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GI > Chronic Liver Disease + Hepatitis > Flashcards

Chronic Liver Disease + Hepatitis Flashcards

1
Q

What liver pathologies come under the umbrella term Chronic liver Disease?

A
  • Chronic Hepatitis
  • Liver Cirrhosis
  • Hepatocellular Carcinoma
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2
Q

What is Liver Cirrhosis?

A

Irreversible liver damage involving fibrosis and nodular regeneration

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3
Q

What are the risk factors of Liver Cirrhosis?

A
  • Chronic Hepatitis B or C infection
  • Chronic excessive alcohol intake
  • Non Alcohol Fatty Liver disease
  • Autoimmune liver disease
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4
Q

What are the potential causes of Liver Cirrhosis?

A
  • Chronic HBV or HCV infection
  • Chronic alcohol use
  • Non-alcohol Fatty liver disease (spectrum of disease ranging from steatosis, NASH, and eventual liver cirrhosis)
  • Autoimmune
  • Drug induced
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5
Q

What are the clinical features of Liver Cirrhosis?

A
  • Parotid gland swelling
  • Gynacosmatia, Spider nevi, Palmar Erythema (excess oestrogen)
  • Liver flap (excess ammonia)
  • Ascites (potral hypertension)
  • Jaundice (increase in unconjugated bilirubin)
  • Clubbing
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6
Q

What is the pathophysiology of Liver Cirrhosis?

A
  • Damaging factors cause hepatocyte apoptosis and necrosis
  • These affected cells release DAMPs and Reactive Oxygen Species (ROS)
  • DAMPs and ROS lead to activation of Stellate and Kuffer cells
  • Activated Stellate cells cause kuffer cells to release cytokines such as TGF and TNF-a

=> Action of TGF:

  • TGF acts on Stellate cells causing the release of collagen, increasing the size of the matrix between hepatocytes and the portal system
  • This causes portal hypertension resulting in ascites as the fluid is pushed out and portosystemic shunt formation

=> Action of TNF-a:

  • Causes T cell and neutrophil recruitment
  • Leads to inflammation, necrosis and nodule regeneration
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7
Q

What are the investigations in suspected Liver Cirrhosis?

A

=> Blood tests
Albumin - low
Unconjugated Bilirubin - High

=> LFTs
ALT - High
AST - High (but not as high as ALT)
ALP - High
GLP - High

=> Liver biopsy

=> Transient Elastography

=> Liver Ultrasound
Every 6 months to check for hepatocellular carcinoma

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8
Q

What group of people is transient elastography offered to?

A
  • People with hepatitis C infection
  • Men who drink > 50 units per week and Women who drink > 35 units per week and have done for several months
  • People diagnosed with alcohol related liver disease
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9
Q

What is the management of Liver Cirrhosis?

A

=> General management:

  • Good nutrition
  • Alcohol abstinence
  • Avoiding hepatotoxic drugs

=> For ascites:

  • Spironolactone
  • Fluid restriction
  • Low salt diet
  • Furosemide if response poor

=> For Hepatitis indued liver cirrhosis:

  • Antivirals
  • Immunise sexual partners
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10
Q

What is Hepatitis?

A

Liver damage and inflammation as a result of viral infection

=> Hepatitis viruses:

  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Hepatitis D
  • Hepatitis E
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11
Q

What are the risk factors of Hepatitis?

A
  • IV drug users
  • Direct sexual contact
  • Gender - male
  • Alcohol consumption
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12
Q

What are the clinical features of Hepatitis?

A
  • Malaise
  • Anorexia
  • Arthralgia
  • Nausea
  • Jaundice
  • Hepatosplenomegaly
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13
Q

How are Hepatitis A and E spread, and what are the specific clinical features of Hepatitis A?

A
  • Faeco-oral route

=> Overview of Hepatitis A:
- Incubation period of 2-4 weeks

=> Specific clinical features of Hepatitis A:

  • Flu like prodome
  • Jaundice
  • Hepatosplenomegaly
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14
Q

What type of infections do Hepatitis A and E cause?

A

Acute

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15
Q

What do Hepatitis A IgM and IgG antibodies indicate if found in the blood?

A

HAV IgM antibody - Active infection
HAV IgG antibody - Recovery or vaccination

=> People vaccinated:

  • People travelling to or going to reside in country where HBC intermediate or high prevalence
  • Men who have sex with men
  • IV drug users
  • Occupational exposure
  • People with Chronic Liver Disease
  • People with Haemophilia
  • People infected with HIV
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16
Q

What do Hepatitis E IgM and IgG antibodies indicate if found in the blood?

A

HEV IgM antibody - Active infection

HEV IgG antibody - Recovery

17
Q

What is the main difference between Hepatitis A and E?

A
  • Hepatitis E has no vaccination
  • Hepatitis E causes a very severe infection in pregnant women known as Fulminant Hepatitis
  • Vaccination is possible in Hep A. A booster must be given 6-12 months following the initial treatment
18
Q

How is Hepatitis C transmitted?

A

Via the blood

  • Childbirth
  • Needle sharing
  • Unprotected sex
19
Q

What type of infection does Hepatitis C cause, and what are its clinical features?

A

Can be acute or chronic

=> Clinical features seen in some with HCV:

  • Arthralgia
  • Fatigue
  • Rise in serum aminotransferase
  • Jaundice

=> Chronic cases develop:

  • Rheumatological problems
  • Eye problems
  • Cirrhosis
  • Hepatocellular carcinoma
  • Cyroglobulinaemia
  • Membranoproliferative glomerulonephritis
20
Q

What tests are used to diagnose Hepatitis C?

A
  • Enzyme immunoassay
  • Recombinant immunoblast assay
  • HCV RNA Test - Gold standard
21
Q

How is Hepatitis B transmitted?

A

=> Same as Hep C, via the blood

  • Childbirth
  • Needle sharing
  • Unprotected sex
22
Q

What type of infection can Hepatitis B cause?

A

Acute which can develop into chronic in 20% of cases

  • More likely in those < 6
  • More likely the younger you are
  • Linked to liver cancer
23
Q

What are the different antigens present in a Hepatitis B virus molecule?

A

Hepatitis B surface antigen - HBsAg

Hepatitis B core antigen - HBcAg

Hepatitis B E antigen - HBeAg

24
Q

What antigens and antibodies are present at the different points of Hepatitis B infection?

A

=> First onset:

IgM
HbsAg
HbcAg

=> During infection:

  • Antigen levels low
  • IgM detectable

=> If antibodies overcome antigens:
IgG antibodies detectable

=> If infection overcomes antibodies:

  • HbsAg detectable
  • HbcAg detectable
25
Q

What must be present for Hepatitis D to infect?

A

Hepatitis B

If infection occurs at the same time - co infection
If HDV infects after HBV - superinfection (more severe)

26
Q

What antibodies must be present in the blood to indicate an active Hepatitis D infection?

A

IgM and IgG

27
Q

What is the management of Hepatitis?

A
  • Immunisation
  • Avoid alcohol
  • Liver transplant
  • Interferon-a for acute liver failure in pregnancy
28
Q

What do the Liver Function Tests show in Hepatocellular and Obstructive Disease?

A

=> Hepatocellular Disease

  • High ALT and AST as these are produced by the liver
  • Normal ALP

=> Obstructive Disease

  • Normal ALT and AST
  • Raised ALP AND GGT
29
Q

What is the marker used to diagnose Hepatocellular Carcinoma, and what is its screening?

A

Alpha-fetoprotein (AFP)

=> Screening via ultrasound with or without AFP in:

  • Those with liver cirrhosis secondary to HBC, HCV or haemochromatosis
  • Men with liver cirrhosis secondary to alcohol
30
Q

What are the features of Hepatitis B?

A
  • Jaundice
  • Fever
  • Elevated transaminases
31
Q

What are the complications of Hepatitis B?

A
  • Chronic Hepatitis (ground glass appearance on histology)
  • Fulminant hepatits
  • Glomerulonephritis
  • Hepatocellular carcinoma
  • Polyarteritis Nodosa
  • Cyroglobuinaemia
32
Q

What are the risk factors of NASH?

A
  • Obesity
  • Type 2 diabetes
  • Hyperlipidemia
  • Jejunoilial bypass
  • Sudden weight loss/ starvation
33
Q

What are the clinical features of NASH?

A
  • Usually asymptomatic
  • Hepatomegaly
  • ALT > AST
  • Increased echogenecity on ultrasound
34
Q

What are the investigations in suspected NASH?

A

=> ELF blood test

=> Ultrasound

35
Q

What is the management of NASH?

A
  • Weight loss

GI (23 decks)

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