Hepatitis Flashcards
Hep A transmission, RF + sx
Transmission: fecal oral, close contact, contaminated food, sexual contact
RF: travelers, MSM, IVDU, homelessness, incarceration
Sx: fever, faundice, malaise, N/V, abdo pain then icteric phase of high bili, jaundice, dark urine, pale stool
Hep A ix + results, management + complications
Ix:
↑↑AST, ↑↑AST, ↑ALP, ↑↑bili
Hep A IgG indicates immunity
Hep A IgM suggests recent/ acute infection
Management:
Close contact precautions + post-exposure prophylaxis (IG)
Fulminant illness = liver transplant
Complications:
Wt loss
Malabsorption
Hep B + C transmission + RF
Transmission:
Blood + body fluids (semen, saliva)
RF:
Household contact
Healthcare worker
IVDU
MSM
Hep B + C complications
Complications:
Cirrhosis
Hepatocellular carcinoma
Immunisations
Hep A + B immunisation schedule + name
Hep B: 3 dose series (Engerix-B, Twinrix)
Hepatitis A + B vaccine schedule timing:
0, 1, 6 months
1st Vaccine: given immediately
2nd Vaccine: given one month later
3rd Vaccine: given six months later
Rapid Schedule: 0, 7, 21 days + 1 year (4 doses)
Sx hepatitis
Nausea
Anorexia
Fatigue
Fever
RUQ pain
Jaundice
Myalgias
Ix for hepatitis + meaning of each
HbsAg: active infection
Anti-HBc: previous infection
IgM: infection in past 6 months
IgG: distant HBV infection
Anti-HBs: immunity from vaccine or prev infection
HBeAg: how active the virus is
HBV DNA = viral laod
Anti-HCV ab - detected 5-10w after exposure
If positive: HCV ENA PCR + genotype + viral load
HCV RNA negative: prev infection that has cleared
Positive: positive
Other tests: AST, ALT, ALP, bili, albumin, CBC, PTT, INR
Screening
Screen for Hep C once for all adults >18 + anyone w/ RF
Management of chronic HBV
Chronic HBV: TIE
Tenofovir
Interferon alfa 2b
Entecavir
Lifestyle: stop alcohol, stop smoking, maintain healthy wt, immunise against A + B
Reduce transmission: never donate blood, never share drug paraphernalia, disclose to sexual partners
management of positive hep C
Positive Hep C: refer to experienced provider, treatment depends on genotype
Lifestyle: stop alcohol, stop smoking, maintain healthy wt, immunise against A + B
Reduce transmission: never donate blood, never share drug paraphernalia, disclose to sexual partners
Labs for pre, post and intra-hepatic dz
Pre-hepatic - high unconjugated bilirubin, normal liver enzymes, high LDH
Hepatic - high conjugated + unconjugated bilirubin, AST + ALT ++
Post-hepatic - high conjugated bilirubin, ALP ++
What is the difference between NASH + NAFLD, and how do you dx NAFLD?
NAFL = fatty liver, reversible
NASH = severe, inflammation, scarring - can lead to fibrosis, cirrhosis
Ix for autoimmune hepatitis
anti smooth muscle antibody
Hepatocellular carcinoma IX
alpha fetal protein
Signs associated with liver cirrhosis
Encephalopathy
Xanthelasma
Scleral Icterus
Jaundice
Fetor Hepaticus
Gynecomastia
Esophageal Varices
Splenomegaly
Spider Angioma
Caput Medusa
Umbilical Hernia
Ascites
Muscle Wasting
Weakness
Easy Bruising
Pruritus
Hemorrhoids
Testicular Atrophy
Edema
Palmar Erythema
Dupuytren’s Contracture
Asterixis
Leuconychia
Clubbing
Encephalopathy