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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
Q

What is the serology for Hep A?

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
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26
Q

What is serology for Hep E?

A
  • 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
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27
Q

As both Hep B and C can be chronic what do you need to consdier?

A

risk of cirrhosis and hepatocellular carcinoma (hepC)

28
Q

How is Hep C spread?

A

Blood product spread (IVDU/transfusion)

29
Q

What is the acute Mx for Hep c?

30
Q

What is the chronic Mx for Hep C?

A

antiviral e.g.:
1. Sofosbuvir
2. Ledipasvir
(DAA_

31
Q

What are the symptoms of Hep C?

A
  1. Almost all initial infections are asymptomatic

2. occasionally patients may experience the typical hepatitis symptoms outlined previously

32
Q

What antivirals are used to treat Hep C?

A

Antivirals used include

  1. Sofosbuvir (NS5B inhibitors)
  2. Ledipasvir (NS5A inhibitors)
  3. Grazoprevir (NS3/4 protease
33
Q

What sort of virus is Hep C?

A

an RNA virus spread primarily through contaminated blood products

34
Q

What is Hep D?

A

-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
Q

Why is having Hep D with Hep B bad?

A

increases risk of liver failure for hep B

36
Q

What does IgM mean?

A

current infection

37
Q

What does IgG mean?

A

lingers after infection

38
Q

What does the Hep B vaccine contain?

A

HBsAg so if have it you get HBsAb

39
Q

What is the Hep B serology for Susceptible (never been vaccinated or had infection)?

A
  1. HBsAg: negative
  2. Anti-HBs: negative
  3. Anti-HBc: negative
40
Q

What is the Hep B serology for vaccinated (and never been infected)?

A
  1. HBsAg: negative
  2. Anti-HBs: positive
  3. Anti-HBc: negative
41
Q

What is the serology for past Hep B infection (but now cleared)?

A
  1. HBsAg: negative
  2. Anti-HBs: positive
  3. Anti-HBc: IgG positive
42
Q

What is the Hep B serology for current/acute infection?

A
  1. HBsAg: positive
  2. Anti-HBs: negative
  3. Anti-HBc: IgM positive
43
Q

What is the Hep B serology for chronic infection?

A
  1. HBsAg: positive
  2. Anti-HBs: negative
  3. Anti-HBc: IgG positive
44
Q

What does HBeAg mean?

A

represents degree of replication and thus infectivity

45
Q

What does HBV DNA show?

A

viral load

46
Q

What is the Hep C serology for acute infection?

A
  1. Anti-HCV IgG: positive

2. HCV-RNA: positive

47
Q

What is the Hep C serology for chronic infection?

A
  1. Anti-HCV IgG: positive

2. HCV-RNA: positive (high for >6months)

48
Q

What is the Hep C serology for infection cleared?

A
  1. Anti-HCV IgG: positive

2. HCV-RNA: negative

49
Q

What is the serology for Hep D acute infection?

A 
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
Q

What is the serology for Hep D chronic infection?

A

Firstly confirm Hep B then

  1. HDV IgM: negative
  2. HDV IgG: positive
  3. HDV RNA: positive
  4. HDAg: negative
51
Q

What is the prognosis for Hep B acute?

A

full recovery

52
Q

What is the Hx like for alcoholic hepatitis?

A

Long term alcohol misuse

but can be after binge

53
Q

What are the Ix for alcoholic hepatitis?

A

AST:ALT >2

increased GGT

54
Q

What is the Mx for alcoholic hepatitis?

A

Alcohol abstinence, nutrition, (steroids)

55
Q

What is the normal Hx for NASH?

A

Insulin resistance, diabetes, obesity, lack of XS alcohol

56
Q

What are the Ix for NASH?

A

AST:ALT <1

57
Q

What is the usual Mx for NASH?

A

Diet + exercise + RF control

58
Q

What is the classic Hx for viral hep?

A
  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
Q

What Ix are common for viral hep?

A
  1. AST/ALT (in 1000s)

2. Viral serology

60
Q

What drugs can cause drug-induced hepatitis?

A
  1. Paracetmol
  2. NSAIDs
  3. GCs
  4. isoniazid
  5. fluclox
  6. erythromycin
61
Q

What Ix will show for drug-induced hepatitis?

A
  1. AST/ALT (in 1000s)

2. Serum paracetamol concentration

62
Q

What is the Mx for drug hepatitis?

A

Paracetemol overdose- N-acetyl cysteine

63
Q

What is the Hx for AI hepatitis?

A
  1. Other AI disease (T1DM, hashimoto’s, coeliac)
  2. F>M
  3. young women
  4. Can progress to liver failure / cirrhosis
64
Q

What are Ix for autoimmune hepatitis?

A
  1. AST/ALT
  2. ANA, ASMA
  3. (Biopsy: interface hepatitis + plasma cells)
65
Q

What drugs can affect hepatocytes?

A

paracetamol, NSAIDs, isoniazid, rifampicin

66
Q

What drugs can induce cholestasis by paralysing the bile duct?

A
  1. co-amoxiclav
  2. nitrofurantoin
  3. oral contraceptive pill

Z Year3 Gastro Conditions (48 decks)

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