoholic Steatosis - fatty infiltration of liver
Alcoholic hepatitis - Fever + Jaundice
Chronic hepatitis and fibrosis/cirrhosis

34
Q

Up to what stage of ALD is it potentially reversible?

A

Up until chronic hepatitis + fibrosis - if you abstain

35
Q

What are the complications/systemic effects of alcoholic liver disease?

A

Portal hypertension - ascites, varices, splenomegaly
Decompensation
HCC

36
Q

What clinical signs are seen in alcoholic liver disease?

A 
Palmar erythema
Spider naevi
Dupuytrens
Caput medusa
Ascites
Jaundice
37
Q

What happens in your brain to form an addiction to a drug?

A

Addictive drugs stimulate dopamine response from VTA into the nucleus accumbens - forms a basic reward circuit

38
Q

Alcohol has 2 functional neuronal targets - what are they?

A

Increase inhibitory pathways - make GABA receptors more effective

Reduce excitatory pathways - Glutamate inhibits NMDA receptors - important in memory loss + calcium channels inhibted

39
Q

What does the himmelsbach hypothesis explain?

A

The effect on taking a drug/alcohol causes the body to adapt homeostasis - you get tolerance.

This tolerance is then also responsible for drug withdrawal

40
Q

What is given to help combat alcohol withdrawal?

A

Benzodiazapines - help with some symptoms

Vit B supplements (eg. pabonex) if giving up long term

41
Q

What treatments can be given for alcoholism?

A

Naltrexone + Nalmefene - opioid receptor agonists
Acamprosate - NMDA receptor antagonist
Behavioural therapy

  • alone none work very well, combined work slightly better
42
Q

What does nicotine act on? What effect does it have?

A

Nicotinic acetylcholine receptors

A stimulant and depressant

43
Q

What receptors can opioids act on?

A

Mu
delta
Kappa

44
Q

Which opioid receptor is most addictive? Which drugs act on it?

A

Mu - heroine, morphine, tentanyl, oxycodone

45
Q

What is a replacement therapy used for opioid addiction?

A

Methadone or buprenorphine

46
Q

How do psychostimulants act on the brain?

A

They reverse the dopamine transporter - so increase dopamine conc at synapse

47
Q

Do you get a withdrawal with psychostimulants?

A

No

48
Q

What drugs are empathogens?

A

MDMA/ectasy

Mixed psychostimulant and hallucinogen

49
Q

What does caffine act on?

A

Adeonsine receptor antagonist

50
Q

What do hallucinogens act on?

A

5HT2A receptor partial agoinists

51
Q

What does ketamine act on?

A

NMDA receptor antagonist

52
Q

What does cannabis act on?

A

Delta-9 tetrahydrocannabinol retrograde neaurotransmitter

53
Q

Which LFTs show hepatocellular damage when increased?

A

ALT + AST

54
Q

Which LFTs are increased in choleostasis?

A

ALP + Gamma GT

55
Q

What is Gamma GT associated with?

A

chronic alcohol clearance - high level = high alcohol intake in last 2 weeks +

56
Q

What are some extrahepatic causes of choleostatic damage / raised ALP?

A

Obstructed biliary tree
Gall stones
Cancer

57
Q

What are some intrahepatic causes of choleostatic damage / raised ALP?

A 
Bile canaliculi
Viral
Alcoholic hep
Cirhossis
Pregnancy
58
Q

What does raised unconjugated bilirubin suggest?

A

Haemolysis - too many RBCs broken down

eg. congenital - gilberts

59
Q

What does raised conjugated bilirubin suggest?

A

Choelostasis - liver processed the bilirubin ok, but it gets stuck
eg. tumour of head of pancreas, blocked bile ducts

60
Q

What is albumin? When are levels reduced?

A

Main protein produced by liver. Reduced if liver function is impaired

61
Q

Why is doing a PTT/clotting time test useful in liver disease?

A

Liver produces clotting factors, which have a short half life, so if liver is damaged then they quickly run out and clotting time increases

Lucy Knox - Year 2 (17 decks)

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