Hepatitis Flashcards
What is the definition of hepatitis
Injury to the liver characterised by inflammatory cells in the tissue
What are the causes of hepatitis
Viral:- Hep A Hep B Hep C Hep D Hep E EBV CMV
Drugs and toxins:-
Alcohol
Paracetamol
NSAIDs
Autoimmune
Ischaemia
What is the commonest cause worldwide of liver damage
Viral hepatitis
How is Hep A spread
Faeco-oral route
How is Hep B spread
Haematogenous spread
Sexually
Vertical transmission
How is Hep C spread
Haematogenous spread
Sexually
Vertical transmission
How is Hep D spread
Only co-infects/superinfects with Hep B
How is Hep E spread
Faeco-oral route
How can acute viral hepatitis present
Prodromal flu-like illness Anorexia Jaundice Tender hepatomegaly Lymphadenopathy Splenomegaly Acute liver failure
What are the complications of chronice Hep B and C hepatitis
Hepatocellular carcinoma
What would you expect to find on LFTs in a patient with viral hepatitis
Very high transaminases
May reach over 10,000 units
What medications would you give to a patient with chronic viral hepatitis (B)
Peginterferon alpha-2a - first line (Not for use in pregnant women)
Tenofovir - second line
How does the presentation of alcoholic hepatitis differ from that of viral hepatitis
Rarely RUQ pain
Symptoms of withdrawal - Delirium tremens
How can you differ between viral and alcoholic hepatitis on investigation
Transaminases usually raised to less than 200 and no over 400 in alcoholic
Signs of cirrhosis in alcoholic - reduced albumin, anaemia, thrombocytopaenia, prolonged PT
AST normally greater than ALT in alcoholic
What other drugs can cause hepatitis
Paracetamol
Anti-TB drugs
Antibiotics - sulphonamides, coamoxiclav, nitrofurantoin
Antiretrovirals - zidovudine
Antiepileptics - phenytoin, carbamazepine
Immune suppression - azathioprine, methotrexate
NSAIDs
Allopurinol
Amiodarone
What is the cause of autoimmune hepatitis
Unknown aetiology
Cell-mediated immune response producing autoantibodies against hepatocytes
Who is more likely to get autoimmune hepatitis
Females
What diseases are associated with autoimmune hepatitis
Autoimmune thyroiditis Autoimmune haemolytic anaemia Pernicious anaemia Fibrosing alveolitis Ulcerative colitis Glomerulonephritis
How can identify autoimmune hepatitis on investigation
Elevated transaminases - higher than in alcoholic but less than viral hepatitis
Viral > Autoimmune > Alcoholic
Positive autoantibodies - ANA, SMA
Increased globulins
What diagnostic test would you do to confirm autoimmune hepatitis
Liver biopsy - chronic inflammatory cell infiltrates, predominately plasma cells
What medication do you give for autoimmune hepatitis
Steroids
Azathioprine
What is ischaemic hepatitis
Occurs when there is decreased blood supply to the liver due to significant hypotension or hepatic arterial occlusion
What are some causes of hepatic arterial occlusion
Sickle cell crisis
Thrombosis
How does ischaemic hepatitis present
Few liver signs/symptoms
Hypotension - low urine production
RUQ pain
