Hepatology Flashcards
Mode of transmission of HAV, HEV?
feco-oral (food transmitted)
Mode of transmission of HBV, HCV?
blood derived.
Pt with +ve anti-HBs and -ve all other HBV serology»>
Vaccination
Pt with +ve anti-HBs, anti-HBc and -ve all other HBV serology»>
Chronic HBV Inf
First marker appears in the blood»>
surface antigen
Marker detected only by liver biopsy»>
Hbc-Ag
Marker of highly infectivity»>
e-Antigen
How to follow u Hepatitis infection?
PCR
Acute cases hepatitis?
NO TTT
CHRONIC HEPATITIS:
More than 6 months with +ve serology.
TTT of chronic HBV?
lamivudin, interferon.
Post- exposure prophylaxis of HBV:
History of previous vaccination?
reassure
Wash hand is the 1st step if needle puncture
First step:
If history of vaccination?
reassure
If not vaccinated? If Hep (+) for antibodies? If (-) for antibodies = susceptible?
check immune status
reassure
vaccine and IVIG
If in the exam no option for checking the immune status?
go for vaccine and IVIG
Baby born to HBV mother what to do with baby?
Vaccine and IVIG immediately to the newly born.
Chronicity of hepatitis B in adult in how many percent?
10-15%
Chronicity of hepatitis B in newly born is how many percent?
over 75 %
TTT of hepatitis B?
INTERFERON AND LAMIVUDINE
Main SE of interferon?
depression and fatigue
If depression occurred in Hep B tx, what to do?
stop interferon
Post- exposure prophylaxis of Hepatitis C:
First step?
Second step?
check base line immune status
serial labs for 6 months
If (+) for HCV antibodies?
IF HCV RNA (+)?
NEXT STEP HCV RNA
start ttt
TTT of hepatitis C?
interferon and ribavirin
Chronicity of hepatitis C?
over 75%
Counseling Q for pts with HCV inf:
Vaginal delivery?
Available
Lactation in Hep C?
Available
Sex in Hep C
Available but preferred to use condom.
Best way to avoid hepatitis C?
avoid sharing razors.. imp
Alcoholic + gynaecomastia + bilateral parotid swelling+ scrotal swelling?
= Alcoholic liver disease
Best way to avoid neonatal Hep C infection ?
avoid scalp electrodes
when to screen for hepatitis C in neonate?
18 months ( antibody)
Pt returned from Thailand presents with fever, jaundice, RUQ abdominal pain. His lab shows increase in ALT, AST, normal AP… Dx:
HAV infection.
Pt returned from Thailand presents with fever, jaundice, RUQ abdominal pain. His lab shows increase in ALT, AST, marked increase AP… Dx:
acute cholangitis.
Pt returned from Thailand presents with fever, RUQ abdominal pain. His lab shows ++WBCs& normal ALT, AST, AP… Dx:
acute cholecystitis.
Prophylaxis against HAV:
inactivated vaccine “4 Ws before travel”
Most effective measure to control HAV epidemic at school?
control of food source
And vaccination
Pt with liver cirrhosis, ascites develops abdominal pain, fever… Dx:
SPB.
Inv of choice for SBP?
paracentesis (++ WBCs, >250 neutrophil)
TTT of choice SBP?
IV cefotaxime
Prevention of recurrence SBP?
TMP-SMX.
Most accurate test of 1ry biliary cirrhosis?
AMA.
Definitive TTT of 1ry biliary cirrhosis?
liver transplant.
Pt with cirrhosis, choriform movement, personality changes: Dx:
wilson’s disease
Best initial test of Wilsons?
– ceruplasmin level& slit lamp exam of eye (kayser flischer ring)
Most accurate test Wilsons?
liver biopsy
TTT of choice wilsons?
penicillamine
Best initial test of hemochromatosis?
trans-ferritin level or ferritin level… If both found in choice: transferritin level.
If ferritin or transferrin high in hemochromatosis?
next step is gene analysis …vvvvvv imp
Most accurate test in hemochromatosis?
liver biopsy.
TTT of hemochromatosis
phlebotomy.
Screening of hemochromatosis:
Normal population:
1st step?
2nd step?
serum ferritin or better transferrin
if any of the above high do gene analysis
Who to screen for hemochromatosis:
those with 1st degree relative with hemochromatosis.
1st step of screening those that are predisposed?
HFE gene mutation
When to test kids for hemochromatosis: ???
If both parents are carrier
Pt with hemochromatosis known to have cirrhosis came with fever, abdominal pain… Dx:
SBP.
Pt with obesity, DM, hyperlipidemia develops hepatomegaly… Dx:
NASH.
Young non-smoker with emphysema, liver cirrhosis… Dx:
A1AT deficiency.
Young non-smoker with pan-acinar emphysema:
U must survey his liver.
Cause of hepatic encephalopathy in pt with cirhhosis:
increase ammonia level……next step is lactulose and enema
MCC of liver cirrhosis in Australia:
alcoholic liver disease.
TTT of emphysematous cholecystitis:
IV fluid, abs & emergent surgery.
VVV imp notes:
Common cause of cirrhosis in Australia:
Alcohol
Most common virus causing chronicity in adult?
C
Most common virus causing chronicity in kids?
B
Most common virus causing liver cancer?
B
Most common virus to be transmitted after needle abrasion?
B
Most common virus transmitted by food?
A
Virus that can kill adult while very benign in kids?
A
Viruses transmitted by food?
A and E
Virus that can kill pregnant women?
E
Virus that is associated with hepatitis B?
D
MC route of HBV transmission?
Perinatal
Best inv of chronic hepatitis?
liver biopsy.
MCC for the need of liver transplantation:
cirrhosis
MCC disease cause need of liver transplant in Australia:?
alcoholic liver disease
Pt on list for transplant, MCC that this pt may not be given the liver?
pt say he can’t stop drinking.
HBV Vaccine
vaccine available & post- exposure prophylaxis also available.
HCV Vaccine
NO vaccine available& NO post- exposure prophylaxis.
Take care:
Most common virus causing Hepatic cancer?
B
Most common toxin causing hepatic cancer?
aflatoxin
Most common cause of hepatic cancer over all?
cirrhosis
If bleeding varices:
. VARICEAL BLEEDING MANAGEMENT:
. The 1st step?
RESUSCITATION (normal saline )
If you need blood:VARICEAL BLEEDING
packed RBC’s ( O- RH- low hemolysis),
1st step to control bleeding………sengstaken tube
Definitive ttt of VARICEAL BLEEDING
If failed?
band ligation
TIPS
Pain in RT upper quadrant area, fever, jaundice + air fluid level in the biliary tree:
Next step?
clostridium cholecystitis
iv fluid and antibiotics
Definitive ttt cholecystitis
surgery
