Hepatitis Flashcards
What three findings do you expect to see on blood tests on a pt with alcoholic hepatitis?
Raised MCV
Raised GGT
AST:ALT>2
How do you treat alcoholic hepatitis?
Pabrinex
Optimise nutrition
Daily weight, LFT’s, U+E’s, INR
What score predicts 30 day mortality in alcoholic hepatitis?
Maddrey score
Mild - 0-5%
Severe - 50%
How many patients with alcoholic hepatitis die after 1 year of admission
40%
What two types of hepatitis are spread faecal-orally?
A and E
How are Hepatitis B, C and D transferred?
IV
What is a hepatitis D infection usually dependent on?
Prior Hepatitis B infection
Describe the three main symptoms in the prodromal phase of hepatitis
Flu-Like:
Malaise
Arthralgia
Nausea
What do hepatitis A suffers acquire a distaste of?
Cigarettes
Which hepatitis infections is the prodrome most common in
A and B
Acute jaundice is seen in which types of hepatitis?
A>B>C
99%>75%>25%
What is the classic triad of hepatitis?
Abdo pain
Hepatomegaly
Cholestasis: Dark urine, Pale Stools
What kind of extrahepatic features can a pt get due to complexes? (esp Hep B?) (5)
Urticaria or vasculitic rash Cryoglobulinaemia PAN GN Arthritis
Which hepatitis infections have the potential to become chronic
Mainly C (80% become chronic) B in childhood (10% become chronic)
What does icteric phase mean?
icteric = jaundice
What are the investigations for infective hepatitis? (4)
FBC
LFT
Clotting
Hep A/B/C serology
What does HBsAg stand for?
Hep B surface antigen
It is the first detectable viral antigen to appear during infection
What does anti-HBc IgM stand for?
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.
What anti-virals are given for Hep B?
PEGinterferon
What anti-virals are given for Hep C?
PEGinterferon + ribavarin
What is the definition of NAFLD (non-alcoholic fatty liver disease)
Cryptogenic cause of hepatitis and cirrhosis associated with insulin resistance and the metabolic syndrome
What is NASH?
Non-alcoholic steatohepatitis - the most extreme form of NAFLD (cirrhosis in 10%)
What are the four main risk factors for NAFLD
Obesity
HTN
T2DM
Hyperlipidaemia
What are the symptoms and signs of NAFLD?
Mostly asymptomatic
Hepatomegaly + RUQ discomfort
What are the signs and symptoms of metabolic syndrome?
Central obesity and two of:
high serum triglycerides
low HDL’s
HTN
Hyperglycaemia
What is the management of metabolic syndrome?
Lose weight
control HTN, DM and lipids
Define autoimmune hepatitis?
Inflammatory disease of unknown cause characterised by antibodies directed against hepatocyte surface antigens
What does it mean if a patient is +ve for anti-HBs?
Indicates previous exposure to the HBV, or patient has been vaccinated against hepB. Virus is no longer present.
