Hepatitis Flashcards
Implications of hepatitis?
Cross-infection
Bleeding
Anaesthesia/drugs
Causes of hepatitis?
Viral - Hep A B C, Epstein Barr virus (glandular fever)
Drug reactions - paracetamol (acute liver damage)
Uncommon - autoimmune
Rare - Wilson’s disuse (liver problem), toxins
What is acute hepatitis?
Self limiting liver inflammation
What causes acute hepatitis?
Viral, acute alcoholic hepatitis, drugs, toxins, medication
Investigations for acute hepatitis?
LFTs - liver function tests - test hepatic enzymes
tests to determine cause e.g. viral serology, immunoglobulins, autoantibody profile
Live ultrasonology
Clinical features of chronic liver disease?
Cirrhosis
Causes of chronic liver disease?
Chronic Hep C and alcohol abuse
Signs and symptoms of chronic liver disease due to…?
Liver fibrosis
Reduced liver cell mass
Portal hypertension
What is the effect of reduced liver cell mass?
Liver does not detoxify as well = encephalopathy = reduced attention span, reverse sleeping pattern
What are the signs and symptoms of chronic liver disease?
Encepahlopathy due to reduced liver cell mass
Loss of lean body mass
Accumulation of body water
Coagulopathy
Why does chronic liver disease cause accumulation of body water?
Effect on protein metabolism, fluid leaks out into extravascular spaces, due to change in oncotic pressure
What will patients with chronic liver disease often present with in history?
Jaundice alcohol intake Known infections History of drug intolerance Bleeding disorder IV drug use Sexual history
Suggest some Q that can establish whether a patient in in high risk category for infection of blood borne virus?
Have you ever been told you are positive for HIV/AIDS or Hep B/C?
Have you ever injected yourself with drugs? This includes body building drugs?
have you ever received a blood transfusion outside of UK? if yes where?
Signs of jaundice?
Yellow skin - especially in the eyes
What is sider nevi?
Central artery with small arterioles coming out
What will patients with chronic liver disease present with in examination?
Jaundice Brusing Spider naevi Liver flap (asterixis) scratch marks Sialosis (enlargement of salivary glands) Palmar Erythema (red palms)
What do raised levels of alanine transaminase (ALT) and aspartate transaminase (AST) suggest?
Problem with liver cell integrity (due to excess alcohol or infection)
It what kind of patient will gammons glutamyl transpeptidase be raised?
Alcoholics
What liver function test can distinguish between alcohol induced liver damage and infection?
ALT and AST raised in both
gamma GT only raised in alcoholics
How will alkaline phosphatase change in liver problems?
Raised
How to reduce cross infection of infectious disease?
Immunisation
Hand washing
Avoidance of needlestick
masks, gloves, specs
Explain the serological markers for Hep B
a) hep B surface antigen
b) Anti Heb B surface antigen
c) hep B core antigen
d) Hep B e Antigen
a) marker of ongoing infectivity
b) protection from infection
c) donor infectivity
d) only found if His Ag positive - signifies active viral replication - index of infectivity
Where are drugs metabolised?
Liver
What is hepato-renal syndrome?
Kidney failure due to liver failure
why are patients with jaundice given the least toxic anaesthetics?
Higher risk of leading to hepato-renal syndrome
In patients with liver problems, should you prescribe miconazole and fluconazole?
Miconazole is contra-indicated. Fluconazole should be at a decreased dose
Why should NSAIDS be avoided in patients with liver problems?
GI bleeding
What are alcoholics at risk of in terms of problems with liver?
Haematemesis (vomiting blood) due to portal hypertension
Due to the risk of haemeatemesis in alcoholic patients, they often take beta blockers, why is this of importance when prescribing anaesthesia?
Reduced plasma clearance of epinephrine (adrenaline)
What are the risks in terms of bleeding in alcoholic patients?
Increased bleeding
What 3 things should you think about if treating a patient with hep/liver problems?
Cross-infection
Bleeding
Issues relating to anaesthesia/drugs
