Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y3 Conditions > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

Hepatitis

What are the main risk factors for alcoholic hepatitis?

4

A
  • Chronic and heavy alcohol consumption
  • Malnutrition
  • Obesity
  • Genetic factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hepatitis

What are the key symptoms associated with alcoholic hepatitis?

5

A
  • Jaundice
  • Nausea/vomiting
  • Loss of appetite
  • Abdominal pain or discomfort, especially in the upper right part of the abdomen
  • Weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hepatitis

How might a very severe case of alcoholic hepatitis present?

A
  • Ascites (accumulation of fluid in the abdomen)
  • Hepatic encephalopathy (confusion, drowsiness and slurred speech)
  • Kidney failure
  • Liver failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hepatitis

In examination, how might a pt with alcoholic hepatitis present?

5

A
  • Hepatomegaly (enlarged liver)
  • Spider angioma (small, dilated blood vessels with a central red spot and radiating vessels)
  • Jaundice
  • Ascites
  • Features of liver failure such as hepatic encephalopathy, coagulopathy (bleeding or bruising easily) and renal impairment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Hepatitis

What are the 1st line investigations for alcoholic hepatitis?

6

A
  • LFTs
  • FBC
  • U&Es
  • Coagulation profile
  • Abdo USS
  • Testing for other causes of liver disease such as hepatitis B and C.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hepatitis

What might the LFTs show in alcoholic hepatitis?

A

raised GGT and AST
raised ALP and bilirubin
AST is usually higher than ALT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hepatitis

What might the FBC show in alcoholic hepatitis?

A

macrocytosis often seen in those with hx of alcohol abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hepatitis

What might the U&Es show in alcoholic hepatitis?

A

raised urea and creatitine in case of kidney injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hepatitis

What might the coagulation show in alcoholic hepatitis?

A

longer PT -> impaired liver synthetic function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hepatitis

What other investigations might you consider to do for alcoholic hepatitis after 1st line?

4

A
  • CT/MRI abdomen
  • Liver biopsy
  • Fibroscan
  • Testing for other alcohol-related damage, such as pancreatitis and heart or nervous system damage.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Hepatitis

What is a fibroscan? (Aka transient elastography)

A

a non-invasive test that measures liver stiffness, helping to estimate the extent of liver scarring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hepatitis

How do we manage alcoholic hepatitis?

3

A
  • Steroids – Prednisolone is used in patients with severe disease to* reduce inflammation*.
  • Abstinence from alcohol – most critical part of treatment
  • Nutritional support
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hepatitis

What is the most common liver infection worldwide?

A

hepatitis B virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Hepatitis

HBV is a ____ DNA virus which can be transmitted by ____, ____ or ____ routes.

A

double-stranded

percutaneous, permucosal or sexual routes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hepatitis

Acquiring HBV at what age provides a pt with the greatest risk?

2

A

perinatal or early childhood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hepatitis

What are then main risk factors for HBV infection?

7

A
  • Perinatal exposure
  • Sexual transmission
  • IV drug use
  • Living or travel to a highly endemic region (Asia and Africa)
  • Incarceration
  • FHxof HBV infection
  • FHx of chronic liver disease and/or HCC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Hepatitis

What are the key symptoms indicative of hepatitis?

A
  • Fever
  • Chill
  • Malaise
  • Arthralgia
  • Maculopapular or urticarial rash

other possible:
* Jaundice
* Nausea/vomiting
* Right upper quadrant pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Hepatitis

70% if people with HBV are asymptomatic, but symptoms may appear when the following complications occur:

3

A
  • Cirrhosis
  • Hepatocellular carcinoma
  • Liver failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Hepatitis

On examination, patients with acute symptomatic HBV infection have the key findings of:

2

A

Tender hepatomegaly
Jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Hepatitis

Some chronic patients who have developed liver cirrhosis may have findings including:

5

A
  • Palmar erythema
  • Spider angioma
  • Ascites
  • Jaundice
  • Asterixis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Hepatitis

What are the 1st line investigations for someone with HBV?

A
  • LFTs
  • FBC
  • U&Es
  • Coagulation profile
  • Serum hepatitis B testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Hepatitis

LFTs:

Elevated ____, ____, and ____ with a low ____ is suggestive of HBV infection

A
  • elevated aminotransferases (ALT/AST),

*elevated ALP and bilirubin with a **low albumin level **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Hepatitis

What might the FBCs of a pt with HBV be like?

A

microcytic anaemia and/or thrombocytopenia due to HBV-related cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Hepatitis

What might the U&Es of a pt with HBV be like?

A

hyponatraemia and raised urea levels are caused by HBV-related cirrhosis

25
Q

Hepatitis

What might the coagulation profile of a pt with HBV be like?

A

normal or elevated in presence of HBV infection and associated manifestations

26
Q

Hepatitis

Explain serum HBV testing.
- Serum hepatitis B surface antigen
- Serum antibody to hepatitis B surface antigen
- Serum antibody to hepatitis B core antigen
- Serum hepatitis B e antigen
- Serum HBV DNA

A
  • Serum hepatitis B surface antigen – can be detected on average of 4 weeks post-viral exposure, will usually become undetectable after 4-6 months in self-limiting acute cases, persistent raise >6 months implies a chronic HBV infection
  • Serum antibody to hepatitis B surface antigen – appears several weeks post hepatitis B surface antigen suggesting infection resolution, also detectable in immunised patients, provides life-long immunity in most cases
  • Serum antibody to hepatitis B core antigen – IgM and IgG antibodies to hepatitis B core antigen provide the best single test for screening household contacts of HBV infected individuals to determine vaccination need
  • Serum hepatitis B e antigen – provides further information regarding likelihood of development from acute to chronic infection
  • Serum HBV DNA – the level is commonly used to assess a patient’s candidacy for antiviral therapy and to subsequently monitor therapy response
27
Q

Hepatitis

What do we use a USS for in HBV infection?

A

evaluate liver for fibrosis, cirrhosis, portal hypertension and HCC

28
Q

Hepatitis

Why might we do a MRI/CT in HBV infection?

A

check for HCC

29
Q

Hepatitis

What is a Transient elastography? (Fibroscan)

What is the purpose of it?

A

non-invasive alternative to liver biopsy, evaluates liver injury measuring stiffness on US, popular choice in identifying cirrhosis

30
Q

Hepatitis

What do we use Alpha-fetoprotein for?

A

used to screen for HCC, elevated levels found in 75% of patients with HCC

31
Q

Hepatitis

For a pt with HBV, what other infections might we also test for and why?

A

HIV, hepatitis C/D status as management options are affected

32
Q

Hepatitis

How do we manage HBV?

A

usually just supporting, buy some pt might need antiviral therapy

33
Q

Hepatitis

Which antiviral therapies are used in HBV? (acutely)

3

A
  • entecavir
  • tenofovir disoproxil
  • tenofovir alafenamide
34
Q

Hepatitis

Which antiviral therapies are used in HBV? (chronically)

A
  • entecavir
  • tenofovir disoproxil
  • tenofovir alafenamide
  • peginterferon alfa 2a
35
Q

Hepatitis

Most HBV pts will need a liver transplant.

True or false?

A

FALSE

95% of immunocompetent patients with an acute infection can be managed with supportive care because are mable to achieve seroconversion with appearance of antibodies to hepatitis B surface antigens

however, if disease progresses, then they might need a liver trasplant and it can result in liver failure

36
Q

Hepatitis

Hepatitis C virus (HCV) is a ____-stranded ____ virus of the Flaviviridae family.

A

single, RNA

37
Q

Hepatitis

Acute HCV is usually self-limiting. Chronic HCV infection often follows a progressive course over many years and can ultimately result in ____, ____, and the need for a ____.

A

cirrhosis
hepatocellular carcinoma
the need for liver transplantation.

38
Q

Hepatitis

What are the main modes of transmission for HCV?

A

mostly blood

(sometimes bodily fluids)

39
Q

Hepatitis

HCV can be symptomatic and asymptomatic. Symptomatic pts tend to develop chronic liver disease.

A

FALSE

a higher percentage of symptomatic pts ‘clear’ the virus

40
Q

Hepatitis

What are some extra-hepatic manifestations of HCV?

A
  • arthritis
  • cryoglobulinaemia with or without glomerulonephritis
  • porphyria cutanea tarda

Porphyria cutanea tarda (PCT) is a rare disorder characterized by painful, blistering skin lesions that develop on sun-exposed skin (photosensitivity). Affected skin is fragile and may peel or blister after minor trauma.

41
Q

Hepatitis

There is a higher incidence of ____, and associations with ____, ____ and ____ lymphoma

A
  • diabetes

and associations with:
- lichen planus
- Sjogren syndrome
- non-Hodgkin’s lymphoma

42
Q

Hepatitis

HBV and HCV

cytokines in the ____ phenotypes are profibrotic and cause the development of chronic infection

A

Th2

43
Q

Hepatitis

HBV and HCV

A dominant ____ response, with a weak ____ response, may lead to rapid fibrosis.

A

A dominant CD4 Th2 response, with a weak CD8 interferon-gamma response, may lead to rapid fibrosis.

44
Q

Hepatitis

HBV and HCV

____ cytokines are antifibrotic and thus a dominant ____ and ____ response may cause less fibrosis.

A

Th1 cytokines are antifibrotic and thus a dominant CD4 Th1 and CD8 cytolytic response may cause less fibrosis.

45
Q

Hepatitis

Which cytokines are profibrotic and which cytokines are anti-fibrotic?

Th1 / Th2

A

Th1 : anti
Th2 : pro

46
Q

Hepatitis

How would a pt with asymptomatic acute HCV be diagnosed?

A
  • 10% of patients having a mild influenza-like illness with jaundice and a rise in serum aminotransferases

Most patients will not be diagnosed until they present, years later, with evidence of abnormal transferase values at health checks or with chronic liver disease.

47
Q

Hepatitis

How might the LFTs of a pt with chronic HCV come back?

A

mild elevations in the aminotransferases (usually ALT)

48
Q

Hepatitis

Testing for hepatitis C virus (HCV) using an HCV antibody test should be considered in the following groups:

Hep C testing https://cks.nice.org.uk/topics/hepatitis-c/#!diagnosisSub:3

A
  1. People who are asymptomatic who are at high risk of hepatitis C infection
  2. People with clinical features that could be indicative of hepatitis
  3. People with abnormal liver function tests (ALT raised more than 10x the upper limit of normal may indicate acute viral hepatitis, but this is not specific for HCV infection)
49
Q

Hepatitis

Which is more likely ot develop into chronic disease? HBV or HCV?

A

HCV

50
Q

Hepatitis

How do we investigate for HCV?

A

evaluation of HCV, RNA and HCV antibodies

51
Q

Hepatitis

HCV RNA can be detected from ____ to ____ weeks after infection.

Anti-HCV tests are usually positive ____ weeks from infection.

A

HCV RNA can be detected from 1 to 8 weeks after infection.

Anti-HCV tests are usually positive 8 weeks from infection.

52
Q

Hepatitis

What baseline investigations should be done while awaiting HCV antibody investigations?

A
  • Hepatitis C RNA test for active hepatitis C and genotyping (if this has not been requested already).
  • FBC
  • U&Es
  • LFTs
  • Clotting screen.
  • HbA1c level.
  • TFTs
  • Ferritin level
  • Hepatitis B surface antigen (HBsAg) or antibody to hepatitis B core antigen (anti-HBc) to check hepatitis B status.
  • HIV test, even if the person has recently been tested.
53
Q

Hepatitis

Why do check TFTs in pt with HCV?

A

for baseline as antiviral therapy can cause thyroid dysfunction

54
Q

Hepatitis

Why check ferritins levels in pt with suspected HCV?

A

to assess iron stores (can be elevated in chronic hepatitis C)

55
Q

Hepatitis

What are we looking for in a FBC for a pt with suspected HCV?

A

anaemia, neutropenia, and thrombocytopenia

56
Q

Hepatitis

How do we manage HCV? (prescribing)

A

Antiviral combination therapy

*Combination dual drug therapy injections of pegylated interferon alpha and daily oral doses of oral ribavirin. *

People with HCV genotype 1 typically have a longer treatment course than other genotypes and have a worse prognosis. They may be considered for treatment with triple therapy involving the addition of a protease inhibitor which has improved treatment success rates compared with dual therapy.

57
Q

Hepatitis

How are Hep A/B/C transmitted?

A

Hep A: faecal oral
Hep B: blood / bodily fluids
Hep C: bloods (bodily fluids sometimes)

58
Q

Hepatitis

Are there vaccines for Hep A/B/C?

A

only for A and B

59
Q
A

Y3 Conditions (55 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions