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Gastrointestinal Conditions (JBR) > Hepatitis, PSC and PBC > Flashcards

Hepatitis, PSC and PBC Flashcards

1
Q

Viral hepatitis presents with?

A 
Nausea
Vomiting 
Fatigue 
RUQ pain
Change in sense of smell or taste
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2
Q

How is Hep A spread?

A

Faecal oral
Poor hygiene
Contaminated food

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3
Q

Hep A presents as an?

A

Acute heptatitis

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4
Q

Hep A is common in?

A

MSM and PWIDs

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5
Q

Hep A is excreted in ___ then _____

A

Bile

Faeces

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6
Q

Hep A has a ____ incubation period

A

short

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7
Q

Epidemiologically, Hep A infections are?

A

Sporadic/endemic

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8
Q

Does Hep A have a carrier state?

A

No, it is directly cytophatic

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9
Q

How severe is Hep A illness?

A

Mild - usually full recovery

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10
Q

What are blood test features of the prodromal stage of Hep A?

A

Bilirubinuria, raised AST or ALT

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11
Q

What are symptomatic features of the prodromal stage of Hep A?

A

Anorexia, nausea, vomiting, alterations in case, arthralgia, malaise, fatigue, urticaria and pruritis

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12
Q

What is arthralgia?

A

joint pain

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13
Q

What is urticaria?

A

hives

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14
Q

What is pruritus?

A

itching without a rash

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15
Q

What are blood test features of the icteric stage of Hep A?

A

Serum bilirubin
Serum AS
Serum ALP is normal

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16
Q

What are symptomatic features of the icteric stage of Hep A?

A

Dark urine, followed by pale-coloured stools
GI symptoms + malaise
May develop RUQ pain with hepatomegaly

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17
Q

What are histopathological features of Hep A?

A

Predominantly lobular inflammation and hepatocyte necrosis

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18
Q

What are investigations for Hep A?

A

PT increased
Anti IgM = acute infection
Bloot test for Hep A IgM antibody

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19
Q

What are treatment options for Hep A?

A

None

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20
Q

What are prevention methods for Hep A?

A

Vaccine
Boil all water
EBV is a big cause

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21
Q

How does Hep B spread?

A

Sex, mother to child, blood

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22
Q

Chronic infection from hep B is more likely if?

A

First exposure is in childhood

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23
Q

What are possible outcomes from Hep B infection?

A 
Fulminant acute infection (death) 
Chronic hepatitis 
Cirrhosis 
HCC
Asymptomatic (carrier)
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24
Q

What causes liver damage in Hep B?

A

Antiviral immune response

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25
Q

For Hep B, Th1 indicates?

A

Viral clearance

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26
Q

For Hep B, Th2 indicates?

A

Chronic infection

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27
Q

Hep B is the only virus containing?

A

DNA (rest contain RNA)

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28
Q

What is the blood test for Hep B?

A

Hep B surface antigen (HBsAg)

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29
Q

If the surface antigen test for Hep B is positive you do a?

A

Full viral profile

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30
Q

What is the marker of acute Hep B infection?

A

Anti-HBc

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31
Q

What is the marker for recent infection with Hep B`

A

Hep B IgM

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32
Q

What is the marker for highly infectious individuals?

A

HepBeAg and DNA in high titre

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33
Q

What is the marker for immunity to Hep B?

A

Anti-HB

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34
Q

How do you treat Hep B?

A

Symptomatically

Monitor markers

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35
Q

How can you control Hep B spread?

A

Minimise exposure (safe blood, sex, needle exchange, screen pregnant, vaccination and post-exposure prophylaxis)

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36
Q

What are post-exposure prophylaxis measures for Hep B?

A

Vaccine

hyperimmune Hep B immunoglobulin (HBIG)

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37
Q

How do you treat chronic viral hepatitis?

A

Adefovir and entecavir
Infection control
Decrease alcohol
Screening

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38
Q

What do you give for chronic viral hepatitis if cirrhotic?

A

Influenza penumococcal

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39
Q

Hep C is more common in?

A

Indian and Pakistani

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40
Q

How is Hep C transmitted?

A

Like Hep B but less via sex

Blood - blood

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41
Q

Hep C is chronic in ___% of cases

A

75

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42
Q

What are blood features of Hep C?

A

Elevated ALT

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43
Q

What are extra hepatic features of Hep C?

44
Q

Symptom-wise, Hep C is often?

A

Asymptomatic

45
Q

How do you prevent Hep C?

A

Minimise exposure (no vaccine)

46
Q

How do you test for HCV?

A

Antibody test
Look for virus by PCR
often diagnosis by exclusion

47
Q

What are microscopic features of chronic HCV?

A

Dense portal chronic inflammation
Piecemeal necrosis
Lobular inflammation
Small amounts of steatosis (fatty liver), fibrosis

48
Q

What are outcomes of HCV?

A

Tends to become chronic

Cirrhosis

49
Q

What are treatment options for HCV?

A

peg interferon and ribacvarin

Th2 - fibrotic

50
Q

Hep D is ____ in the UK

51
Q

Hep D can only occur if?

A

In conjunction with Hep B

52
Q

Why can Hep D only coexist with hep B?

A

Incomplete RNA particle - can’t replicate on its own

53
Q

How does Hep E spread?

A

Faecal oral

Animals (pigs, deer, rabbit)

54
Q

Hep E is more common where?

A

Tropic (Travellers)

55
Q

Is there a vaccine for Hep E?

56
Q

Which viral hepatitis patients do you treat?

A

Antibody present

Risk of complications

57
Q

When do you treat viral hepatitis?

A

Before complications

Evidence of inflammation

58
Q

What is peginterferon (IFN-a)?

A

Human protein component of viral immune response made by genetic engineering

59
Q

What are side effects of IFN-a?

A

Makes you feel ill as if you have the flu

Can get thyroid, autoimmune and psychiatric disease

60
Q

What is Ribavirin?

A

An antiviral given alongside IFN-a

61
Q

What are side effects of ribavirin?

62
Q

What are treatment options for Hep B?

A

IFN-a
Suppressive antiviral drug
reduce progression of liver disease

63
Q

What are examples of suppressive antiviral drugs?

A

Enteclavir

Tenofovir

64
Q

What is the effect of suppressive antiviral drugs?

A

Suppress only don’t cure

Resistance can develop

65
Q

How do you treat hep C?

A

Remove RNA from blood

Antivirals

66
Q

Relapse from Hep C is?

67
Q

Progress of Hep C treatment is measured by?

A

SVR (sustained virological response)

68
Q

Which Hep C types are most common in Tayside?

A

Type 3 and 1a

69
Q

Autoimmune hepatitis is more common in?

70
Q

For PH, viral hepatitis is a?

A

Notifiable disease

71
Q

What are histology features of AI hepatitis from a biopsy?

A

Piecemeal necrosis
Interface hepatitis
Excess of plasma cells

72
Q

Features of type I AI hepatitis?

A

Adult (associated with extra-hepatic manifestations like Grave’s)

73
Q

Features of type II AI hepatitis?

A

Children/young adults

74
Q

AI hepatitis may have some triggers including some?

75
Q

How does AI hepatitis present?

A

Hepatomegaly, jaundice stigmata of chronic liver disease, splenomegaly

76
Q

What are blood marker features of AI hepatitis?

A 
ALT 100-800
Increased AST
Increased PT 
ASMA ++ 
Increased IgG 
Serum Immunoglobulins
77
Q

What are non-specific features of AI Hepatitis?

A 
Malaise
Fatigue 
Lethargy 
Nausea
Abdo pain
Anorexia
78
Q

How do you diagnose AI Hepatitis?

A

Presence of autoimmune antibodies

Liver biopsy

79
Q

How do you treat Autoimmune Hepatitis?

A

Prednisolone (acute)

Azathioprine (steroid-sparing - lon-term)

80
Q

What does PBC stand for?

A

Primary Biliary Cirrhosis/Cholangitis

81
Q

What is PBC?

A

Rare autoimmune condition of unknown origin
Destruction of the bile ducts by immunological mechanisms leading to damage of hepatocytes, subsequent fibrosis with hepatocyte regeneration leading to cirrhosis

82
Q

What is the autoimmune component of PBC?

A

T-cell mediated

CD4 cells react to M2 target

83
Q

What is found on histopathology of PBC?

A

Chronic portal inflammation

Bile ducts inflamed

84
Q

PBC is more common in?

85
Q

How does PBC present?

A

Usually asymptomatic

Fatigue, itch without rash, xanthelasma/xantheloma

86
Q

How do you investigate PBC?

A

2/3 have +ve AMA (anti-mitochondrial antibody)
Cholestatic LFTs
Liver biopsy

87
Q

What does ASMA stand for?

A

Autoantibodies to smooth muscle

88
Q

What is Liver biopsy used for in the investigation of PBC?

A

Stage disease

89
Q

How do you treat PBC?

A

Ursodeoxycholic acid

90
Q

What is a common side effects of ursodeoxycholic acid?

91
Q

What are rare side effects of ursodeoxycholic acid?

A

Abdominal pain
Gallstone calcification
Urticaria
Nausea, vomiting, pruritus

92
Q

What is PSC?

A

Autoimmune destruction of medium and large sized bile ducts

93
Q

PSC is more common in?

94
Q

PSC stands for?

A

Primary sclerosis cholangitis

95
Q

PSC is associated with which condition?

A

Ulcerative Colitis

96
Q

PSC is a chronic inflammatory process affecting?

A

Intra and extra-hepatic bile ducts

97
Q

PSC leads to?

A

Periductal fibrosis (onion skinning), duct destruction, jaundice and fibrosis

98
Q

PSC causes an increased risk of?

A

Malignancy in bile ducts and the colon

99
Q

How does PSC present?

A

Recurrent cholangitis

100
Q

How do you investigate PSC?

101
Q

How do you manage PSC?

A

Maintain bile flow

Monitor for cholangiocarcinoma and CRC

102
Q

Chronic Drug induced hepatitis has similar features to?

A

All other types of chronic hepatitis

103
Q

Chronic Drug induced hepatitis can be does related or?

A

Idiosyncratic

104
Q

Chronic Drug-induced hepatitis may trigger?

A

Autoimmune hepatitis

105
Q

What is seen microscopically for chronic drug-induced hepatitis?

A

Chronic active process: granuloma, fibrosis, necrosis, failure, cholestasis +/- cirrhosis

Gastrointestinal Conditions (JBR) (33 decks)

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