GI Problems Four: Viral hepatitis Flashcards
Does acute hepatitis have specific symptoms?
Very much non-specific so anyone with non-specific illness do LFTs
What serology do you do for Hep A?
- HAV IgM
- HAV IgG
Why doe cholestasis occur with hepatitis?
Inflamed liver compresses billiary tree
What serology do you do for Hep B?
- HBsAg
- HBsAb
- HB Core AB IgM (acute inf)
What serology do you do for Hep C?
- Anti-HCV Ab
How is acute Hep B transmitted?
- Adult transmission
- Parenteral and sexual
How is chronic Hep B transmitted?
- Neonate or childhood transmission
- Perinatal/verticle and horiztonal common
Whats important with acute Hep B serology?
- Around 26 weeks theres a period of time when HBsAg lost and no anti-HBsa
- THus must check anti-HBcore (but this is not protective)
What are the four phases of chronic hep B?
1) No treatment, body doesnt react
2) Body tries to clear virus, ALT rise
3) Body controls virus (healthy carrier, virus in low levels)
4) Re-emergence of virus, ALTs rise. Can lead to cirrhosis because of continuous low level inflammation therefore Hep B carries need tests
What can result from decompensated cirrhosis?
-> portal hypertension
= Variceal hemorrhage
= Ascites (spont. bact. perit) or HRS
-> Liver insufficiency
= Encephalopathy
= Jaundice
What happens with portal hypertension?
- Hypersplenism (mod. anaemic, neutropenia, thrombocytopenia)
- Eosophageal or rectal varices.
Describe the pathogenesis of ascities:
- Cirrhosis -> Increased resistance to portal flow -> Portal hypertension
1) Inc. BHP + Dec. albumin (Oncotic pressure)
2) Spalchnic vasodilation -> Systemic art. underfilling -> RAAS activation -> Na and water retention
= Ascites (tranjudate, water movement)
Whats the pathophysiology of hepatic encephalopathy?
- Gut flora produce ammonia
- Disease liver cant metabolise
- Portosystemic shunt, so blood reaches systemic circulation AND toxins effect the brain (HE)
-> Hepatic flap. etc
Lactulose -> Diarrhoea -> Prevents NH3 absorption
