26/1 Flashcards

1
Q

types - acute hepatitis

A
  • autoimmune
  • drug induced
  • viral - hep A-E, HSV if immunosuppressed, CMV, yellow fever, EBV
  • bacterial - leptospirosis, Q fever, syphilis
  • parasite - malaria
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2
Q

acute hepatitis - general

  • define
  • age/ sex/ cause
  • patho
  • RF
A

define
- inflammation of liver

age/ sex
- autoimmune - type 2 paediatric, type 1 adult (15-25, 40-50s, F)

patho

  • hepatocytes - swelling and vaculoation (degen) >> necrosis and removal
  • necrosis esp central zone 3 (centrilobular and so less o2)
  • can lead to fulminant hep

RF
- risky sex, needles, tattoos, blood infusion pre-1990

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3
Q

acute hepatitis - alcoholic liver disease

  • RF
  • symptoms
  • signs
  • Ix
  • DDx
  • Dx
  • Mx
  • complications
A

patho

  • alcoholic related fatty liver >> alcoholic hep >> cirrhosis

RF

  • alcohol

symptoms
- post-binge, jaundice, RUQ pain, systemic upset

signs

  • hepatomegaly, spider naevi, gynaecomastia, palmar erythema, bruising, ascites, caput medusaw, asterixis (flapping tremor)
  • hepatic encephalopthy - liver flap, constructional apraxia, confusion, altered GCS, triphasic slow waves on ECG, raised ammonia
  • viral - elevated transaminases

Ix

  • FBC - raised MCV
  • LFT - elevated AST, ALT (AST:ALT>2) and GGT, ALT elevated later, low alubmin, IN bilirubin (cirrhosis)
  • DF - discriminant function>32 is severe
  • elevated PT
  • hepatorenal syndrome - derranged UEs
  • USS - early fatty changes called IN echogenicity, fibroscan for degree of cirrhosis
  • endoscopy - oesophagela varcies if ?portal HTN
  • CT and MRI - fatty liver infiltration, hepat carcinoma, hepatosplenomegaly, abnormal bvessels
  • liver biopsy - if needing steroids
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4
Q

acute hepatitis - autoimmune

  • symptoms
  • signs
  • Ix
  • DDx
  • Dx
  • Mx
  • complications
A

symptoms

  • 40% present as chronic - NSS - fatigue. wt loss, fever, arthralgia

signs
- other conditions e.g. PSC, PBC, IBD

Ix

  • elevated AST, ALT
  • elevated IgG
  • negative viral serology
  • high ANA, ASMA
  • liver biopsy

Mx

  • pred 30mg o.d - reduce dose to 10mg/day for 4W if falls in ALT/ AST
  • azathiopprine 1mg/kg/day after TPMT assay
  • LT - azathioprine and pred (5-10mg), bisphosphonated amd PPI

-

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5
Q

acute hepatitis - viral hepatitis

  • symptoms
  • signs
  • Ix
  • DDx
  • Dx
  • Mx
  • complications
A

symptoms
- pre-icteric - 1-2W - fatigue, malaise, arthralgia, headache, anorexia, cig smoke aversion, RUQ pain

  • icteric - jaundice, pale stool, dark urine, pruiritis, skin rash
  • A and C - mild sx
  • extrahep - B

signs
- icteric - lymphadenopathy

  • hepatoplenomegaly

Ix

  • viral serology

Mx

  • B - support, no alc, antiviral
  • C - DAA
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6
Q

liver biopsy

  • indications
  • contrainidications
  • complications
A

indications

  • chronic hep
  • cirrhosis
  • ?neoplasm
  • storage
  • unexplained hepatomegaly

CI

  • prolonged PT
  • plt <80
  • ascites
  • extra hep cholestasis

complications

  • within 2hrs - abdo/ shoulder pain, minor intraperitoneal bleed
  • rare - haemothorax, pleurisy, haemobilia. biliary peritonitis
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7
Q

chronic hep

  • causes
  • patho
A

causes

  • alcohol
  • wilsons, haemochromatosis, alpha-1 antitrypsin
  • hep B, C and D
  • autoimmune - 40%
  • hyperlipidaemia
  • drugs - nitrofurantoin, methyldopa

patho

  • >6M
  • inflammation and fibrosis >> portal tract >> loss of definition, necrosis and fibrosis >> cirrhosis

inflam - grade

fibrosis - severity

child pugh score for severity

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