Acute, Autoimmune and Chronic Hepatitis Flashcards
Know the principal functions of the liver.
- Metabolism of Carbohydrate and Fatty acids
- Production of serum proteins – including factors involved in coagulation cascade and lipids
- Synthesis: Fat-soluble vitamins (A, D, E, K)
- Bile transport
- Detoxification of blood from gut
Know the labs that are used to evaluate the synthetic function of the liver as well as the presence of inflammation (hepatocellular and cholestatic injury).
- Synthetic function: Albumin and Prothrombin time (PT) (Factors II, VII, IX and X)
- Inflammation of Liver: ALT/AST/Gamma GGT
- Biliary obstruction: Alkaline phosphatase & total bilirubin
What are the various causes of acute hepatitis (ie: viral, autoimmune, drugs etc.)?
Viral Hepatitis: A, B/D, C, E, EBV, CMV, HSV
Drugs;
– Ethanol, Tylenol (have to overdose on it), Halothane
– Anabolic steroids, Estrogens, Erythromycin, Sulfa, NSAIDs
Toxins: Jamaica Bush tea, W. Mushrooms, energy drinks
Vascular: hypotension, Budd-chiari
Autoimmune Hepatitis
Metabolic disorders: Wilson’s disease, A1AT
What are the various causes of chronic hepatitis (ie: viral, autoimmune, drugs etc.)?
Viral Hepatitis: B and C
Drugs: methotrexate, INH, amiodarone
Alcohol
NAFLD (fatty liver disease)
Autoimmune: Autoimmune hepatitis, Primary biliary cirrhosis (PBC),
Primary sclerosing cholangitis (PSC)
Metabolic: A1AT,Hemochromatosis,Wilson’s
Understand the basic diseases associated with autoimmune/hereditary.
Autoimmune
– Personal or FHx of liver/diabetes/thyroid
Genetic (FHx)
– Diabetes, Cardiac, Arthritis, HFE
– Neuropsychiatric problems (Wilson’s)
– Emphysema out of proportion to age/smoking hx (A1AT)
What is Primary Biliary Cirrhosis (PBC)?
CLD that destroys the bile ducts
What are the signs and symptoms of PBC?
fatigue itching jaundice diarrhea swollen abd/feet cholesterol deposits
How do we diagnose PBC?
signs/symptoms
blood test
liver biopsy
How do we treat Wilson’s disease?
lifetime D-Penicillamine
What labs and imaging studies are used to diagnose hepatocellular cancer and cholestatic patterns?
- Screening methods: AFP > 400 ng/mL, CT scan, U/S, MRI; PE = friction rub
- Cholestasis: BR, ALP, 5-Nucleotidase and gamma-GGT
Know the basic metabolic causes of hepatitis.
Alcoholic Liver Disease and Non-alcoholic Fatty Liver Disease.
What are the characteristics of Alcoholic liver disease?
- Spectrum of ALD
- Can present as acute hepatitis and jaundice
- AST/ALT ratio 2-3:1
What is the treatment for Alcoholic liver disease?
Stop ETOH or refer to rehab program (EtOH hepatitis NOT an indication for OLTx)
Severe alcoholic hepatitis may require Steroids
Pentoxifylline*
What are the characteristics of Non-acoholic fatty liver disease?
Condition that resembles alcohol-induced liver disease but occurs in patients who are not heavy drinkers
Strong associations with obesity, dyslipidemia, hyperinsulinemia and insulin resistance, and overt type II diabetes
Spectrum: Steatosis -> NASH -> cirrhosis
Ratio of AST/ALT usually <1
Typical fatty infiltration seen on ultrasound,CT or MRI
What is the treatment for non-alcholic fatty liver disease?
No good treatment. Advise on treating diabetes and lose weight. Vitamin E helpful in steatohepatitis.
Of the viral causes of hepatitis, what are the routes of infection?
A: Feces; Fecal-oral
B: Blood/Blood-borne body fluids ; Percutan/ permucosal/ vertical
C: Blood/Blood-borne body fluids; Percutaneous/ permucosal
D: Blood/Blood-borne body fluids; Percutaneous/ permucosal
E: Feces; Fecal-oral
Know the possible outcomes of HBV – understand Antigen and Antibody relationships – what results demonstrate infection, replication and immunity?
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Understand the serologic markers of HBV and the possible outcomes of HBV – understand Antigen and Antibody relationships – what results demonstrate infection, replication and immunity?
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When does each Hep virus evolve to chronic hep?
- Hepatitis A - Never
- Hepatitis B – >90% (perinatal acquisition) to <5% (adult infection)
- Hepatitis C - 60-80%
- Hepatitis D - 2% (coinfection) to 90% (superinfection)
- Hepatitis E - Occasionally in immunosuppressed patients
Chapter 44 - What is the definition of fulminant liver disease? What are the potential complications and what is the main treatment?
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What is hepatitis?
Inflammation of the hepatocytes, caused by toxins and viruses
What are the causes of hepatitis?
5 hepatitis virus noted (A, B, C, D, E) – Oral/Fecal
What are the clinical manifestations of hepatitis?
Skin and scleral icterus
Hepatomegaly
Dark urine and light stools
What labs results would you expect in a patient with hepatitis?
Elevated AST and ALT (10-20X normal)
Prothrombin time
Serology testing
What are the characteristics of Hepatitis A?
- Transmitted fecal-oral route, shellfish
- No chronic hepatitis
- Incubation 20-40 days
Serology
Treatment: Vaccine
What are the characteristics of Hepatitis B?
- Spread by direct contact with blood or body fluids. Sexual contact.
- Acute and chronic disease
- Incubation 60-100 days
Treatment: Interferon and Ribavirin, Prophylaxis, Vaccine
What are the characteristics of Hepatitis C?
- Main cause of post-transfusion hepatitis
- Transmitted by blood and body fluids
- Time to seroconversion is 6 weeks
- 70% develop chronic hepatitis
- There is a link between hepatitis C and hepatocellular cancer
Serology: Hepatitis C antibody
Treatment: Chronic: Alpha interferon and Ribavirin
What are the characteristics of Hepatitis D?
- Delta hepatitis
- Transmitted parenterally
- Seen only in conjunction with Hepatitis B
Serology: Hepatitis delta antibody
Treatment: Hepatitis B vaccine
What are the characteristics of Hepatitis E?
- Transmitted fecal-oral route
- Contaminated food and water
- No chronic disease
- No test available to test for hepatitis E
