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Hepatology > Chronic Hepatitis لغايه Chirosis > Flashcards

Chronic Hepatitis لغايه Chirosis Flashcards

1
Q

What is the definition of Chronic Hepatitis?

A

Chronic continuing inflammatory disease of the liver for more than 6 months which may progress to more severe disease (Cirrhosis), subside with or without treatment, or continue unchanged.

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2
Q

What are the common causes of Chronic Hepatitis?

A
  • Infections: HBV, HCV, HDV
  • Autoimmune chronic hepatitis (common in females)
  • Iatrogenic: Drug induced (INH, Rifampicin, NSAIDs, MTX, Herbal medicines)
  • Inborn errors of Metabolism: Wilson’s disease, cystic fibrosis, alpha-1 antitrypsin deficiency
  • Idiopathic: Neonatal liver disease
  • Inherited disorders: Alagille syndrome, PFIC
  • Others: EHBA, Budd Chiari syndrome, Cholangitis
  • Nonalcoholic fatty liver disease
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3
Q

What is the most common cause of Chronic Hepatitis in developed countries?

A

Nonalcoholic fatty liver disease.

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4
Q

What are the clinical presentations of Chronic Hepatitis?

A
  • Asymptomatic: Accidentally diagnosed
  • Acute hepatitis with failure of recovery for more than 6 months
  • Firm Hepatomegaly or Hepatosplenomegaly
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5
Q

What are the manifestations of chronic liver cell failure?

A
  • General: Anorexia, weight loss, jaundice, ascites
  • Bleeding or esophageal varices (hematemesis), palmar erythema, spider naevi
  • Hepatic encephalopathy: precipitated by infections or bleeding
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6
Q

True or False: Chronic Hepatitis can only progress to cirrhosis.

A

False.

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7
Q

Fill in the blank: Chronic Hepatitis is defined as an inflammatory disease of the liver lasting for more than _______.

A

6 months.

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8
Q

What are the corneal findings associated with Wilson’s disease?

A

Kayser-Fleischer ring.

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9
Q

What are common symptoms in autoimmune hepatitis?

A

Skin rash, arthritis, nephritis, and hemolytic anemia.

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10
Q

What gastrointestinal manifestations can occur in Ulcerative colitis (IBD)?

A
  • Bleeding per rectum
  • Diarrhea
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11
Q

What are the possible outcomes of Chronic Hepatitis?

A
  • Progress to cirrhosis
  • Continue unchanged
  • Subside with or without treatment
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12
Q

Which viruses are associated with Chronic Hepatitis?

A
  • HBV
  • HCV
  • HDV
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13
Q

Identify the non-infectious cause of Chronic Hepatitis that is common in females.

A

Autoimmune chronic hepatitis.

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14
Q

What is the incidence of Nonalcoholic fatty liver disease?

A

Most common cause in developed countries.

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15
Q

What is a major complication of cirrhosis?

A

Hepatic carcinoma

Especially with HBV & HCV infections

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16
Q

What are common complications associated with portal hypertension?

A

Varices & Ascites

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17
Q

What is end-stage liver cell failure characterized by?

A

Encephalopathy

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18
Q

What are liver function tests usually indicative of?

A

Abnormal results

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19
Q

What does a liver biopsy assess?

A

Bridging fibrosis (porto-portal / portal-central areas)

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20
Q

What imaging technique assesses liver size, spleen size, and ascites?

A

Abdominal ultrasound

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21
Q

What does Doppler ultrasound evaluate in hepatology?

A

Portal vein patency & flow

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22
Q

What procedure may be needed to detect associated varices?

A

Endoscopy

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23
Q

What is the purpose of ascitic fluid tapping?

A

To analyze the fluid for diagnostic purposes

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24
Q

What serological marker indicates viral hepatitis?

A

Persistent positive HBSAg

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25
Q

In Wilson disease, what is typically low in serum?

A

Ceruloplasmin

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26
Q

What test is used to detect auto-immune hepatitis?

A

Positive autoantibodies (ANA, ASMA) & Hypergammaglobulinemia

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27
Q

What is the purpose of the Alpha 1 anti-trypsin assay?

A

To assess for Alpha 1 anti-trypsin deficiency

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28
Q

What is Fibroscan used for?

A

To assess liver stiffness and fibrosis

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29
Q

What is the role of anti-viral drugs in viral hepatitis treatment?

A

To treat chronic HBV & HCV infections

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30
Q

What immunosuppressants are used in auto-immune hepatitis?

A

Prednisolone, azathioprine

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31
Q

What agents are used for copper chelation in Wilson disease?

A

D-penicillamine

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32
Q

What dietary changes are recommended to reduce ammonia levels?

A

Reduce protein intake

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33
Q

What medications are used to decrease ammonia production?

A

Neomycin and Lactulose (oral or enema)

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34
Q

What are common treatments for fluid retention and ascites?

A

Fluid restriction, diuretics, Paracentesis

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35
Q

What type of nutritional support is recommended for liver disease patients?

A

CHO rich diet, Vitamins & Medium chain triglycerides

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36
Q

What is the survival rate for liver transplantation in end-stage liver disease?

A

70 - 90 %

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37
Q

Fill in the blank: In end-stage liver disease, liver transplantation started in _______.

A

Egypt in 2001

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38
Q

Mentio dx caused by herbs

A

Chronic hepatitis
Vod

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39
Q

Mention complications pf chrponic hepatitis

A
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40
Q

Mention complications pf chrponic hepatitis

A
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41
Q

How to detect fibrosis in chronic hepatitis

A

Liver biopsy
Hepatic elastography

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42
Q

Why we give salt free albumin in controlling ascites

A

Bec salt will cause hyper volumia that causes heart failure and also overfill theory that will cause rebound ascites

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43
Q

What type of genetic disorder is Alpha 1 Antitrypsin Deficiency?

A

Autosomal recessive (AR) disorder

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44
Q

What gene is mutated in Alpha 1 Antitrypsin Deficiency?

A

Protease inhibitors (Pi) gene

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45
Q

Where is Alpha-1 Antitrypsin synthesized and secreted?

A

Liver

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46
Q

What is the primary function of Alpha-1 Antitrypsin?

A

Inhibitor of trypsin and other proteases

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47
Q

What is the major target organ affected by Alpha 1 Antitrypsin Deficiency?

A

Lung

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48
Q

What lung condition can result from Alpha 1 Antitrypsin Deficiency?

A

Emphysema

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49
Q

What occurs due to the accumulation of abnormal Alpha 1 Antitrypsin in hepatocytes?

A

Damage to hepatocytes

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50
Q

True or False: Alpha-1 Antitrypsin protects the lungs from neutrophil elastase.

A

True

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51
Q

What is the role of neutrophil elastase produced by white blood cells?

A

Break down harmful bacteria

52
Q

Fill in the blank: Alpha-1 Antitrypsin deficiency leads to the lungs lacking _______ coating.

A

Alpha-1 antitrypsin

53
Q

What damage occurs to the lungs when they lack Alpha-1 Antitrypsin?

A

Open to damage by neutrophil elastase

54
Q

What does the unopposed action of trypsin and proteases result in?

A

Tissue damage

55
Q

List two consequences of Alpha 1 Antitrypsin Deficiency.

A
  • Emphysema
  • Liver damage
56
Q

What is the initial clinical picture of liver affection in hepatology?

A

Asymptomatic

This indicates that patients may not show symptoms in the early stages of liver disease.

57
Q

What is the first sign of liver affection in neonates?

A

Neonatal Jaundice (Cholestasis)

This condition indicates an early liver problem often seen in newborns.

58
Q

What are the subsequent liver conditions that may develop after neonatal jaundice?

A
  • Chronic hepatitis
  • Cirrhosis
  • Portal hypertension

These conditions reflect progressive liver damage and complications.

59
Q

At what age does lung affection typically manifest in hepatology?

A

Usually in the third decade of life

This indicates that lung issues may not appear until the patient is in their 30s.

60
Q

What is the most common lung manifestation associated with liver affection?

A

Emphysema

Emphysema is a type of chronic obstructive pulmonary disease (COPD) that affects lung function.

61
Q

What is the normal range for ar-antitrypsin levels in serum?

A

150 - 350 mg

This measurement is crucial for diagnosing liver and lung conditions.

62
Q

What specific tests should be done to confirm the diagnosis of liver affection?

A
  • Specific Pi phenotyping (M & S)
  • Liver biopsy

These tests help in identifying the specific type of liver disease.

63
Q

What imaging studies are recommended for pulmonary affection in patients with liver disease?

A
  • CXR (Chest X-Ray)
  • CT chest

These imaging techniques help assess lung damage and complications.

64
Q

What are the complications associated with chronic liver disease?

A
  • Cirrhosis
  • Carcinoma

These complications are serious and can significantly impact health outcomes.

65
Q

What is the main treatment option for liver disease in this context?

A

Enzyme replacement from plasma

This treatment aims to manage the deficiency associated with liver and lung diseases.

66
Q

What is Wilson disease?

A

A treatable genetic disorder characterized by the accumulation of copper in the body.

67
Q

What chromosome is affected in Wilson disease?

A

Chromosome 13

68
Q

What are the primary organs affected by copper accumulation in Wilson disease?

A

Liver, Brain, Cornea, Kidneys

69
Q

What type of genetic inheritance pattern does Wilson disease follow?

A

Autosomal Recessive (AR)

70
Q

What is the role of Ceruloplasmin in Wilson disease?

A

It is the copper carrier protein affected by the disease.

71
Q

What causes the impaired hepatic excretion of copper in Wilson disease?

A

Defect in the copper carrier protein Ceruloplasmin.

72
Q

Where is dietary copper absorbed in the body?

A

Stomach and Duodenum

73
Q

How is dietary copper transported to the liver?

A

Bound to albumin

74
Q

What happens to copper in the liver?

A

It is incorporated into Ceruloplasmin and secreted into the blood.

75
Q

What is the consequence of decreased hepatic copper excretion?

A

Hepatic accumulation of copper over years.

76
Q

What occurs once cirrhosis develops in Wilson disease?

A

Copper leaks into plasma and is deposited in other tissues.

77
Q

Which tissues can accumulate copper besides the liver?

A

Kidneys, RBCs, Brain, Eyes

78
Q

What is the consequence of copper accumulation in Wilson disease?

A

Severe functional impairment leading to irreversible damage.

79
Q

Fill in the blank: Wilson disease is also known as _______.

A

Hepatolenticular degeneration

80
Q

What is gene and early late affection of alpha 1 anti trypsin defecincu

A

14
Liver
Lung

81
Q

How to diff the type of anemia in wilson dx

A

By coomb it will be negative because it is hemolytic anemia due to direct toxic effect of the copper

82
Q

What is the age of onset for liver disease associated with Wilson Disease?

A

Less than 30 years

Most commonly in the 1st to 2nd decades of life.

83
Q

What are the hepatic manifestations of Wilson Disease?

A
  • Chronic hepatitis
  • Cirrhosis
  • Portal hypertension
  • Ascites
  • Variceal bleeding
  • Acute liver failure
  • Progressive jaundice
  • Encephalopathy

Presentation may vary from minor abnormalities to fulminant liver cell failure, especially in children.

84
Q

What neurological symptoms are associated with Wilson Disease?

A
  • Extra-Pyramidal Manifestations
  • Tremors
  • Rigidity
  • Drooling
  • Dysarthria
  • Dementia
  • Grimacing
  • Winging upper limb movements

Basal Ganglia damage is noted, particularly in the Lentiform nucleus.

85
Q

Which psychiatric diseases may occur in Wilson Disease?

A
  • Anxiety
  • Hysteria
  • Personality changes

These manifestations can affect the patient’s mental health.

86
Q

What is the Kayser-Fleischer ring?

A

Greenish-Brown band at the junction of the iris and cornea

Pathognomonic for Wilson Disease and can be detected with slit lamp examination.

87
Q

What renal manifestations are associated with Wilson Disease?

A
  • Renal Fanconi syndrome
  • Progressive renal failure

These conditions primarily affect the proximal convoluted tubule (PCT).

88
Q

What blood conditions may be present in Wilson Disease?

A
  • Hemolytic anemia
  • Jaundice (Coomb’s negative)

These conditions are related to copper accumulation.

89
Q

What skeletal issues can arise from Wilson Disease?

A
  • Osteoporosis
  • Rickets

Primarily affecting the knees and wrists due to copper deposition.

90
Q

What are the key investigations for Wilson Disease?

A
  • Serum Copper: Decreased
  • Ceruloplasmin: Decreased
  • Urinary copper: Increased
  • Liver biopsy: Focal necrosis + fibrosis
  • Slit lamp examination: Kayser-Fleischer ring
  • MRI Brain: Hyper-intensity of basal ganglia

Genotyping and screening of family members are also important.

91
Q

What is the first-line treatment for Wilson Disease?

A

D-Penicillamine

It is a copper chelating agent used for initial therapy and maintenance.

92
Q

What role does Zinc acetate or Sulphate play in the treatment of Wilson Disease?

A

Decreases intestinal absorption of copper

Used as pre-symptomatic treatment.

93
Q

What dietary restrictions are advised for patients with Wilson Disease?

A
  • Mushrooms
  • Shellfish
  • Chocolate
  • Liver

These foods are high in copper and should be avoided.

94
Q

In what cases is liver transplantation considered for Wilson Disease?

A

Advanced or fulminant cases

It may improve quality of life.

95
Q

True or False: Any patient with unexplained hepatic and neurological manifestations should be screened for Wilson Disease.

A

True

Early detection is crucial for management.

96
Q

What is most common cause for chronic hepatitis

97
Q

Mention causes of chronic hepatitis

98
Q

Bleeding per rectum , diarhhea +hepatitis

99
Q

Hepatitis +skin rash +arthritis +nephritis+hemolytic anemia

A

Aid he-atitis

100
Q

Mention cp of chronic hepatitis

101
Q

Metion type of ascites in chronic hepatitis

A

Transudate with no albumin

102
Q

Mention ttt of chronic hepatitis

103
Q

Mention pre symptomatic ttt of wilson dx

A

Zinc acetate or sulphate

104
Q

What is Auto-Immune Hepatitis?

A

Disease of unknown cause characterized by the presence of chronic hepatitis and lymphocytic infiltration on histologic examination, hypergammaglobulinemia, and autoantibodies in blood.

Diagnosis requires the exclusion of other chronic liver diseases that have similar features.

105
Q

What are the two peaks of incidence for Auto-Immune Hepatitis?

A

Usually occurs in females (70%) mostly between 15-25 years or at menopause (45 years)

This highlights the demographic susceptibility to the disease.

106
Q

What is the prevalence of Type 1 Auto-Immune Hepatitis?

A

More than 80%

Type 1 is more common and typically affects individuals older than 30 years.

107
Q

What is the average age of onset for Type 2 Auto-Immune Hepatitis?

A

Average 10 years old

Type 2 is considered more aggressive.

108
Q

What is the response to treatment for Type 1 Auto-Immune Hepatitis?

A

Good response to treatment

40% develop cirrhosis.

109
Q

What are the auto-antibodies associated with Type 1 Auto-Immune Hepatitis?

A

ANA & ASMA

These auto-antibodies are important for diagnosis.

110
Q

What are common hepatic manifestations of Auto-Immune Hepatitis?

A
  • May be asymptomatic
  • Acute fulminant hepatitis
  • Chronic hepatitis with jaundice, fatigue, and tender hepatomegaly

Complications include cirrhosis and portal hypertension.

111
Q

What are the characteristics of Type 2 Auto-Immune Hepatitis?

A

About 20% prevalence, more aggressive, average age 10 years old, resistant to treatment, 80% develop cirrhosis

Type 2 is associated with more severe outcomes.

112
Q

List some autoimmune features associated with Auto-Immune Hepatitis.

A
  • Skin rash
  • Polyarthritis
  • Nephritis
  • Autoimmune hemolytic anemia (SLE)
  • Sjögren’s syndrome
  • Celiac disease

These features indicate a broader autoimmune disorder spectrum.

113
Q

True or False: Auto-Immune Hepatitis can lead to cirrhosis.

A

True

Both types of Auto-Immune Hepatitis can progress to cirrhosis.

114
Q

Fill in the blank: Auto-Immune Hepatitis requires the exclusion of other _______.

A

[chronic liver diseases]

This is crucial for accurate diagnosis.

115
Q

What are some autoimmune diseases associated with Auto-Immune Hepatitis?

A
  • ITP
  • Rheumatoid arthritis
  • Hashimoto thyroiditis
  • Ulcerative colitis

These conditions can coexist with Auto-Immune Hepatitis.

116
Q

What is the significance of positive autoantibodies in hepatology investigations?

A

Indicates hyper-gammaglobulinemia (IgG) and suggests autoimmune hepatitis

Positive autoantibodies include Anti-Nuclear Antibodies (ANA), Anti-Smooth Muscle Antibodies (ASMA), Anti-Liver-Kidney Microsomal (LKM) antibodies, and Anti-Soluble Liver Antigen antibodies (SLA).

117
Q

Which liver enzymes are typically elevated in autoimmune hepatitis?

A

AST & ALT

Alkaline phosphatase (ALP) is not markedly increased.

118
Q

What findings are indicative of autoimmune hepatitis in a liver biopsy?

A

Lymphocytic and plasma cell infiltration, no biliary lesions

A liver biopsy helps to estimate fibrosis and exclude other disorders.

119
Q

What is the primary aim of investigating autoimmune hepatitis?

A

Identify features suggestive of AIH and exclude other disorders

Other disorders may include infiltration by lymphoma or adenocarcinoma.

120
Q

List some differential diagnoses for hepatitis.

A
  • Viral hepatitis
  • Wilson’s disease
  • Alcoholic hepatitis
  • NASH
  • Alpha-1 antitrypsin deficiency
  • Primary biliary cirrhosis (PBC)

These conditions must be considered to differentiate from autoimmune hepatitis.

121
Q

What is the first regimen for treating autoimmune hepatitis?

A

Combination therapy: Prednisolone and Azathioprine

Prednisolone: 30mg/day for 2 weeks, then maintenance 10mg/day for 4 weeks. Azathioprine: 50mg/day or 6-Mercaptopurine.

122
Q

What are the actions of corticosteroids in the treatment of autoimmune hepatitis?

A

Improve symptoms, signs, liver function tests (LFTs), and histology

Corticosteroids are a key treatment modality.

123
Q

What is the second regimen for treating autoimmune hepatitis?

A

Mono-therapy with Prednisolone

Initially 60mg/day, then reduced to 20mg/day for less than 4 weeks.

124
Q

Which immunosuppressive drugs have been tried alone in autoimmune hepatitis treatment?

A
  • Azathioprine
  • Cyclosporine

These drugs are considered ‘steroid-sparing agents’.

125
Q

What is a potential complication after liver transplantation for autoimmune hepatitis?

A

The condition may recur after transplantation

This highlights the need for ongoing management post-transplant.

Hepatology (5 decks)

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