Hepatology & Biliary Tree Disease Flashcards
Which test confirms an active hepatitis A infection?
anti-HAV IgM
What investigation demonstrates a patient has been immunized against HBV?
HBV sAb
Which HBV serology indicates that a patient is immune due to previous infection/exposure?
HBV sAb +
HBV Core IgG + (IgM -)
HBV eAb +
All other serology negative.
What HBV serological indicates on acute infection?
HBV sAg +
HBV IgM +
HBV eAg +
HBV DNA +
Otherwise negative
What HBV serology indicates chronic hepatitis B infection?
HBV sAg +
HBV Core IgG +
HBV DNA +
Variable HBV eAg & HBV eAb
Otherwise negative.
What is the treatment for an acute hepatitis B infection?
- Supportive for patient
- Ensure household and sexual contacts are immune -> provide hepatitis B immune globulin and hepatitis B vaccine if they are not immune
Which patients with chronic hepatitis B infection need to be screened every 6 months for HCC?
Asian M > 40 or Asian F > 50 African > 20 All Cirrhotics Family Hx HCC (Start at age 40) All HIV co-infected patients (Start at 40)
Which patients with chronic HBV do you treat?
Cirrhosis Extra-Hepatic Manifestations HBeAg + w/increased ALT & DNA > 20000 HBeAg - w/increased ALT & DNA > 2000 Pregnancy - to prevent fetal transmission
What is the 1st line treatment for HBV infection?
1st Line: Nucleotide Analogues (tenofovir, enter air, lamivudine)
List 3 extra-hepatic manifestations of HBV infection.
Vasculitis - Polyarteritis Nodosa
Renal - Membranous Nephropathy > MPGN
Heme - Aplastic Anemia
Who should you treat for HCV?
ALL patients except those with short life expectancy owning to comorbidities.
What are the extra intestinal manifestations of HCV?
Autoimmune - thyroid, myasthenia, sjogren’s
Renal - MPGN > MN
Derm - Porphyria cutanea tarda, leukocytoclastic vasculitis, lichen planus
Heme - cryoglobulinemia, lymphoma, autoimmune hemolytic anemia, ITP
How do you use the Maddrey discriminate function score?
< 32 - No role for steroids in alcoholic hepatitis
> or = 32 - Prednislone 40 mg PO daily x 28 days
What are the contraindications to prednisolone in alcoholic hepatitis (4)?
Infection — SBP, active HBV, TB +/- HCV
Active GI Bleeding (relative)
Multi organ failure/shock
AKI with Cr > 221 mmol/L
When should a liver transplant be considered for hepatic failure?
Refer if MELD > or = 21 OR if Child-Pugh C liver cirrhosis.