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CP3 SURGERY > HPB - Hepatitis and Jaundice > Flashcards

HPB - Hepatitis and Jaundice Flashcards

1
Q

What is hepatitis

A

Inflammation of hepatocytes

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2
Q

Acute causes of hepatitis (4)

A

Viral
Autoimmune
Drug reactions e.g. paracetamol
Alcohol

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3
Q

Chronic causes of hepatitis (7)

A 
Hep viruses 
Autoimmune hepatitis 
Alcohol 
Hyperlipidaemia 
Drugs 
Metabolic - Wilson's, alpha-1-antitrypsin deficiency, haemochromatosis
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4
Q

Hepatitis A - structure

A

RNA picorna virus

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5
Q

Hepatitis A - transmission

A

Fecal - oral

Fish

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6
Q

Hepatitis A - incubation period

A

2-6w

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7
Q

Hepatitis A - PS

A

80% asymp
Hepatomegaly
Increased ALT
Doesn’t –> CLD

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8
Q

Hepatitis A - common?

A

Yes = most common hepatitis

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9
Q

Hepatitis A - vaccine?

A

Yes = whole killed vaccine

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10
Q

Hepatitis E - structure

A

RNA calcivirus

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11
Q

Hepatitis E - tranmission

A

F-O

Pork

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12
Q

Hepatitis E - disease progression

A

Acute + self limiting

No progression to chronic disease

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13
Q

Hepatitis E - where in the world

A

India

China

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14
Q

Hepatitis E - who is it most severe in

A

Pregnant women

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15
Q

Hepatitis E - is there a vaccine?

A

no

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16
Q

Hepatitis B - structure

A

Hepa-DNA virus

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17
Q

Hepatitis B - transmission

A

Blood
Semen
Saliva

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18
Q

Hepatitis B - incubation period

A

1-6 months

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19
Q

Hepatitis B - disease progression

A

10% –> chronic disease

1% –> fulminant liver disease

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20
Q

Hepatitis B - is there a vaccine?

A

Yes

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21
Q

Hepatitis D - structure

A

Incomplete RNA virus

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22
Q

Hepatitis D - transmission

A

Body fluid

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23
Q

Hepatitis D - disease progression

A

Can only cause disease if with Hep B

Can be acute or chronic

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24
Q

Hepatitis D - is there a vaccine?

A

Yes

HBV

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25
Q

Hepatitis C - structure

A

RNA flavivirus - quasispecies

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26
Q

Hepatitis C - transmission

A

Bodily fl

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27
Q

Hepatitis C - disease progression

A

85% –> chronically infected

30% - cirrhosis in 20 y

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28
Q

Hepatitis C - who is at risk

A

IVDU
Males
Older
Alcoholics

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29
Q

Hepatitis C - is there a vaccine

A

No

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30
Q

What % of viral hepatitis are non-A-E>

A

10-15%

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31
Q

e.g.s of non-A-E viral hepatitis

A

CMV
EBV
Yellow fever
HSV

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32
Q

Pathological changes acute hepaitits

A

Hepatocytes undergo degenerative changes before necrosis + rapid removal

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33
Q

Which zone of the hepatocyte is necrosis maximal in?

A

Zone 3

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34
Q

Def chronic hepatitis

A

Hepatitis lasting >6 months

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35
Q

How is the overall severity of chronic heaptitis judged?

A

Degree of inflammation (grading) + extent of fibrosis (staging)

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36
Q

HbaAG

A

Hepatitis B surface antigen

Active infection - appears within 6w + disappears by 3m

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37
Q

HBsAb

A

Anti-hepatitis B surface antibody

Prev infection/vaccination

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38
Q

HBeAg

A

Hepatitis Be antigen

Viral replication/infectivity

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39
Q

HBeAb

A

Anti-hepatitis Be antibody

Natural immunity

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40
Q

HbcAb IgG

A

Anti-hepatitis B core IgG antibody

Non-specific marker of current/prev infection

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41
Q

HBcAb IgM

A

Anti-hepatitis B core IgM aantibody

Infection within last 6 months

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42
Q

Markers raised in acute hepatitis

A

All markers

Apart from HbsAb

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43
Q

Markers raised in chronic hepatitis

A

HBeAg positive

HBeAb negative

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44
Q

PS of pre-icteric phase acute hepatitis

A

1-2 w prodrome malaise, arthralgia, headache + anorexia
Aversion to cig smoke
Vague RUQ pain

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45
Q

PS of icteric phase acute hepatitis

A

Pt = jaudinced w/ pale stools, dark urine, pruritis + skin rash

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46
Q

IN which type of viral heaptitis are extra hepatic features most common

A

Hep B

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47
Q

PS acute alcohol hepatitis (4)

A

After binge
Jaundice
RUQ pain
systemic upset

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48
Q

What is Discriminant function

A

Bilirubin
PT
Hepatic encephalopathy
All combined to predict survival in acute alcohol hepatitis

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49
Q

What must the AST:ALT be to be alcoholic liver disease

A

> 2

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50
Q

What does autoimmune hepatitis mostly present as

A

Chronic hepatitis

51
Q

PS - chronic autoimmune hepatitis

A 
Insidious 
Tired 
Arthralgia 
Fevers 
W loss
52
Q

Age peaks - autoimmune hepatitis

A

15-25

or perimenopausal

53
Q

Which other autoimmune conditions is autoimmune hepaitits aassociated with?

A

1’ biliary cirrhosis
1’ sclerosing cholangitis
IBD

54
Q

Ix autoimmune hepatitis

A

High transaminase + IgG levels
-ve viral serology
High titre autoantibodies - ANA, ASMA

55
Q

How is the final diagnosis of autoimmune hepatitis made?

A

Liver biopsy

56
Q

When can chronic hepatitis be diagnosed?

A

When ALT has been elevated for >6m

57
Q

Mx autoimmune hepatitis

A

prednisolone 30mg OD
+ azathioprine 1mg/kg/day
LT - + bone protection + monitoring

58
Q

Mx Hep B - acute ep

A

Supportive therapy

Alcohol avoidance

59
Q

Mx Hep B - chronic

A

SC peginterferon-alpha-2a for 48w

60
Q

3 types of liver biopsy

A

Needle biopsy
USS/CT guided biopsy
Laparoscopic biopsy

61
Q

Indications liver biopsy (5)

A 
Chronic hepatitis 
Cirrhosis 
Suspected neoplastic disease 
Storage disease 
Unexplained hepatomegaly
62
Q

C/I liver biopsy (4)

A

Prolonged PT
Platelet count <80
Ascites
Extra-hepatic cholestasis

63
Q

Newer alternative for liver biopsy?

A

Fibroscan

64
Q

What type of reaction do intrinsic hepatotoxins cause?

A

Type A reactions - dose dependent + predictable

65
Q

Drugs that are > likely cause chronic hepatitis

A

Methyldopa
Nitrofurantoin
Monocyclic lisinopril
Diclofenac

66
Q

What type of hepatotoxin is paracetamol?

A

Intrinsic

67
Q

What is NAPQI mopped up by?

A

Glucothione

68
Q

PS Paracetamol OD - 1st 24hrrs (4)

A

Asymp
Nausea
Vomiting
Anorexia

69
Q

PS Paracetamol OD after 24hrs (6)

A 
RUQ pain 
Metabolic acidosis 
HOTN
Hypogylcaemia 
Pancreatitis 
Arrhythmias
70
Q

When is liver damage detectable on blood tests - paracetamol OD

A

AFter 18hrs

71
Q

Peak damage LFT’s paracetamol OD

A

72-96hrs post ingestion

72
Q

Tx paracetamol OD

A 
AA-E
Lavage if >12g taken 1hr
Activated charcoal if <1hr
<8hrs - IV N-acetylcystine + Tx 20hrs 
Liason psych team review
73
Q

How does N-acetylcysteine work in paracetamol OD

A

Replenishes cellular glutathione stores + may repair oxidative damage

74
Q

SE NAC

A

Rash
Oedema
Bronchosplasm

75
Q

Mx of SE of N-acetylcysteine

A

IV chlorphenamine

76
Q

Alternative Tx to NAC

A

PO methionine

77
Q

When can PO mmethionine be given?

A

Up to 12hr post ingestion paracetamol

78
Q

When can methionine be used in paracetamol OD

A

If vomiting

If activated charcoal has been used

79
Q

Lifespan of RBC

A

120 days

80
Q

Where are RBC destroyed

A

Reticuloendothelial system of spleen

81
Q

What makes stools dark

A

Urobilinogen

82
Q

What makes urine dark

A

Urobilinogen when exposed to air –> urobilin

83
Q

bilirubin for jaundice to be visible

A

50 micromol/L

84
Q

Why does pre-hepatic jaundice occur

A

2’ to increased erythrocyte breakdown

85
Q

Form of bilirubin in blood - pre-hepatic jaundice

A

Mainly unconjugated

86
Q

Urine and stools - pre-hepatic jaundice

A

Normal urine

Normal stools

87
Q

What is cholestatic jaundice

A

Obstruction to bile outflow from liver –> cholestasis

88
Q

Form of biliruin in blood - cholestatic jaundice

A

Mainly conjugated

89
Q

Urine and stools appearance - cholestatic jaundice

A

Pale stools

Dark urine

90
Q

Intrahepatic cholestatic jaundice =

A

obstruction of hepatic bile canaliculi

91
Q

Causes of intrahepatic cholestatic jaundice (6)

A 
Hepatitis 
Alcoholic liver disease 
Cirrhosis 
Neoplasm 
Dx 
Pregnancy
92
Q

Extrahepatic cholestatic jaundice =

A

Obstruction of hepatic ducts/biliary tree

93
Q

Luminal causes extrahepatic jaundice

A

Gallstones

94
Q

Intramural causes extrahepatic jaundice (4)

A

Cholangiocarcinoma,
1’SC
Congenital atresia CBD
Strictures

95
Q

External causes extrahepatic jaundice (5)

A 
Chronic pancreatitis
Tumour of pancreas head 
Hilar lymphadenopathy 
GB carcinoma 
Pseudocyst
96
Q

What is hepatocellular jaundice

A

Issue w/ cells of liver –> dysfunction + partial inability to conjugate bilirubin

97
Q

Form of bilirubin in blood - hepatocellular jaundice

A

Mixed conju + unconju

98
Q

Causes hepatocellular jaundice (4)

A

Hepatitis B C
Cirrhosis
Neoplasm
Hepatotoxic Dx

99
Q

Hepatotoxic Dx causing hepatocellular jaundice (3)

A

Paracetamol
Methyldopa
Barbiturates

100
Q

Urine and stools appearance hepatocellular jaundice

A

Dark urine

Normal stools

101
Q

Ix - jaundice

A 
Bloods - FBC, U+E, LFT, albumin, clotting, toxins 
Virology 
Autoantibodies + tumour markers 
CT
EUS
USS liver 
MRCP
Biopsy
102
Q

What is Courvoisier’s sign?

A

Palpable enlarged bladder that is non-tender w/ jaundice - likely to be malignancy of either gall bladder or pancreas

103
Q

What is Gilbert’s syndrome?

A

Congenital lack of gluconyltransferase

104
Q

What % pop have Gilbert’s syndrome

A

7%

105
Q

When do people with Gilbert’s get transient ep’s of jaundice?

A

Following infection e.g. URTI

106
Q

LFT’s Gilberts syndrome

A

Unconjugated bilirubin = raised

LFTs + reticulocytes = normal

107
Q

LFTs - what does: Raised bilirubin, ALK + GGT indicate

A

Extrahepatic biliary obstruction

108
Q

LFTs - what does: Elevated AST indicate (5)

A 
Acute hepatitis 
Or Skeletal injury
Cardiac injury
Kidney injury 
Brain injury
109
Q

Which is more specific to liver, ALT or AST

A

ALT

110
Q

LFTs - what does: Elevated ALK + GGT indicate

A

Alcohol induced injury

Drug induced injury

111
Q

LFTs - what does: Elevated bilirubin indicate

A

Gilberts

112
Q

Which liver markers are most raised in hepatocellular jaundice + intrahepatic obstruction

A

Transaminases

113
Q

Which liver markers are most raised in cholestasis

A

ALP

114
Q

Glucose in liver failure

A

Low

115
Q

Glucose in pancreatic disease

A

High

116
Q

Magnetic resonance cholangippancreatography (MRCP)

A

Gives non-invasive, high resolution imaging of biliary tree

117
Q

What is Endoscopic retrograde cholangiopancreatography (ERCP)

A

Ampulla vater = cannulated using endoscope + contrast = injected to demonstrate lesions

118
Q

Is ERCP diagnostic or therapeutic

A

Diagnostic

119
Q

Which ABx should be given before ERCP as prophylaxis

A

Ciprofloxacin

120
Q

Complications ERCP (3)

A

Pancreatitis
Bleeding
Perforation

121
Q

Is MRCP used diagnostically or therapeutically

A

Diagnostically

122
Q

What is Percutaneous transhepatic cholangiography (PTC)

A

PCT cannulation of dilated bile duct

123
Q

When is PTC used?

A

therapeutically if ERCP is not available or pt is too unwell for it

CP3 SURGERY (19 decks)

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