Hepatitis

Question 1

What three findings do you expect to see on blood tests on a pt with alcoholic hepatitis?

Answer 1

Raised MCV
Raised GGT
AST:ALT>2

Question 2

How do you treat alcoholic hepatitis?

Answer 2

Pabrinex
Optimise nutrition
Daily weight, LFT’s, U+E’s, INR

Question 3

What score predicts 30 day mortality in alcoholic hepatitis?

Answer 3

Maddrey score

Mild - 0-5%
Severe - 50%

Question 4

How many patients with alcoholic hepatitis die after 1 year of admission

Answer 4

40%

Question 5

What two types of hepatitis are spread faecal-orally?

Answer 5

A and E

Question 6

How are Hepatitis B, C and D transferred?

Answer 6

IV

Question 7

What is a hepatitis D infection usually dependent on?

Answer 7

Prior Hepatitis B infection

Question 8

Describe the three main symptoms in the prodromal phase of hepatitis

Answer 8

Flu-Like:

Malaise
Arthralgia
Nausea

Question 9

What do hepatitis A suffers acquire a distaste of?

Answer 9

Cigarettes

Question 10

Which hepatitis infections is the prodrome most common in

Answer 10

A and B

Question 11

Acute jaundice is seen in which types of hepatitis?

Answer 11

A>B>C

99%>75%>25%

Question 12

What is the classic triad of hepatitis?

Answer 12

Abdo pain
Hepatomegaly
Cholestasis: Dark urine, Pale Stools

Question 13

What kind of extrahepatic features can a pt get due to complexes? (esp Hep B?) (5)

Answer 13

Urticaria or vasculitic rash
Cryoglobulinaemia
PAN
GN
Arthritis

Question 14

Which hepatitis infections have the potential to become chronic

Answer 14

Mainly C (80% become chronic)
B in childhood (10% become chronic)

Question 15

What does icteric phase mean?

Answer 15

icteric = jaundice

Question 16

What are the investigations for infective hepatitis? (4)

Answer 16

FBC
LFT
Clotting
Hep A/B/C serology

Question 17

What does HBsAg stand for?

Answer 17

Hep B surface antigen

It is the first detectable viral antigen to appear during infection

Question 18

What does anti-HBc IgM stand for?

Answer 18

Anti-Hep B core antigen Immunoglobulin M

This is tested to assess whether the body has responded to the Hep B virus. Usually paired with a test for anti-HBc IgG termed collectively as a ‘total anti-HBc’ assay.

Question 19

What anti-virals are given for Hep B?

Answer 19

PEGinterferon

Question 20

What anti-virals are given for Hep C?

Answer 20

PEGinterferon + ribavarin

Question 21

What is the definition of NAFLD (non-alcoholic fatty liver disease)

Answer 21

Cryptogenic cause of hepatitis and cirrhosis associated with insulin resistance and the metabolic syndrome

Question 22

What is NASH?

Answer 22

Non-alcoholic steatohepatitis - the most extreme form of NAFLD (cirrhosis in 10%)

Question 23

What are the four main risk factors for NAFLD

Answer 23

Obesity
HTN
T2DM
Hyperlipidaemia

Question 24

What are the symptoms and signs of NAFLD?

Answer 24

Mostly asymptomatic

Hepatomegaly + RUQ discomfort

Question 25

What are the signs and symptoms of metabolic syndrome?

Answer 25

Central obesity and two of:

high serum triglycerides
low HDL’s
HTN
Hyperglycaemia

Question 26

What is the management of metabolic syndrome?

Answer 26

Lose weight

control HTN, DM and lipids

Question 27

Define autoimmune hepatitis?

Answer 27

Inflammatory disease of unknown cause characterised by antibodies directed against hepatocyte surface antigens

Question 28

What does it mean if a patient is +ve for anti-HBs?

Answer 28

Indicates previous exposure to the HBV, or patient has been vaccinated against hepB. Virus is no longer present.