Hepatitis 2 Flashcards
What is fulminant hepatic failure (FHF)?
Sever hepatic failure in which encephalopathy develops in under 2 weeks in a patient with a previously normal liver
(occasionally in previous damage i.e D virus superinfection in a carrier and in Wilson’s)
2-12 weeks is subacute/subfulminant
Caused by viral hepatitis and paracetamol overdose (not HCV)
Multiacinar necrosis
What are the clinical features of FHF?
Jaundice, small liver, signs of encephalopathy
Neurological- drowsy to coma
Fetor hepaticus
Rare- ascites, splenomegaly
Fever, vomiting, hypotension, hypoglycaemia
Cerbral oedema
Complications- infections, GI bleeds, resp arrest, renal failure, pancreatitis
What are the investigations for FHF?
High bilirubin, high serum animotransferases and low coagulation factors (prothrombin and V)
Aminotransferases aren’t useful as they fall with albumin
EEG to grade encephalopathy
Ultrasound
What is the transfer criteria to specialised units for patients with acute liver injury?
INR >3
Hepatic encephalopathy
Hypotension after resuscitation with fluid
Metabolic acidosis
Prothrombin time (s) > interval (hours) from overdose (paracetamol cases)
What other viruses cause acute hepatitis?
Infectious mononucleosis- EBV (Paul-bunnell or monospot positive)
Cytomegalovirus- particularly in immune compromised
Yellow fever- carried by mosquito
Herpes simplex- immunosuppressed and pregnancy
What is chronic hepatitis?
Any hepatitis lasting for 6 months or longer
Due to viral disease (hep B, C)
Due to autoimmune disease
Drug induced (methyldopa, isoniazid, nitrofurantoin, ketoconazole)
Hereditary (a1-antitrypsin deficiency, Wilson’s)
Others- IBD (UC)
What are the clinical features of chronic hepatitis (hep B)?
More frequent in men
Often preceded by an acute attack, or may be mild progressing, 50% present with established chronic liver disease
Moderate rise in aminotransferases, high ALP
Bilirubin normal
What are the clinical features of chronic hepatitis (hep C)?
Usually asymptomatic
Elevation in ALT
Severe inflammation fatigue
Some present with signs and symptoms of cirrhosis
What is autoimmune hepatitis?
Most frequent in women
Type 1 association with other diseases (pernicious anaemia, thyroiditis, Coombs positive haemolytic anaemia)
What are the clinical features of autoimmune hepatitis?
Peaks at peri and post menopausal
Early twenties- acute hepatitis, jaundice, high LFTs, clinical features of cirrhosis with hepatosplenomegaly
What investigations can aid in diagnosis of autoimmune hepatitis?
High LFTs, less elevation in ALP and bilirubin
y-globulin high, particularly IgG
Mild normochromic normocytic anaemia is seen with thrombocytopenia and leucopenia, PT prolonged
Type 1 (antinuclear/anti-actin)
Type 2 (anti-LKM1)
Type 3 (soluble liver antigen)
Liver biopsy
What are the differences between acute and chronic hepatitis?
Acute: nausea, vomiting, RUQ pain, high bilirubin
Chronic: sometimes asymptomatic, fever, fatigue, loss of appetite, extra hepatic symptoms
Acute: hepatomegaly
Chronic: liver may feel normal (if cirrhosis lower margin can feel irregular)
What is chronic D hepatitis?
Spontaneous revolution rare
60-70% patients will develop cirrhosis more rapidly than with HBV alone
Anti-delta antibody in patient with chronic liver disease who is HBsAG +
Which antibodies are found in autoimmune hepatitis?
Anti-smooth muscle
