26/1 Flashcards
types - acute hepatitis
- autoimmune
- drug induced
- viral - hep A-E, HSV if immunosuppressed, CMV, yellow fever, EBV
- bacterial - leptospirosis, Q fever, syphilis
- parasite - malaria
acute hepatitis - general
- define
- age/ sex/ cause
- patho
- RF
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
acute hepatitis - alcoholic liver disease
- RF
- symptoms
- signs
- Ix
- DDx
- Dx
- Mx
- complications
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
acute hepatitis - autoimmune
- symptoms
- signs
- Ix
- DDx
- Dx
- Mx
- complications
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
-
acute hepatitis - viral hepatitis
- symptoms
- signs
- Ix
- DDx
- Dx
- Mx
- complications
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
liver biopsy
- indications
- contrainidications
- complications
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
chronic hep
- causes
- patho
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