Hepatology Conditions B Flashcards
Viral Hepatitis - Description
inflammation of the liver due to viral infection
Viral Hepatitis - Causes (6)
1) hepatitis A
2) hepatitis B
3) hepatitis C
4) hepatitis D
5) hepatitis E
6) herpes (CMV, EBV)
Viral Hepatitis - Types (Acute) (4)
< 6 months
1) hepatitis A
2) hepatitis B
3) hepatitis E
4) herpes (CMV, EBV)
Viral Hepatitis - Types (Chronic) (2)
> 6 months
1) hepatitis B (±D)
2) hepatitis C
Viral Hepatitis - Transmission (HAV) (1)
faecal oral
1) contaminated food and water
Viral Hepatitis - Transmission (HBV) (3)
blood borne
1) contaminated needles
2) sexual intercourse
3) vertical transmission
Viral Hepatitis - Transmission (HCV) (1)
blood borne
1) contaminated needles —> IV drug abusers*
Viral Hepatitis - Transmission (HDV) (3)
blood borne
1) contaminated needles
2) sexual transmission
3) contaminated blood products
Viral Hepatitis - Transmission (HEV) (1)
faecal oral
1) contaminated food and water
Viral Hepatitis - Symptoms (Acute) (8)
1) asymptomatic (HBV>70%, HEV>95%)
2) non-specific flu-like symptoms (clinically silent)
3) right upper quadrant pain
4) nausea
5) fever
6) malaise
7) arthralgia (HAV, HBV)
8) urticaria - hives (HBV)
Viral Hepatitis - Symptoms (Chronic) (2)
1) asymptomatic
2) non-specific symptoms
Viral Hepatitis - Signs (HAV)
1) hepatomegaly
2) jaundice
Viral Hepatitis - Signs (HEV) (2)
1) hepatomegaly
2) jaundice
Viral Hepatitis - Complications (4)
acute 1) fulminant hepatitis chronic 2) cirrhosis 3) liver failure 4) hepatocellular carcinoma
Viral Hepatitis - Diagnosis (HAV) (6)
1) high AST (day 22-40)
2) high ALT (day 22-40)
3) high bilirubin (icteric stage)
4) high ESR
5) low WCC
6) anti HAV IgM
Viral Hepatitis - Diagnosis (HBV) (3)
1) HBsAg (month 1-6, infected)
2) HBsAg (month 6->, carrier)
3) anti HBV IgM
Viral Hepatitis - Diagnosis (HCV) (2)
1) HCV RNA
2) anti HCV IgM
Viral Hepatitis - Diagnosis (HDV) (1)
1) anti HDV IgM (request only if HBsAg +ve)
Viral Hepatitis - Diagnosis (HEV) (6)
1) high AST (day 22-40)
2) high ALT (day 22-40)
3) high bilirubin (icteric stage
4) high ESR
5) low WCC
6) anti HEV IgM
Viral Hepatitis - Management (HAV) (4)
1) supportive (self-limiting)
2) monitor liver function (spot fulminant liver failure)
3) vaccine (travelling to endemic areas)
4) alcohol cessation
Viral Hepatitis - Management (Acute HBV ± HDV) (6)
1) supportive
2) monitor liver function (spot fulminant liver failure)
3) vaccine (primary prevention)
4) vaccine (close contacts)
5) anti HBV IgG (close contacts)
6) alcohol cessation
Viral Hepatitis - Management (Chronic HBV ± HDV) (3)
1) SC pegylated INFα2A
2) tenofovir/entecavir (nucleotide analogues)
3) alcohol cessation
Viral Hepatitis - Management (HCV) (3)
1) SC pegylated INFα2A/2B
2) ribavirin (anti-viral)
3) alcohol cessation
Viral Hepatitis - Management (HEV) (4)
1) supportive (self-limiting)
2) monitor liver function (spot fulminant liver failure)
3) vaccine (travelling to endemic areas)
4) alcohol cessation
Hereditary Haemochromatosis - Description
increased intestinal iron absorption
Hereditary Haemochromatosis - Causes (2)
1) HFE gene mutation (autosomal recessive)
2) other gene mutations (autosomal dominant)
Hereditary Haemochromatosis - Risk Factors (4)
1) family history
2) alcoholic
3) high dietary iron
4) high dietary chelating agents (e.g. vitamin C)
Hereditary Haemochromatosis - Pathophysiology (6)
1) homogenous chromosome 6 HFE gene mutation
2) deficiency of hepicidin
3) decreased inhibition of ferroportin
4) increased intestinal iron absorption via ferroportin
5) increased plasma iron
6) iron accumulation in organs
Hereditary Haemochromatosis - Symptoms (4)
early
1) asymptomatic
2) fatigue
3) arthralgia (esp. 2nd MCP, 3rd MCP, knee)
4) low libido
Hereditary Haemochromatosis - Signs (4)
later 1) slate grey skin pigmentation signs of chronic liver disease 2) ascites 3) bruising 4) oedema
Hereditary Haemochromatosis - Complications (7)
1) diabetes mellitus*
2) dilated cardiomyopathy —> heart failure
3) hepatitis
4) cirrhosis
5) hepatocelluar carcinoma
6) hypogonadism
7) osteoporosis
Hereditary Haemochromatosis - Investigations (2/3)
initial
1) iron studies (high iron, high ferritin)
2) LFT (high)
consider
1) genetic testing (confirmation if abnormal iron studies)
2) liver MRI
3) liver biopsy (Perls’ stain —> blue)
Hereditary Haemochromatosis - Management (3/1/1)
conservative 1) monitor iron studies 2) low dietary iron (e.g. avoid tea, coffee, fruit, red meat) 3) screen all first-degree relatives medical 1) deferoxamine (chelating agent) surgery 1) venesection* (3-4 times yearly)