Alcoholic (and non) Liver disease Flashcards
What are the 3 stages of alcoholic liver disease? Tell me whether they’re reversible or not.
- Alcoholic fatty liver (reversible - when alcohol cessation)
- alcoholic hepatitis (mild is reversible)
- Cirrhosis (NOT reversible)
Give me some symptoms of alcoholic liver disease.
- non-specifics - weight loss, decreased appetite, lethargy, tachy w/ fever
- skins things - spider naevi, puritis, palmar erythema
- clubbing
- asterixis
- jaundice
- anaemia stuff - B12 deficiency
- hepatomegaly + tenderness
- ascites
- increased oestrogens - men grow boobs, women stop bleeding
What results would you expect in a patient with alcoholic liver disease?
LFTS
- increased AST + ALT
- AST/ALT ratio high (toAST with alcohol)
- increased GGT
- increased bilirubin
- decreased albumin (initially normal)
Clotting
- increased INR
- increased PPT
do other liver screen
- viral heps
- alpha 1
- haematinics
- wilson’s
Other than blood tests what other investigations would be helpful in query alcoholic liver disease?
- USS - enlarged liver, fibrotic nodules, atrophy,
- CT - fatty liver, ascites, splenomegaly, fibrosis
- Biopsy - gold standard for cirrhosis diagnosis
What do you need to monitor for in someone with confirmed alcoholic liver disease? How do you do it?
- HCC check every 12 months
- abdo USS
- alpha fetoprotein blood test
what vitamin occurs in alcoholics?
-B1 deficiency/B12
Acute causes of hepatitis?
- viral hep A, B, C and E
- EBV, CMV, yellow fever
- alcohol
- pregnancy
- copper or iron overload
Chronic causes of hepatitis?
- Hep B +/- D
- Hep C
- drugs - methyldopa, nitrofurantoin, isoniazid
- copper or iron overload
- IBD
- autoimmune
- alcohol
Which viral heps are a) faecal-oral b) parenteral? which are Acute and which are chronic?
a) hep A and E - EAT you can’t spell eat without E and A ACUTE (A&E is acute stuff) THEREFORE self limiting
B) B, C and D (comes with B) (blood, vertical and needles)
What hepatitis needs reporting to PHE?
ALL OF THEM
Tell me about Hep A?
- Faecal-oral route, shellfish, traveller, infected food handlers, close contacts
- 2-4 week incubation
- flu like prodrome, N&V, lethargy, jaundice, hepatomegaly, RUQ pain
- raised ALT, ESR, lymphocytes
- anti- HAV antibodies - IgM (at the moment), IgG (when it’s gone)
- Tx - self limiting, refrain from alcohol, vaccine (first then 6-12 months later
Tell me about Hep B?
- double stranded highly infectious replicates in hepatocytes
- HBsAg secreted into serum = marker of infection
- blood borne -needle stick, IVDU sharing, vertical (maternal to child), horizontal (child to child), MSM, tatoos
- presentation - general liver signs + may be polyarthritis
4 phases of hep B infection?
- immune tolerance
- immune activation
- inactive carrier
- reactivation
How do you define a chronic Hep B infection?
- HBsAg +ve in serum for 6 months or more
- progression depends on virulence + immunostatus of the patient
Tell me about the antibodies and when they’re present or not?
- HBsAg - acute phase 3/52-3/12 or elevated in chronic infection
- HBeAg - acute infection rises and declines rapidly or chronic persists and indicates severity
how is hep B treated?
- 1st line - pegylated interferon alpha - reduced replication
- anti-virals - tenofovir or entecavir
who should be vaccinated?
- children as part of imms schedule
- healthcare workers
- sex workers
- IVDU
- renal transplants
- close family members of those who had hep B
- chronic liver disease patients
- 2, 3, 4 months + booster at 5 years
- HBsAg in vaccine see what the anti-HB response >100 = good
Tell me about Hep C?
- RNA virus
- blood borne
- hep C RNA is the investigation of choice - chronic if present for >6 months
- Tx - combination of daclatasvir + sofosbuvir and ribavirin (tetragenic)
GO with hep D GO!
- delta virus - incomplete DNA
- cannot replicate w/o hep B
- usually presents at the same time as Hep B
- co-infection better than superinfection (which is B then D opposed to at the same time)
- superinfection = worse outcomes i.e. fulminant liver failure
- diagnose with reverse polymerase chain reaction for hep D RNA
- Tx with interferon
Tell me about Hep E?
- least infection
- faecal oral route
- often asymptomatic - can be acute liver picture
- most risk when contracted during pregnancy
- diagnosis with anti-HE IgM and IgG
- Tx supportive +/- ribavirin
Autoimmune hepatitis?
- young females with other autoimmune disorders
- thyroid, pernicious anaemia, coeliac - HLA B8 and DR3
- ANA/SMA/LKM1 IgG
- acute liver picture or chronic disease
- amenorrhoea
- liver biopsy confirms
- Tx - steroids or azathioprine or transplant
