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*B32 GI and Surgery* > Acute liver disease > Flashcards

Acute liver disease Flashcards

1
Q

What are the 3 different antigens of Hep B

A

Hb surface antigen = HBsAg
Hb E antigen = HBeAg
Hb Core antigen = HBcAg

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2
Q

HBsAg +ve indicates

A

Infection

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3
Q

HBsAg +ve for >6 months =

A

Chronic infection

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4
Q

HBeAg +ve indicates

A

In acute phase of infection (virus replicating)

marker of infectivity so ↑ levels = ↑ infectivity

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5
Q

Anti-Hbs +ve indicates

A

current infection

If all others negatives = previous immunisation against Hep B

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6
Q

Anti-HBc -ve but HBsAg +ve

A

Previous Hep B but not a carrier

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7
Q

anti-HBc +ve and HBsAg +ve

A

Previous Hep B and carrier

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8
Q

If IgM Anti-HBc +ve it means..

A

Acute infection

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9
Q

If IgM Anti-HBc -ve it means

A

Chronic infection

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10
Q

Hep B serology explained

A

HBsAg indicates infection

HBeAg indicates infectivity (2nd marker)

Anti-HBs =recovery and immunity

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11
Q

Pre-hepatic causes of portal hypertension

A

Portal vein or splenic vein thrombosis

Infiltration of vessel by tumour (pancreatic cancer)

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12
Q

Hepatic causes of portal hypertension

A

Cirrhosis
Hepatocellular cancer
Schistosomiasis
Sarcoidosis

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13
Q

Post-hepatic causes of portal hypertension

A

Hepatic vein thrombosis -> can lead to Budd-Chiari
Heart failure
Restrictive pericarditis

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14
Q

Portal hypertension complications

A 
Esophageal varices
Anorectal varices 
Caput Medusae (dilated veins in abdo wall)
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15
Q

Budd-Chiari syndrome

A

Thrombosis of hepatic vein = occlusion

Presents with RUQ pain, ascites, hepatomegaly

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16
Q

Risk factors for Budd-Chiari syndrome

A 
Contraceptive pill use 
Pregnancy
Post-partum period
Polycythaemia vera, essential thrombocytosis
Hypercoagulable states
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17
Q

Varices =

A

Dilated veins due to elevated pressure in the portal venous system

Leads to weakened vessels walls

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18
Q

Varices develop in patients w/ cirrhosis when portal pressure is.

A

> 10mmHg

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19
Q

Variceal bleed can occur when portal pressure is

A

> 12mmHg

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20
Q

Causes of ↑ ALT

A

Hepatocellular damage

Acute hepatocellular injury, alcholic hepatitis, cirrhosis

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21
Q

Drugs causing increase in ALT

A 
Paracetamol overdose (AST and ALT)
Phenothiazines, chlorpromazine
Barbiturates
Tetracycline, isoniasid, nitrofurantoin
Morphine, codeine
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22
Q

AST found to be released during

A

Damage of cardiac muscle, liver, skeletal muscle, brain

V. non-specific - not used a lot

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23
Q

↑ ALP

A

Usually due to biliary or liver pathology

Use GGT to confirm

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24
Q

↑ ALP but normal GGT or

isolated ↑ ALP and normal other LFTs

A

Bone origin = Bone mets, hyperparathyroidism

check calcium

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25
Tests of hepatic dysfunction
Albumin (reduced) Prothrombin time (increased) Bilirubin (increased)
26
↑ Conjugated Bilirubin indicates
Obstructive jaundice ``` Bile duct stone Head of pancreas carcinoma Pancreatitis Cholangiocarcinoma Biliary atresia ```
27
absent bilirubin but raised urobilinogen in urine = ___________ jaundice
Haemolytic jaundice/pre hepatic jaundice due to increased amount of bilirubin production from breakdown of cells
28
Raised bilirubin but normal/absent urobilinogen in urine = ___________ jaundice
Obstructive jaundice/post hepatic jaundice Remember: urobilinogen made in small intestines and reabsorbed into blood -> urine. If obstruction then no formation of urobilinogen
29
Causes of Pre-hepatic jaundice
Excessive RBC breakdown -> Unconjugated hyperbilirubinaemia Haemolytic anaemia Gilbert's syndrome Criggler-Najjar syndrome
30
Causes of Hepatic jaundice
Due to dysfunction of liver (may not be able to conjugate- so mixed bilirubinaemia is seen) ``` Alcoholic liver disease Hepatitis (Viral/autoimmune) Medication Haemochromatosis Primary biliary cirrhosis/Primary sclerosing cholangitis Hepatocellular carcinoma ```
31
Causes of Post-Hepatic jaundice
Mainly obstruction of biliary drainage (conjugated hyperbilirubinaemia as already passed through liver) ``` Gallstones Cholangiocarcinoma Strictures Drug-induced cholestasis Pancreatic cancer or abdominal masses (e.g. lymphomas) ```
32
Normal urine and normal stools Pre hep/hepatic/post hep jaundice?
Pre hepatic jaundice
33
Dark urine and normal stool Pre hep/hepatic/post hep jaundice?
Hepatic jaudice
34
Dark urine and pale stools indicates what? Pre hep/hepatic/post hep jaundice?
Post-hepatic jaundice
35
↑ bilirubin ↑ ALP ↑ GGT
Cholestatic pattern
36
↑ INR ↓Albumin ↓ Platelets Whats the problem?
Poor liver function - problem with synthesis
37
↑ Bilirubin only - diagnosis?
Gilbert's syndrome (↑ unconjugated:conjugated bilirubin) =
38
What is Gilbert's syndrome?
Hereditary unconjugated hyperbilirubinaemia Reduced activity of UDP glucuronosyltransferase
39
When does Gilbert's syndrome typically cause jaundice?
During prolonged fasting Illness | Stressful periods
40
What is Criggler-Najjar Syndrome
Hereditary unconjugated hyperbilirubinemia (absent UDP-glucuronosyltransferase enzyme) Presents early in life Severe brain damage at infancy
41
Symptoms of viral hepatitis
of viral hepatitis General malaise, fever, anorexia, arthralgia RUQ pain, jaundice, hepatosplenomegaly
42
Which Viral hepatitis: Unusual to have acute symptomatic disease
Hep C
43
Hep ___ and ____ never/rarely cause chronic disease
Hep A and Hep E
44
Hepatitis __ almost always causes chronic disease
Hep C Chronic infection also seen in Hep B and D
45
Hep ___ and ___ = faecal oral route of transmission
``` Hep A (common amongst travelers) Hep E ``` ingestion of faeces contaminated food and water
46
In Viral serology IgM Ab indicates what
Active infection
47
In Viral serology IgG Ab indicates what
Recovery from infection or vaccination
48
Hepatitis ___ is dangerous in pregnant woman
Hep E Can lead to acute liver failure
49
Hepatitis __ is a DNA virus
Hep B Rest are RNA viruses
50
How is viral hepatitis detected
HepA = IgM/IgG Hep B = HBsAg/HbeAg Heb C =PCR/immunoassay HCV IgG/ELISA
51
Hep ___ needs Hep B to complete viral replication and transmission cycle
Hep D
52
Hep ___, ___ and ____ transmission route is parenteral
Hep B, C, D Transmission via blood and body fluids - Needles, sexual intercourse, MTCT, razors, toothbrushes
53
Vaccination available for Hepatitis ___ and Hepatitis ____
Hep A and B
54
What is Hep D Co-infection and superinfection?
Co-infection: HepB and Hep D infection at the same time Superinfection: A hep B surface antigen +ve patient subsequently develops a hep D infection (can quickly progress to cirrhosis)
55
Hep C treatment
Direct acting antivirals (DAAs) Sofosbuvir, Simeprevir with ribavirin
56
Hep B treatment
Vaccination and supportive treatment Avoid alcohol
57
Heb A and Hep E treatment
Self-limiting
58
Acute liver failure=
Rapid onset of hepatocellular dysfunction leading to complications
59
Acute liver failure causes
Paracetamol overdose Alcohol Viral hepatitis (usually A or B) Acute fatty liver of pregnancy
60
Features of acute liver failure how does it differ from Wernicke's encephalopathy
``` Jaundice Coagulopathy: raised prothrombin time Hypoalbuminaemia Hepatic encephalopathy Renal failure (hepatorenal syndrome') ``` Wernicke's encephalopathy is due to a deficiency of thiamine whilst acute liver failure encephalopathy is due to high levels of ammonia in the blood stream due to liver failure
61
Patients at risk of paracetamol overdose
Suicidal patients Use of certain drugs (rifampicin, phenytoin, carbamazepine, chronic alcohol excess, St John's Wort) Malnourished patients (anorexia, bulimia, CF, hep C, HIV) Alcoholic liver disease Patients who haven't eaten for a while
62
Paracetamol overdose pathophysiology
Paracetamol metabolised by cyto P450 NAPQI produced which is toxic but gets metabolised by glutathione In overdose -> depletion of glutathione -> NAPQI build up -> hepatotoxicity
63
Management of paracetamol overdose
Acetylcysteine (precursor to glutathione so increases levels) Activated charcoal if soon after ingestion
64
Causes of raised ALP
Bone mets Paget's disease, osteomalacia, rickets, bone fractures, primary bone tumours, pregnancy (as it is released by the placenta), hyperparathyroidism Tests to exclude other causes: PTH, calcium, PSA and a skeletal survey
65
Hepatorenal syndrome
Rapid deterioration in kidney function in individuals with cirrhosis or fulminant liver failure (liver failure THEN acute renal failure) Will see rise in creatinine
66
Wernicke's encephalopathy
Confusion, ataxia and ophthalmoplegia Due to thiamine deficiency -> treat with thiamine replacement Occurs with alcohol excess, the malnourished and in pregnancy CAN LEAD TO KORSAKOFFS (irreversible)
67
Most common organism that causes SBP
E coli (2nd is klebsiella)
68
SBP features, diagnosis and treatment
Ascites Abdominal pain Fever Diagnosis Paracentesis: neutrophil count > 250 cells/ul and culture (Usually E-coli) Management = intravenous cefotaxime is usually given

*B32 GI and Surgery* (9 decks)

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