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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
What are the 5 key functions of the liver?
``` Storage of glycogen Production of clotting factors Drug metabolism Removal of toxins Production of bile ```
26
What are the 3 major causes of chronic liver disease?
Alcoholic liver disease Chronic viral Hep Obestiy
27
Describe drug metabolism steps in the liver
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
How is a small amount alcohol metabolised?
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
When a large amount of alcohol is consumed, how is it metabolised?
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
Why is taking drugs and drinking excess alcohol dangerous?
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
What is the consequence of alcohol metabolism?
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
What effect does alcohol have on the CNS?
It is a depressant
33
What are the stages in alcoholic liver disease?
Alcoholic Steatosis - fatty infiltration of liver Alcoholic hepatitis - Fever + Jaundice Chronic hepatitis and fibrosis/cirrhosis
34
Up to what stage of ALD is it potentially reversible?
Up until chronic hepatitis + fibrosis - if you abstain
35
What are the complications/systemic effects of alcoholic liver disease?
Portal hypertension - ascites, varices, splenomegaly Decompensation HCC
36
What clinical signs are seen in alcoholic liver disease?
``` Palmar erythema Spider naevi Dupuytrens Caput medusa Ascites Jaundice ```
37
What happens in your brain to form an addiction to a drug?
Addictive drugs stimulate dopamine response from VTA into the nucleus accumbens - forms a basic reward circuit
38
Alcohol has 2 functional neuronal targets - what are they?
Increase inhibitory pathways - make GABA receptors more effective Reduce excitatory pathways - Glutamate inhibits NMDA receptors - important in memory loss + calcium channels inhibted
39
What does the himmelsbach hypothesis explain?
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
What is given to help combat alcohol withdrawal?
Benzodiazapines - help with some symptoms | Vit B supplements (eg. pabonex) if giving up long term
41
What treatments can be given for alcoholism?
Naltrexone + Nalmefene - opioid receptor agonists Acamprosate - NMDA receptor antagonist Behavioural therapy - alone none work very well, combined work slightly better
42
What does nicotine act on? What effect does it have?
Nicotinic acetylcholine receptors | A stimulant and depressant
43
What receptors can opioids act on?
Mu delta Kappa
44
Which opioid receptor is most addictive? Which drugs act on it?
Mu - heroine, morphine, tentanyl, oxycodone
45
What is a replacement therapy used for opioid addiction?
Methadone or buprenorphine
46
How do psychostimulants act on the brain?
They reverse the dopamine transporter - so increase dopamine conc at synapse
47
Do you get a withdrawal with psychostimulants?
No
48
What drugs are empathogens?
MDMA/ectasy | Mixed psychostimulant and hallucinogen
49
What does caffine act on?
Adeonsine receptor antagonist
50
What do hallucinogens act on?
5HT2A receptor partial agoinists
51
What does ketamine act on?
NMDA receptor antagonist
52
What does cannabis act on?
Delta-9 tetrahydrocannabinol retrograde neaurotransmitter
53
Which LFTs show hepatocellular damage when increased?
ALT + AST
54
Which LFTs are increased in choleostasis?
ALP + Gamma GT
55
What is Gamma GT associated with?
chronic alcohol clearance - high level = high alcohol intake in last 2 weeks +
56
What are some extrahepatic causes of choleostatic damage / raised ALP?
Obstructed biliary tree Gall stones Cancer
57
What are some intrahepatic causes of choleostatic damage / raised ALP?
``` Bile canaliculi Viral Alcoholic hep Cirhossis Pregnancy ```
58
What does raised unconjugated bilirubin suggest?
Haemolysis - too many RBCs broken down | eg. congenital - gilberts
59
What does raised conjugated bilirubin suggest?
Choelostasis - liver processed the bilirubin ok, but it gets stuck eg. tumour of head of pancreas, blocked bile ducts
60
What is albumin? When are levels reduced?
Main protein produced by liver. Reduced if liver function is impaired
61
Why is doing a PTT/clotting time test useful in liver disease?
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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