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Liver > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

What is hepatitis?

A

Inflammation of the liver

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2
Q

What is the difference between acute and chronic hepatitis?

A

Acute: less than 6 months, usually self limiting and liver returns to normal

Chronic: over 6 months, repeated attacks on liver takes a toll on it.

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3
Q

How does acute hepatitis present?

A

Can be asymptomatic

Malaise
GI upset
Myalgia
Abdominal pain
Jaundice
Dark urine + pale stools
Tender hepatomegaly
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4
Q

Causes of acute hepatitis?

A

Infection:

  • viral
  • bacterial
  • parasitic
Alcohol
Drugs
Toxins
Pregnancy
Autoimmune
Genetic conditions
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5
Q

Which viruses can cause acute hepatitis?

A

Hepatitis A-E

Herpes viruses

  • Epstein Barr virus
  • Cytomegalovirus
  • Varicella Zoster virus
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6
Q

Which bacteria can cause acute hepatitis?

A

Leptospirosis

Coxiella

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7
Q

Which parasite(s) can cause acute hepatitis?

A

Toxoplasmosis

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8
Q

How does chronic hepatitis present?

A

Asymptomatic

Jaundice
Ascites
Low albumin
Coagulopathy

Signs of chronic liver disease:

  • Clubbing
  • Palmar erythema
  • Spider naevi
  • Dupuytren’s contracture
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9
Q

What is coagulopathy?

A

Impaired ability to clot blood, because the liver isn’t producing enough of the proteins in the coagulation cascade

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10
Q

What is palmar erythema?

A

Red palms

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11
Q

What are spider naevi?

A

On the skin

A central red spot and reddish extensions which radiate outwards like a spider’s web.

They are caused by swollen blood vessels

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12
Q

What is Dupuytren’s contracture?

A

Fixed forward curvature of finger(s) caused by the development of fibrous tissue between finger tendons and on the skin of the palm

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13
Q

What happens in chronic hepatitis that means liver function is maintained?

A

Compensation

The body compensates for the problems, meaning chronic hepatitis can sometimes be asymptomatic

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14
Q

What are some complications of chronic hepatitis?

A

Chronic liver disease - fibrosis, cirrhosis

Hepatocellular carcinoma

Portal hypertension

Gastro-oesophageal varices

GI bleed

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15
Q

What causes chronic hepatitis?

A

Hepatitis B-D

Autoimmune hepatitis
Drugs
Alcohol
Genetic conditions

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16
Q

Describe the effect on acute hepatitis on the liver?

A

Damage to cells

Influx of neutrophils causes necrosis

Death of cells due to necrosis or apoptosis

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17
Q

Describe the effect of chronic hepatitis on the liver?

A

Damage and destruction of hepatocytes and other cells

The liver regenerates not in an orderly fashion

Damaged cells are replaced with scar tissue

Over time, there are only a few islands of hepatocytes left amongst the scar tissue

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18
Q

How would you distinguish autoimmune hepatitis from other types?

A

Blood tests:
Increased IgG levels
Antibodies against liver proteins

Biopsy: mononuclear infiltrate, you would see white blood cells in the liver

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19
Q

What causes autoimmune hepatitis?

A

Genetics

Sometimes viral infections (viral hepatitis or EBV)

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20
Q

How do patients with autoimmune hepatitis present?

A

Acute initially, but they will eventually become chronic

Fatigue
Anorexia
Weight loss
Amenorrhoea
Abdominal pain
Coagulopathy
Jaundice
Hepatomegaly
Ascites
Signs: Palmar erythema, spider naevi
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21
Q

How would you manage autoimmune hepatitis?

A

Immunosuppressants

  • prednisolone
  • non-steroids

Liver transplant

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22
Q

Name the hepatitis viruses.

A 
A
B
C
D
E
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23
Q

How is hepatitis A spread?

A

Faecal-oral route

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24
Q

What type of virus is hepatitis A?

A

RNA virus

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25
Q

What food is hepatitis A commonly found in?

A

Shellfish

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26
Q

Does hepatitis A cause an acute or chronic illness?

A

Acute, it never progresses to chronic

It is a self-limiting infection

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27
Q

Do you acquire immunity to hepatitis A after an infection with it?

A

Yes

100% immunity

28
Q

How long does a hep A infection usually last?

A

3-6 weeks

29
Q

Management of hep A infection.

A

Supportive care

Monitor liver

Check close contacts and give them prophylaxis

30
Q

What can you do to prevent hep A infection?

A

Vaccinate

HNIG - human normal immunoglobulin - provide someone with donor hep A antibodies

31
Q

Summarise hep A!

A

A is Acquired by mouth for Anus, is Always cleared Acutely and only ever Appears once

32
Q

How is hep E spread?

A

Faecal-oral route

Water or food-borne

33
Q

What type of virus is hep E?

A

A small RNA virus

34
Q

There are different genotypes of hep E, one of these is found in an animal, which animal?

A

Pigs

Virus can be found in some British sausages

35
Q

Does hep E cause an acute or chronic infection?

A

Usually self-limiting acute infection

It can become chronic in the immunocompromised

36
Q

Which people do you need to be extra concerned about if they get hep E?

A

Pregnant women: mortality is as high as 10-20%

Immunocompromised: can progress to chronic hepatitis

37
Q

Summarise hep E!

A

E is Even in England and can be Eaten, if not always beaten

38
Q

What is the link between hep B and D?

A

You can’t be infected with D without having B too

39
Q

What type of virus is hep B?

A

DNA virus

40
Q

How is hep B spread?

A

Blood-borne

  • needle stick
  • tattoos
  • sexual
  • vertical
41
Q

Is hep B an acute or chronic infection?

A

Acute

But can become chronic if the immune system can’t right it off

42
Q

Management of hep B?

A

Supportive care
Monitor liver function
Treat with drugs

Contacts: post-exposure prophylaxis, vaccination

43
Q

What is a serious complication that can occur from hep B?

A

Fulminant liver failure

44
Q

What 2 drug treatment options are there to treat hep B?

Describe them briefly

A

Pegasys

  • stimulates the immune system to fight off infection better
  • weekly subcut injection
  • nasty side effects

Nucleoside analogues

  • inhibit viral replication
  • one tablet per day
  • fewer side effects
  • lifelong
45
Q

What is fulminant liver failure?

A

Acute liver failure that results in encephalopathy within 8 weeks

46
Q

What is encephalopathy?

A

Neurological symptoms: confusion, coma, can lead to death

47
Q

What is the delta virus?

A

Hepatitis D

48
Q

Why is it that hep D cannot infect without hep B?

A

The virus is a bit defective

It needs the hep B surface antigens to survive

49
Q

Is it best to have hep B and D together or to have just hep B?

A

Best to have just hep B

Hep B and D together cause a faster rate of fibrosis of the liver

50
Q

In an infection of hep B and D, which virus is dominant?

A

Hep D

51
Q

Does hep D cause a chronic or acute infection?

A

Acute leading to chronic

52
Q

Where is hep B virus found?

A

All over the place

53
Q

Summarise hep B?

A

B is Blood-Borne and if not Beaten can be Bad

54
Q

Summarise hep B and D?

A

B and D are DastarDly

55
Q

What type of virus is hep C?

A

A flavivirus - RNA

56
Q

How is hep C spread?

A

Blood-borne
Sexually transmitted
Mother to baby

57
Q

What are the complications of a hep C infection?

A

Chronic hep C can lead to cirrhosis

Which can lead to Hepatocellular carcinoma

58
Q

Is hep C a chronic or acute infection?

A

Acute that becomes chronic

59
Q

Management of hep C?

A

Drug treatment: Pegasys + Ribvirin

Contacts: screen

60
Q

How do you prevent hep C?

A

No vaccine

Take precautions: needle exchanges, condoms

61
Q

Summarise hep C?

A

C is usually Chronic but Can be Cured at a Cost

62
Q

How does hep A present?

A 
Nausea
Anorexia
Jaundice
Dark urine + pale stools
Hepatomegaly
Skin rash
Lymphadenopathy
63
Q

How does hep B present?

A

Skin rash
Arthralgia

Nausea
Anorexia
Jaundice
Dark urine + pale stools
Hepatomegaly
Lymphadenopathy
64
Q

How does hep C present?

A

Mild symptoms, occasionally jaundice

Not usually picked up until infection is chronic

65
Q

How does hep E present?

A 
Nausea
Anorexia
Jaundice
Dark urine + pale stools
Hepatomegaly
Skin rash
Lymphadenopathy

Signs of chronic liver disease

Liver (10 decks)

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