Hepatology Flashcards
Metabolism and detoxification of drugs are dependant on what system?
An effective liver enzyme system
What is jaundice?
Yellowish pigmentation of the skin, conjunctiva, and other mucous membranes
What is hyperbilirubinemia?
A build up of bilirubin in the blood, this causes the yellow colour in jaundice
What is the first thing to change colour when bilirubin levels rise?
Conjunctiva
What is the conjunctiva?
The conjunctiva is a tissue that lines the inside of the eyelids and covers the sclera (the white of the eye)
What is pre hepatic jaundice?
Excessive red cell breakdown which overwhelms the liver’s ability to conjugate bilirubin. This causes an unconjugated hyperbilirubinaemia.
What is hepatic jaundice?
Dysfunction of the hepatic cells. The liver loses the ability to conjugate bilirubin
What is post hepatic jaundice?
Obstruction of biliary drainage
Potential causes for pre hepatic jaundice? (4)
- Malaria
- Sickle cell anaemia
- Thalassemia
- Gilbert’s syndrome
Potential causes for hepatic jaundice? (6)
- Viral Hepatitis
- Drug induced hepatitis
- Alcoholic liver disease
- Hepatotoxicity
- Cirrhosis
- Leptospirosis
Potential causes for post hepatic jaundice? (4)
- Gallstone
- Pancreatic cancer
- Liver flukes
- Stricture of bile duct
What does the outer envelope of the HBV contain? (3)
- Hepatitis B surface antigen protein (HBsAg)
- Glycoproteins
- Cellular lipid
Where is the highest prevalence of the HBV infection?
Sub-saharan Africa and East Asia
What are the modes of transmission for HBV? (5)
- Perinatal
- Sexual
- Blood transfusion
- Intravenous drug user
- Needle-stick injury
What does the Hepatitis B vaccination contain?
HBsAg adsorbed onto aluminium hydroxide adjuvant
What percentage of adults are non responders to the Hep B vaccine?
10% - 15%
What would be the antibody titre for a;
- Non responder
- Poor responder
- Good responder
- <10
- 10-100
- > 100
If a person has an antibody titre of <10 (besides being a non responder) would could this suggest? (3)
- Natural immunity due to past infection
- Incubating actue Hep B
- Carrier of Hep B
Interpret the following
HBsAg (-)
Anti-HBc (-)
Anti-HBs (-)
Susceptible to Hep B
Interpret the following
HBsAg (-)
Anti-HBc (+)
Anti-HBs (+)
Immune due to natural infection
Interpret the following
HBsAg (-)
Anti-HBc (-)
Anti-HBs (+)
Immune due to Hep B vaccination
Name 2 treatments for HBV
- Lamivudine
- Interferon
What is Hepatitis D?
Virus that requires HBV for its replication. HDV infection occurs only simultaneously or as super-infection with HBV.
What are the routes of transmission for HCV? (4)
- Blood transfusion
- Intravenous injection
- Nosocomial transmission (Hospital transmission from needle stick, colonoscopy)
- Rarely sexually transmitted
What is the treatment available for HCV? (2)
- Pegylated interferon
- Ribavirin
(Used together)
What type of vaccination is available for HCV?
No vaccination available
What is the structure of the Hepatitis A virus?
Enveloped? Shape? Single/Double stranded? Sense? Type of RNA?
- Non-enveloped
- Spherical
- Single stranded
- Positive sense
- Linear RNA
What is the structure of the Hepatitis C virus?
Enveloped?
Shape?
Single/Double stranded?
Sense?
- Enveloped
- Spherical
- Single stranded
- Positive sense
What are the risk factors of HAV? (5)
- Children/Staff in childcare facilities
- Patients/Staff in mental health institutions
- Homosexual males
- Intravenous drug user
- Travellers in endemic areas
What are some of the symptoms of Acute Hepatitis A?
- Fever
- Headache
- Malaise
- Anorexia
- Vomiting
- Weight loss
What is Cholestasis?
What is it a clinical feature of?
- Dark urine and pale stools
- HAV
When investigating HAV what do the presence of the following antibodies indicate?
- HAV IgM
- HAV IgG
- HAV IgM indicates acute phase of infection
- HAV IgG indicates past infection
What is the structure of the Hepatitis E virus?
Enveloped?
Shape?
Single/Double stranded?
Sense?
- Non-enveloped
- Spherical
- Single stranded
- Positive sense
What are the routes of transmission for HEV? (4)
- Waterborne
- Foodborne
- Blood transfusion
- Zoonotic transmission (animals)
When investigating HEV what do the presence of the following antibodies indicate?
- HEV IgM
- HEV IgG
- HEV IgM indicates acute phase of infection
- HEV IgG indicates past infection
