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.
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
3
Q
What is the most common cause of Chronic Hepatitis in developed countries?
A
Nonalcoholic fatty liver disease.
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
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
6
Q
True or False: Chronic Hepatitis can only progress to cirrhosis.
A
False.
7
Q
Fill in the blank: Chronic Hepatitis is defined as an inflammatory disease of the liver lasting for more than _______.
A
6 months.
8
Q
What are the corneal findings associated with Wilson’s disease?
A
Kayser-Fleischer ring.
9
Q
What are common symptoms in autoimmune hepatitis?
A
Skin rash, arthritis, nephritis, and hemolytic anemia.
10
Q
What gastrointestinal manifestations can occur in Ulcerative colitis (IBD)?
A
- Bleeding per rectum
- Diarrhea
11
Q
What are the possible outcomes of Chronic Hepatitis?
A
- Progress to cirrhosis
- Continue unchanged
- Subside with or without treatment
12
Q
Which viruses are associated with Chronic Hepatitis?
A
- HBV
- HCV
- HDV
13
Q
Identify the non-infectious cause of Chronic Hepatitis that is common in females.
A
Autoimmune chronic hepatitis.
14
Q
What is the incidence of Nonalcoholic fatty liver disease?
A
Most common cause in developed countries.
15
Q
What is a major complication of cirrhosis?
A
Hepatic carcinoma
Especially with HBV & HCV infections
16
Q
What are common complications associated with portal hypertension?
A
Varices & Ascites
17
Q
What is end-stage liver cell failure characterized by?
A
Encephalopathy
18
Q
What are liver function tests usually indicative of?
A
Abnormal results
19
Q
What does a liver biopsy assess?
A
Bridging fibrosis (porto-portal / portal-central areas)
20
Q
What imaging technique assesses liver size, spleen size, and ascites?
A
Abdominal ultrasound
21
Q
What does Doppler ultrasound evaluate in hepatology?
A
Portal vein patency & flow
22
Q
What procedure may be needed to detect associated varices?
A
Endoscopy
23
Q
What is the purpose of ascitic fluid tapping?
A
To analyze the fluid for diagnostic purposes
24
Q
What serological marker indicates viral hepatitis?
A
Persistent positive HBSAg
25
In Wilson disease, what is typically low in serum?
Ceruloplasmin
26
What test is used to detect auto-immune hepatitis?
Positive autoantibodies (ANA, ASMA) & Hypergammaglobulinemia
27
What is the purpose of the Alpha 1 anti-trypsin assay?
To assess for Alpha 1 anti-trypsin deficiency
28
What is Fibroscan used for?
To assess liver stiffness and fibrosis
29
What is the role of anti-viral drugs in viral hepatitis treatment?
To treat chronic HBV & HCV infections
30
What immunosuppressants are used in auto-immune hepatitis?
Prednisolone, azathioprine
31
What agents are used for copper chelation in Wilson disease?
D-penicillamine
32
What dietary changes are recommended to reduce ammonia levels?
Reduce protein intake
33
What medications are used to decrease ammonia production?
Neomycin and Lactulose (oral or enema)
34
What are common treatments for fluid retention and ascites?
Fluid restriction, diuretics, Paracentesis
35
What type of nutritional support is recommended for liver disease patients?
CHO rich diet, Vitamins & Medium chain triglycerides
36
What is the survival rate for liver transplantation in end-stage liver disease?
70 - 90 %
37
Fill in the blank: In end-stage liver disease, liver transplantation started in _______.
Egypt in 2001
38
Mentio dx caused by herbs
Chronic hepatitis
Vod
39
Mention complications pf chrponic hepatitis
40
Mention complications pf chrponic hepatitis
41
How to detect fibrosis in chronic hepatitis
Liver biopsy
Hepatic elastography
42
Why we give salt free albumin in controlling ascites
Bec salt will cause hyper volumia that causes heart failure and also overfill theory that will cause rebound ascites
43
What type of genetic disorder is Alpha 1 Antitrypsin Deficiency?
Autosomal recessive (AR) disorder
44
What gene is mutated in Alpha 1 Antitrypsin Deficiency?
Protease inhibitors (Pi) gene
45
Where is Alpha-1 Antitrypsin synthesized and secreted?
Liver
46
What is the primary function of Alpha-1 Antitrypsin?
Inhibitor of trypsin and other proteases
47
What is the major target organ affected by Alpha 1 Antitrypsin Deficiency?
Lung
48
What lung condition can result from Alpha 1 Antitrypsin Deficiency?
Emphysema
49
What occurs due to the accumulation of abnormal Alpha 1 Antitrypsin in hepatocytes?
Damage to hepatocytes
50
True or False: Alpha-1 Antitrypsin protects the lungs from neutrophil elastase.
True
51
What is the role of neutrophil elastase produced by white blood cells?
Break down harmful bacteria
52
Fill in the blank: Alpha-1 Antitrypsin deficiency leads to the lungs lacking _______ coating.
Alpha-1 antitrypsin
53
What damage occurs to the lungs when they lack Alpha-1 Antitrypsin?
Open to damage by neutrophil elastase
54
What does the unopposed action of trypsin and proteases result in?
Tissue damage
55
List two consequences of Alpha 1 Antitrypsin Deficiency.
* Emphysema
* Liver damage
56
What is the initial clinical picture of liver affection in hepatology?
Asymptomatic
## Footnote
This indicates that patients may not show symptoms in the early stages of liver disease.
57
What is the first sign of liver affection in neonates?
Neonatal Jaundice (Cholestasis)
## Footnote
This condition indicates an early liver problem often seen in newborns.
58
What are the subsequent liver conditions that may develop after neonatal jaundice?
* Chronic hepatitis
* Cirrhosis
* Portal hypertension
## Footnote
These conditions reflect progressive liver damage and complications.
59
At what age does lung affection typically manifest in hepatology?
Usually in the third decade of life
## Footnote
This indicates that lung issues may not appear until the patient is in their 30s.
60
What is the most common lung manifestation associated with liver affection?
Emphysema
## Footnote
Emphysema is a type of chronic obstructive pulmonary disease (COPD) that affects lung function.
61
What is the normal range for ar-antitrypsin levels in serum?
150 - 350 mg
## Footnote
This measurement is crucial for diagnosing liver and lung conditions.
62
What specific tests should be done to confirm the diagnosis of liver affection?
* Specific Pi phenotyping (M & S)
* Liver biopsy
## Footnote
These tests help in identifying the specific type of liver disease.
63
What imaging studies are recommended for pulmonary affection in patients with liver disease?
* CXR (Chest X-Ray)
* CT chest
## Footnote
These imaging techniques help assess lung damage and complications.
64
What are the complications associated with chronic liver disease?
* Cirrhosis
* Carcinoma
## Footnote
These complications are serious and can significantly impact health outcomes.
65
What is the main treatment option for liver disease in this context?
Enzyme replacement from plasma
## Footnote
This treatment aims to manage the deficiency associated with liver and lung diseases.
66
What is Wilson disease?
A treatable genetic disorder characterized by the accumulation of copper in the body.
67
What chromosome is affected in Wilson disease?
Chromosome 13
68
What are the primary organs affected by copper accumulation in Wilson disease?
Liver, Brain, Cornea, Kidneys
69
What type of genetic inheritance pattern does Wilson disease follow?
Autosomal Recessive (AR)
70
What is the role of Ceruloplasmin in Wilson disease?
It is the copper carrier protein affected by the disease.
71
What causes the impaired hepatic excretion of copper in Wilson disease?
Defect in the copper carrier protein Ceruloplasmin.
72
Where is dietary copper absorbed in the body?
Stomach and Duodenum
73
How is dietary copper transported to the liver?
Bound to albumin
74
What happens to copper in the liver?
It is incorporated into Ceruloplasmin and secreted into the blood.
75
What is the consequence of decreased hepatic copper excretion?
Hepatic accumulation of copper over years.
76
What occurs once cirrhosis develops in Wilson disease?
Copper leaks into plasma and is deposited in other tissues.
77
Which tissues can accumulate copper besides the liver?
Kidneys, RBCs, Brain, Eyes
78
What is the consequence of copper accumulation in Wilson disease?
Severe functional impairment leading to irreversible damage.
79
Fill in the blank: Wilson disease is also known as _______.
Hepatolenticular degeneration
80
What is gene and early late affection of alpha 1 anti trypsin defecincu
14
Liver
Lung
81
How to diff the type of anemia in wilson dx
By coomb it will be negative because it is hemolytic anemia due to direct toxic effect of the copper
82
What is the age of onset for liver disease associated with Wilson Disease?
Less than 30 years
## Footnote
Most commonly in the 1st to 2nd decades of life.
83
What are the hepatic manifestations of Wilson Disease?
* Chronic hepatitis
* Cirrhosis
* Portal hypertension
* Ascites
* Variceal bleeding
* Acute liver failure
* Progressive jaundice
* Encephalopathy
## Footnote
Presentation may vary from minor abnormalities to fulminant liver cell failure, especially in children.
84
What neurological symptoms are associated with Wilson Disease?
* Extra-Pyramidal Manifestations
* Tremors
* Rigidity
* Drooling
* Dysarthria
* Dementia
* Grimacing
* Winging upper limb movements
## Footnote
Basal Ganglia damage is noted, particularly in the Lentiform nucleus.
85
Which psychiatric diseases may occur in Wilson Disease?
* Anxiety
* Hysteria
* Personality changes
## Footnote
These manifestations can affect the patient's mental health.
86
What is the Kayser-Fleischer ring?
Greenish-Brown band at the junction of the iris and cornea
## Footnote
Pathognomonic for Wilson Disease and can be detected with slit lamp examination.
87
What renal manifestations are associated with Wilson Disease?
* Renal Fanconi syndrome
* Progressive renal failure
## Footnote
These conditions primarily affect the proximal convoluted tubule (PCT).
88
What blood conditions may be present in Wilson Disease?
* Hemolytic anemia
* Jaundice (Coomb's negative)
## Footnote
These conditions are related to copper accumulation.
89
What skeletal issues can arise from Wilson Disease?
* Osteoporosis
* Rickets
## Footnote
Primarily affecting the knees and wrists due to copper deposition.
90
What are the key investigations for Wilson Disease?
* 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
## Footnote
Genotyping and screening of family members are also important.
91
What is the first-line treatment for Wilson Disease?
D-Penicillamine
## Footnote
It is a copper chelating agent used for initial therapy and maintenance.
92
What role does Zinc acetate or Sulphate play in the treatment of Wilson Disease?
Decreases intestinal absorption of copper
## Footnote
Used as pre-symptomatic treatment.
93
What dietary restrictions are advised for patients with Wilson Disease?
* Mushrooms
* Shellfish
* Chocolate
* Liver
## Footnote
These foods are high in copper and should be avoided.
94
In what cases is liver transplantation considered for Wilson Disease?
Advanced or fulminant cases
## Footnote
It may improve quality of life.
95
True or False: Any patient with unexplained hepatic and neurological manifestations should be screened for Wilson Disease.
True
## Footnote
Early detection is crucial for management.
96
What is most common cause for chronic hepatitis
B,c
Aid
97
Mention causes of chronic hepatitis
98
Bleeding per rectum , diarhhea +hepatitis
Ibd
99
Hepatitis +skin rash +arthritis +nephritis+hemolytic anemia
Aid he-atitis
100
Mention cp of chronic hepatitis
101
Metion type of ascites in chronic hepatitis
Transudate with no albumin
102
Mention ttt of chronic hepatitis
103
Mention pre symptomatic ttt of wilson dx
Zinc acetate or sulphate
104
What is Auto-Immune Hepatitis?
Disease of unknown cause characterized by the presence of chronic hepatitis and lymphocytic infiltration on histologic examination, hypergammaglobulinemia, and autoantibodies in blood.
## Footnote
Diagnosis requires the exclusion of other chronic liver diseases that have similar features.
105
What are the two peaks of incidence for Auto-Immune Hepatitis?
Usually occurs in females (70%) mostly between 15-25 years or at menopause (45 years)
## Footnote
This highlights the demographic susceptibility to the disease.
106
What is the prevalence of Type 1 Auto-Immune Hepatitis?
More than 80%
## Footnote
Type 1 is more common and typically affects individuals older than 30 years.
107
What is the average age of onset for Type 2 Auto-Immune Hepatitis?
Average 10 years old
## Footnote
Type 2 is considered more aggressive.
108
What is the response to treatment for Type 1 Auto-Immune Hepatitis?
Good response to treatment
## Footnote
40% develop cirrhosis.
109
What are the auto-antibodies associated with Type 1 Auto-Immune Hepatitis?
ANA & ASMA
## Footnote
These auto-antibodies are important for diagnosis.
110
What are common hepatic manifestations of Auto-Immune Hepatitis?
* May be asymptomatic
* Acute fulminant hepatitis
* Chronic hepatitis with jaundice, fatigue, and tender hepatomegaly
## Footnote
Complications include cirrhosis and portal hypertension.
111
What are the characteristics of Type 2 Auto-Immune Hepatitis?
About 20% prevalence, more aggressive, average age 10 years old, resistant to treatment, 80% develop cirrhosis
## Footnote
Type 2 is associated with more severe outcomes.
112
List some autoimmune features associated with Auto-Immune Hepatitis.
* Skin rash
* Polyarthritis
* Nephritis
* Autoimmune hemolytic anemia (SLE)
* Sjögren's syndrome
* Celiac disease
## Footnote
These features indicate a broader autoimmune disorder spectrum.
113
True or False: Auto-Immune Hepatitis can lead to cirrhosis.
True
## Footnote
Both types of Auto-Immune Hepatitis can progress to cirrhosis.
114
Fill in the blank: Auto-Immune Hepatitis requires the exclusion of other _______.
[chronic liver diseases]
## Footnote
This is crucial for accurate diagnosis.
115
What are some autoimmune diseases associated with Auto-Immune Hepatitis?
* ITP
* Rheumatoid arthritis
* Hashimoto thyroiditis
* Ulcerative colitis
## Footnote
These conditions can coexist with Auto-Immune Hepatitis.
116
What is the significance of positive autoantibodies in hepatology investigations?
Indicates hyper-gammaglobulinemia (IgG) and suggests autoimmune hepatitis
## Footnote
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
Which liver enzymes are typically elevated in autoimmune hepatitis?
AST & ALT
## Footnote
Alkaline phosphatase (ALP) is not markedly increased.
118
What findings are indicative of autoimmune hepatitis in a liver biopsy?
Lymphocytic and plasma cell infiltration, no biliary lesions
## Footnote
A liver biopsy helps to estimate fibrosis and exclude other disorders.
119
What is the primary aim of investigating autoimmune hepatitis?
Identify features suggestive of AIH and exclude other disorders
## Footnote
Other disorders may include infiltration by lymphoma or adenocarcinoma.
120
List some differential diagnoses for hepatitis.
* Viral hepatitis
* Wilson's disease
* Alcoholic hepatitis
* NASH
* Alpha-1 antitrypsin deficiency
* Primary biliary cirrhosis (PBC)
## Footnote
These conditions must be considered to differentiate from autoimmune hepatitis.
121
What is the first regimen for treating autoimmune hepatitis?
Combination therapy: Prednisolone and Azathioprine
## Footnote
Prednisolone: 30mg/day for 2 weeks, then maintenance 10mg/day for 4 weeks. Azathioprine: 50mg/day or 6-Mercaptopurine.
122
What are the actions of corticosteroids in the treatment of autoimmune hepatitis?
Improve symptoms, signs, liver function tests (LFTs), and histology
## Footnote
Corticosteroids are a key treatment modality.
123
What is the second regimen for treating autoimmune hepatitis?
Mono-therapy with Prednisolone
## Footnote
Initially 60mg/day, then reduced to 20mg/day for less than 4 weeks.
124
Which immunosuppressive drugs have been tried alone in autoimmune hepatitis treatment?
* Azathioprine
* Cyclosporine
## Footnote
These drugs are considered 'steroid-sparing agents'.
125
What is a potential complication after liver transplantation for autoimmune hepatitis?
The condition may recur after transplantation
## Footnote
This highlights the need for ongoing management post-transplant.
