Infections causing jaundice Flashcards
What are types of viral hepatitis
Viral - A,B,C,D,E can also get hepatitis through EBV and CMV
What is the method of spread of the viral hepatitis?
A&E - faecal-oral
B,C&D - blood borne spread by sexual contact or vertical transmission
Describe Hep A
- RNA virus
Generally food borne - Endemic worldwide
- Vaccine available for high risk patients e.g. homosexual men and medical staff
- Improved sanitation primary control
- benign so no treatment (also self limiting)
- can have some liver damage caused by immune response
- Diagnosis made with serological test looking for immune response
Describe Hep E
- Often water-borne
- Also affects animals
- Associated with Asia
- Use serological test to confirm
- most infections mild, pregnant women more at risk for chronic
- no vaccine and no treatment
Describe Hep B
- DNA virus called hepadna virus
- transmission is usually vertical, sexual contact or contaminated equipment
- Almost always get jaundice
- Some become chronic carriers
- Primarily in SE Asia and subsaharan Africa
- Prevention: at risk groups vaccinated, mothers screened (babies given immunoglobulins, passive immunisation) and equipment decontaminated
- Acute no treatment
- Chronic
Describe Hep C
- RNA virus
Usually spread through contaminated needles - Diagnosis can be serological test or PCR
- No vaccine as many varieties
- Most develop chronic infection and cirrhosis common
- Treatment being developed, aims to decrease viral detection which will in turn reduce cirrhosis, liver failure and cancer
Describe Hep D
- Only infected with Hep D if already have Hep B
- Spread in same way as B
- Will make disease more severe
- no vaccine or treatment
What is the difference between core, surface and E antibodies?
- Hep B example
Core = HBcAg
Surface = HBsAg
e = HBeAg - core is seen in patients who had hep B but have recovered
- surface is seen in people who currently have an infection and indicates infectivity
- e signifies high infectivity
What are the causes of biliary tract infections?
- Obstruction: gallstones, intrinsic narrowing due to inflammation or extrinsic narrowing due to enlarged organ
- Bile stasis due to bile thickening (can occur in stress responses e.g. sepsis or starvation)
- Duodenum has rich microbiome which is often where infective organisms come from, most often get E.coli poisoning
- Often get jaundice when infection and obstruction at same time
Biliary tract infection symptoms?
- Cholecystitis (inflammation gallbladder)
- Cholangitis (inflammation biliary tract)
- Pain in RUQ of abdomen, can radiate to back and shoulder
- nausea and vomiting
- fever
- abdominal tenderness
- Murphy’s sign
- signs of sepsis
What are the signs of sepsis?
Adult - Breathlessness - Rash - Confusion or slurred speech - Blotchy skin Child (same +) - more sleepy - high pitched cry
How are biliary tract infections treated?
1) Ensure free flow of bile so relieve obstruction may need surgical intervention to fix abscess or perforation or endoscopic dilation of vessels to release gallstones
2) Antibiotics
- usually given after bile flow is successful
- wide-spectrum given until culture taken when can give specific antibiotics
- Usually Co-amoxiclav or Piperacillin-tazobactam (beta-lactam + beta-lactase inhibitors) are given
What is an abscess?
- Destruction of normal tissues due to infection and replacement of normal structures with pus
- Primary treatment is pus drainage
What the three types of infection which can cause a liver abscess?
1) Bacteria - which usually has a different primary infection site which then travels to the liver via the portal veins, can also be from direct invasion from neighbouring organs
2) Amoeba - food/water borne usually causes diarrhoea
3) Helminths - worms which can then lead to cysts which in presence of bacteria can cause abscesses
What are the most common types of amoeba and helminths infections causing liver abscess?
Amoeba - protozoa entamoeba histolytica
Helminths - echinococcus granulosus
Treatments of liver abscess?
- Pus drainage using ultrasound or CT guidance if possible
- Culture taken and given broad-spectrum antibiotics for bacterial
- Serological tests used to check for amoebic infection given metronidazole
- Hydatid cysts (helminths) need to be drained very carefully as contents can cause anaphylaxis
Define zoonotic disease?
infectious disease which is transmissible from animal to human e.g. leptospirosis
Define Vector?
living intermediary which carries an agent from reservoir to susceptible host e.g. malaria
What bacteria causes leptospirosis and what is the infection process?
Leptospira interrogans which infect rodents, dogs or pigs, passes to humans through infected water or food
- organisms can also enter through skin breaks or mucosa when swimming
What are the phases of leptospirosis infection?
Incubation period 1-2 weeks
Phase 1 - flu like illness
Phase 2 - more serious Weil’s disease (caused by inflammatory response to infection) which causes hemorrhagic complications e.g. Hepatitis, Jaundice, haemorrhage and meningitis
Treatment of Leptospirosis?
Doxycycline
What are the reasons a disease may be notifiable to Public heath agency?
- Epidemic potential
- Food borne so ongoing risk
- Diseases which are assumed to be eradicated
