HPB Flashcards
Cessation criteria for NAC - in paracetamol OD
1) ALT/AST downtrending
2) Patient is clinically well
3) INR <2.0
4) With patients with initial serum paracetamol level double normogram line –> paracetamol level now <10mg/L
Indications for fulminant liver failure
1) Progressive increase in aminotransferases and INR >3.0 at 48h mark or INR >4.5 any time
2) Oliguria, Cr >200
3) Persistent lactic acidosis pH <7.3, arterial lactate >3
4) Systolic hypotension
5) Severe thrombocytopenia
6) Altered GCS
Hepatitis C Therapy
Pan-genotypic therapy
Direct acting antivirals for 8-12 weeks
Hepatitis A virus features
Symmetrical RNA virus
Hepatitis B virus features
DNA virus which replicates through an RNA intermediate
Hepatitis C virus features
RNA virus
Hepatitis D virus features
RNA virus
- Requires HBV for lipoprotein envelope - helps complete virion assembly and secretion
Acute HDV/HBV co-infection prognosis
Higher risk of liver failure than HBV alone
Usually transient, self-limiting
Acute HDV superinfection with chronic HBV prognosis
Severe acute hepatitis
Can progress to chronic HDV infection
Chronic HDV infection prognosis
Can cause more rapid progression to HCC or cirrhosis compared to HBV alone
Lifestyle Management of NASH
Weight loss (improves liver histology)
Other
- Exercise
- Coffee
- Mediterranean diet
Pharmacological Management of NASH
Vitamin E
Metformin (in diabetics)
Rosiglitazone - improves insulin sensitivity
Primary Sclerosing Cholangitis Ab
p-ANCA
Primary Biliary Cirrhosis Ab
AMA
Autoimmune Hepatitis
- Type 1
- Type 2
Type 1 - SMA, ANA
Type 2 - LKM1, ALC1
