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Z Year3 Gastro Conditions > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

What is hepatitis?

A

inflammation of liver

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2
Q

What enzymes are high in hepatitis?

A

Raised: AST and ALT

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3
Q

What are markers for liver function?

A

PT and albumin

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4
Q

What are other DDx for hypoalbuminaemia?

A
  • nephrotic syndrome

- heart failure

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5
Q

What are possible causes of hepatitis?

A
  1. Alcoholic
  2. NASH
  3. Viruses
  4. Drugs
  5. Autoimmune
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6
Q

What are symptoms of hepatitis?

A
  1. RUQ pain
  2. jaundice
  3. hepatomegaly
  4. joint pain
  5. nausea
  6. fatigue
  7. dark urine
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7
Q

What are different types of hepatitis?

A

acute or chronic (>6months)

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8
Q

What can happen when you have acute hepatitis?

A
  1. Recovery
  2. Liver failure
  3. Chronic hepatitis to cirrhosis to liver failure
  4. Can recover from chronic hep
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9
Q

What is Hep A and E?

A

acute

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10
Q

How is hep A and E spread?

A

sex/contaminated water e.g. shellfish

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11
Q

Where is hep A and E common?

A

Asia and Africa and men with men sex

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12
Q

What is the management for hep A and E?

A
  1. supportive

2. avoid alcohol/excess paracetmol

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13
Q

When can Hep E be chronic?

A
  • E can be chronic in immunocompromised

- E can be severe in pregnancy ( liver failure)

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14
Q

How can chronic Hep E be managed?

A

Antiviral (ribavirin) for immunocompromised with hep E

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15
Q

What are symptoms of Hep A and E/

A
  • Mostly asymptomatic between 2-6 weeks after infection

- Then symptoms

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16
Q

What are possible symptoms of Hep A and E?

A
  1. Nausea
  2. Vomiting (+ Diarrhoea)
  3. Fever
  4. Jaundice
  5. Abdominal pain (particularly RUQ)
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17
Q

What sort of infection is Hep B?

A

Acute or chronic – more commonly acute

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18
Q

What are different types of Hep B?

A
  1. Most adults clear it (full recovery)
  2. 10% become carriers
  3. 10% get chronic hep B
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19
Q

What is epid for Hep B?

A

children more likely to be carriers/chronic

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20
Q

What are RF for Hep B?

A
  1. Sexually transmitted
  2. IVDU
  3. vertical
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21
Q

What is the acute Mx for Hep B?

A

supportive as most will clear

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22
Q

What is the chronic Mx for Hep B?

A

antiviral:
1. Peginterferon-a-2a
OR
2. Tenofovir

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23
Q

What sort of infection is Hep C?

A

acute or chronic more commonly chronic

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24
Q

What are the stages of Hep C?

A

most adults develop chronic hepatits (80%), only 30% clear it

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25
What is the serology for Hep A?
- Current infection: anti-HAV IgM but no anti-HAV IgG - If anti-HAV IgG but not anti-HAV IgM suggest past infection - Anti-HAV IgG persists for life
26
What is serology for Hep E?
- Current infection: anti-HEV IgM but no anti-HEV IgG - If anti-HEV IgG but not anti-HEV IgM suggest past infection - Anti-HEV IgG persists for a few years
27
As both Hep B and C can be chronic what do you need to consdier?
risk of cirrhosis and hepatocellular carcinoma (hepC)
28
How is Hep C spread?
Blood product spread (IVDU/transfusion)
29
What is the acute Mx for Hep c?
antivirus
30
What is the chronic Mx for Hep C?
antiviral e.g.: 1. Sofosbuvir 2. Ledipasvir (DAA_
31
What are the symptoms of Hep C?
1. Almost all initial infections are asymptomatic | 2. occasionally patients may experience the typical hepatitis symptoms outlined previously
32
What antivirals are used to treat Hep C?
Antivirals used include 1. Sofosbuvir (NS5B inhibitors) 2. Ledipasvir (NS5A inhibitors) 3. Grazoprevir (NS3/4 protease
33
What sort of virus is Hep C?
an RNA virus spread primarily through contaminated blood products
34
What is Hep D?
-Superinfection of B- requires HbSAg to infect cells -Peginterferon-a AND tenofovir -Hepatitis D requires co-infection with HBV HDV required HBV surface antigen to access liver cells
35
Why is having Hep D with Hep B bad?
increases risk of liver failure for hep B
36
What does IgM mean?
current infection
37
What does IgG mean?
lingers after infection
38
What does the Hep B vaccine contain?
HBsAg so if have it you get HBsAb
39
What is the Hep B serology for Susceptible (never been vaccinated or had infection)?
1. HBsAg: negative 2. Anti-HBs: negative 3. Anti-HBc: negative
40
What is the Hep B serology for vaccinated (and never been infected)?
1. HBsAg: negative 2. Anti-HBs: positive 3. Anti-HBc: negative
41
What is the serology for past Hep B infection (but now cleared)?
1. HBsAg: negative 2. Anti-HBs: positive 3. Anti-HBc: IgG positive
42
What is the Hep B serology for current/acute infection?
1. HBsAg: positive 2. Anti-HBs: negative 3. Anti-HBc: IgM positive
43
What is the Hep B serology for chronic infection?
1. HBsAg: positive 2. Anti-HBs: negative 3. Anti-HBc: IgG positive
44
What does HBeAg mean?
represents degree of replication and thus infectivity
45
What does HBV DNA show?
viral load
46
What is the Hep C serology for acute infection?
1. Anti-HCV IgG: positive | 2. HCV-RNA: positive
47
What is the Hep C serology for chronic infection?
1. Anti-HCV IgG: positive | 2. HCV-RNA: positive (high for >6months)
48
What is the Hep C serology for infection cleared?
1. Anti-HCV IgG: positive | 2. HCV-RNA: negative
49
What is the serology for Hep D acute infection?
``` Firstly confirm Hep B then Acute infection 1. HDV IgM: high 2. HDV IgG: negative 3. HDV RNA: positive 4. HDAg: positive or negative ```
50
What is the serology for Hep D chronic infection?
Firstly confirm Hep B then 1. HDV IgM: negative 2. HDV IgG: positive 3. HDV RNA: positive 4. HDAg: negative
51
What is the prognosis for Hep B acute?
full recovery
52
What is the Hx like for alcoholic hepatitis?
Long term alcohol misuse | but can be after binge
53
What are the Ix for alcoholic hepatitis?
AST:ALT >2 | increased GGT
54
What is the Mx for alcoholic hepatitis?
Alcohol abstinence, nutrition, (steroids)
55
What is the normal Hx for NASH?
Insulin resistance, diabetes, obesity, lack of XS alcohol
56
What are the Ix for NASH?
AST:ALT <1
57
What is the usual Mx for NASH?
Diet + exercise + RF control
58
What is the classic Hx for viral hep?
1. A&E: travel to endemic area/faeco-oral (contaminated water) 2. B: Unprotected sex/MSM/vertical 3. C: blood products (IVDU needle sharing) 4. FEVER
59
What Ix are common for viral hep?
1. AST/ALT (in 1000s) | 2. Viral serology
60
What drugs can cause drug-induced hepatitis?
1. Paracetmol 2. NSAIDs 3. GCs 4. isoniazid 5. fluclox 6. erythromycin
61
What Ix will show for drug-induced hepatitis?
1. AST/ALT (in 1000s) | 2. Serum paracetamol concentration
62
What is the Mx for drug hepatitis?
Paracetemol overdose- N-acetyl cysteine
63
What is the Hx for AI hepatitis?
1. Other AI disease (T1DM, hashimoto’s, coeliac) 2. F>M 3. young women 4. Can progress to liver failure / cirrhosis
64
What are Ix for autoimmune hepatitis?
1. AST/ALT 2. ANA, ASMA 3. (Biopsy: interface hepatitis + plasma cells)
65
What drugs can affect hepatocytes?
paracetamol, NSAIDs, isoniazid, rifampicin
66
What drugs can induce cholestasis by paralysing the bile duct?
1. co-amoxiclav 2. nitrofurantoin 3. oral contraceptive pill

Z Year3 Gastro Conditions (48 decks)

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