General Flashcards
HBV serology:
sAg - Neg
sAb - Neg
cAb - Neg
Never had HBV and not vaccinated
HBV serology
sAg - Neg
cAb - Neg
sAb - Pos
Vacinated but never had HBV
HBV Serology
sAg - neg
sAb - Pos
cAb - Pos
Previous HBV infection, now resolved
HBV serology
sAg - Positive
sAb - Positive
cAb - Positive
Currently infected with HBV
How is Hep A&E transmitted?
Oral-faecal
Symptoms of hepatitis
Abdo pain
Dark urine
Pale steatorea
Jaundice
Puritis (itch)
What is the incubation period of viral hep?
about 2 weeks before detectable in faeces, and 4 weeks before Ig is detectable.
If there is an exposure eg needlestick, multiple follow up tests are required to check for new development of Ag/Ab.
?Hepatitis investigations
LFT
U&E
FBC
Serology
Clotting
if serology positive - PCR for virus genotype
Acute HBV treatment
Nothing!
Unless otherwise indicated - immunocomp, pregnant, cirrhosis etc.
If it becomes chronic (6 months) - treat
Chronic HBV treatment - 1st and 2nd line
1st Peginterferon
2nd Entecavir / Tenefovir
Treatment for acute HCV
Nothing - usually self limiting
Treatment for chronic HCV
A changeable feast!
- Need PCR for genotype
- differs depending on previous treatment for Hepatitis.
- Generally mixture/all of:
Pegylated IFN
Ribavirin
Directly Acting Antivirals (DAAs)
Treatment of HDV
Only occurs in the presence of HBV,
treat at same time ie :
- IFN
- entecavir / tenafovir
What enzyme is associated with the clearence of high levels of alcohol (indicative of long term alcohol use)
Gamma GT
Disease and relevance to liver
Wilson’s disease
Inability to excrete copper, which then builds up in certain organs: eyes and liver among others. Can lead to acute liver disease.
What different classifications of jaundice and anaemia can there be?
prehepatic, associatd with unconjugated bilirubin anaemia
posthepatic, associated with conjugated bilirubin
Other than Hep A-G, what other viruses can commonly cause hepatitis?
EBV, CMV.
Both also AIDS defining ilnesses if causing hepatitis in HIV pos.
Non viral causes of hepatitis
Fatty liver disease
Non-alcohol fatty liver disease (NAFLD)
Wilsons
Autoimmune
Budd-Chiari
Primary Sclerosing Cholangitis (PSC)
LFT raise AST causes
AST is a mitochondrial enzyme. It can be raised due to:
- CHF
- Muscle injury
- Hepatitis……high levels in necrosis
- MI
LFT raised ALT causes
specific to liver injury (unlike AST)
It’s ratio wrt AST can indicate specific pathologies
Acute viral hepatitis. What do you expect AST and ALT to be?
Both raised, ALT higher than AST
If AST is raised - chirrosis
Viral hepatitis confirmed,
AST and ALT are raised,
AST is higher than ALT
What can be deduced?
Chirrosis
AST higher than ALT in viral hepatits = ChirroSiS
Serology negative
high ALT
Very high AST
Most likely cause?
Alcoholic and or fatty liver disease
usually presents with high AST:ALT ratio
Rasied ALP alone
- choleostasis
- Bone mets
- intestineal problems
- from placenta
Look at ASP in conjunction with the other LFTs - if Gama GT is also raise, assume the ASP is rasied due to liver.
Raised Gama GT
Rasied ASP
Safe to assume that rasied ASP is due to liver
Intra and extrahepatic Choleostasis causes raised ASP
