Acute hepatitis Flashcards
What is acute hepatitis
Inflammation of the liver –> acute parenchymal liver disease
How many people are affected by Hep B
1 mil/year - IV drug users, health workers, haemophiliacs
What causes acute hepatitis
Viral Hep A-E
- Hep A (RNA) - most common cause ACUTE –> never causes cirrhosis
- Vaccination for Hep A+B
- hep C - no vaccine - IVDU
- Hep D - only in those w Hep B
Alcoholic hepatitis
- eventually cirrhosis
Drug induced
- Paracetamol overdose, TB Abx (rifampicin, isoniziad), statins, sodium valproate, halothane, MAOIs
Ischaemic hepatitis
- ass HF, shock, sepsis
- Bloods = high AST + ALT
Infectious mononucleosis, CMV, herpes, toxoplasmosis, yellow fever, WIlsons
What is the pathophysiology of acute hepatitis
- Degenerative changes –> swelling, cytoplasmic granularity –> necrosis
- Collapse of reticulin framework between central veins
- Lobules infiltrated by lymphocytes
- fatty changes
What are the risk factors for hepatitis
- Vertical transmission for Hep B
- Drug users, tattooists or acupuncturists
- male sex
What are the symptoms of acute hepatitis
- Non-specific, flu like initially
- -> fever, headache, myalgia, N+V, diarrhoea, headache
- Loss of appetite
- Aversion to smoking
- Abdo discomfort
AFTER 2 WEEKS
- Jaundice, vom, nausea, mental confusion
Hep C mostly asymptomatic
What are the signs of acute hepatitis
- Dark urine + pale stools (intrahepatic cholestasis)
- Tender lymphadenopathy
- Transient rash
- Hep B: resembles Hep A but extrahepatic signs more common – arthralgia, urticarial
What are the investigations for acute hepatitis
Bloods
o Raised AST & ALT & LDH (lactate dehydrogenase)
o Prolonged PT
Hep B surface antigen test
Test for alpha 1 antitrypsin deficiency –> ++ protein in liver can –> inflammation
Leucopenia.
PT is prolonged.
ESR raised.
IgG for hepatitis A, B
How do you treat hepatitis
- Hep A - no spec Tx
- Hep B - symptomatic Tx
- Hep C - interferon used to prevent chronic disease
What is the prognosis
- Hep A - excellent
- Hep B - variable - flare ups, hepatocellular carcinoma risk high
- Hep C - 85-90% asymptomatic - develop chronic liver disease –> cirrhosis in 20-80%
- Hep D = poor - 70% get cirrhosis