hepatitis and liver disease

Question 1

HBsAg surface antigen is first marker to rise

when is it detectable

Answer 1

virus is actively present

Question 2

Anti-HBsAg is human antibody against HBsAg what does this imply

Answer 2

this implies immuniy either via vaccination or recovered from infection

Question 3

Anti-HBc is the core antibody - when is it only made

Answer 3

in response to an infection, not a vaccine.

Question 4

anti-HBC is divided into what two anitbodies and what does this tell us

Answer 4

It is divided into IgG and IgM – the IgM is only detectable in acute infection whereas the IgG is detectable for life

Question 5

what would an acute infection show

Answer 5

positive for
HbsAg
anti-igM Hbc
anti-IgG HBc

Question 6

what would a chronic infection show

Answer 6

HbsAg
Anti-IgG Hbc

Question 7

vaccinated

Answer 7

Anti-HbsAG positive

Question 8

recovered

Answer 8

Anti-IgG Hbc
anti-HbsAg

Question 10

how do you manage heb b infections

Answer 10

Antiviral therapy – pegylated interferon and nucleoside analogues

Question 11

what type of hepatitis follows tis pattern

typically produces a flu-like prodrome before signs of acute hepatitis (tender hepatomegaly and jaundice) but does not typically cause chronic disease.

Answer 11

hep A

Question 12

f hep c is left untreated what could it led to

Answer 12

liver cirrhosis with a high risk of hepatocellular carcinoma.

Question 13

Transient elastography uses ultrasound vibrations to measure what

Answer 13

liver stiffness - chronic liver failuree

Question 14

NAFLD is the most common cause of
ld

Answer 14

Its aetiology is thought to be associated with increased insulin resistance.

There is a build-up of fat in hepatocytes (steatosis) which leads to inflammation called steatohepatitis. Over time, it slowly progresses to liver cirrhosis.

It is associated with metabolic factors e.g., type 2 diabetes and hyperlipidemia.

Question 15

how does the serum ascites albumin gradient SAAG tell us whether the ascites has been caused by liver diseasee or not

Answer 15

If > 11 g/L, indicative of liver disease (as it suggests it is due to increased hydrostatic pressure secondary to portal hypertension)

If < 11 g/L, this suggest the cause is not liver related, e.g., malignancy, TB, trauma

Question 16

mx of ascites

Answer 16

Fluid restriction

Diuretics such as spironolactone

Drainage if very large

Question 17

Spontaneous Bacterial Peritonitis is what

Answer 17

infection of the ascitic fluid, despite the absence of a clear infection source.
secondary to E. coli bacterial translocation from the bowel, usually as a complication of ascites secondary to liver cirrhosis.

Question 18

how is SBP dx

Answer 18

This leads to a triad of ascites, abdominal pain and fever.

It is diagnosed by an ascitic tap which can be sent for cytology and culture.
Paracentesis (ascitic tap) and check for raised neutrophils

Question 19

mx of SBP

Answer 19

Prophylactic antibiotics (e.g., norfloxacin) are given to patients who have a fluid protein less than 15 g/L or a previous episode of SBP

Treatment involves antibiotics (e.g., cefotaxime)

Question 20

what is hepatic encephalopathy

Answer 20

The liver is unable to remove ammonia from the blood, due to decreased function.

This allows ammonia to enter the systemic circulation and reach the brain.

It is theorized that neurotoxic substances, including ammonia and manganese, may gain entry into the brain in the setting of liver failure. These neurotoxic substances may then contribute to morphologic changes in the astrocytes. In cirrhosis, astrocytes may undergo Alzheimer type II astrocytosis
Ammonia is neurotoxic and can result in central nervous system dysfunction.

This ranges from mild confusion to asterixis and decreased consciousness.

Question 21

sx of hepatic encephalopathy

Answer 21

Gives altered GCS, and asterixis (liver flap) and constructional apraxia (can’t draw a star)

Stage 1 (irritability)

Stage 2 (confusion)

Stage 3 (Incoherent)

Stage 4 (coma)

Question 22

management of hepatic encephalopathy

Answer 22

1st line is lactulose (a laxative which flushes out ammonia producing gut bacteria)

Other options include rifaximin, an antibiotic which kills ammonia producing bacteria

Question 23

3 major complications of liver failure

Answer 23

heaptic encephalopathy
SBP
ascites