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FINALS - GI > infective, autoimmune, iscahemic hepatitis > Flashcards

infective, autoimmune, iscahemic hepatitis Flashcards

1
Q

what is acute hepatitis

A

liver dysfunction in previously well liver lasting less than 6 months

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2
Q

what are the common causes of acute hepatitis (5)

A

alcohol // autoimmine // infection (hep a–>E) // ischaemia // drugs eg paracetamol

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3
Q

presentation acute hepatitis

A

prodromal flu like illness + fever // jaundice // itch // RUQ pain // hepatosplenomegaly // deranged LFTs

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4
Q

how is hep A spread + what is the virus

A

faecal oral // RNA picornavirus

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5
Q

who should be vaccinated for hep A (6)

A

travel to high prevalance areas // chronic liver disease // haemophillia // MSM // IV drugs // occupational risk eg sewage

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6
Q

mx hep A

A

vaccine // conservative

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7
Q

what type of vaccine is hep A

A

inactive

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8
Q

how is hep B spread and what is incubation

A

blood/ bodily fluid spread // 6-20 weeks

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9
Q

what are some complications of Hep B (6)

A

chronic hepatitis // liver failure // hepatocellular carcinoma // GN // polyarteritis nodosa // cyroglobulinaemia

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10
Q

what pathology could you expect in a slowly deteriorating hep B patient

A

hepatocellular carcinoma

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11
Q

1st line mx hep B

A

pegylated interferon alpha

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12
Q

2nd line mx hep B

A

antivirals eg tenofovir, entecavir

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13
Q

at what age are children in the UK vaccinated against hep B

A

1 vaccine each at: 2, 3, and 4 months

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14
Q

what antibody does the hep C vaccine contain + what vaccine is it

A

HBsAg - subunit vaccine

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15
Q

who is at risk for failing to respond to hep B vaccine

A

obese, 40+, smoking, alcohol excess, immunosuppressed

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16
Q

who needs tested for anti-HBs to see if vaccine has worked + when

A

occupational exposure + CKD patietns // 1-4 months after first vaccine

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17
Q

what anti-HBs level indicates good vaccine response + when would booster be required

A

100+ // 5 years

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18
Q

what anti-HBs level indicates suboptimal vaccine response + what should be done

A

10-100 // give 1 more vaccine

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19
Q

what anti-HBs level indicates non-responder vaccine + what should be done (4)

A

<10 // test for current infection // give 3 more vaccines + retest // if fails HBIG

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20
Q

what should babies born to women with chronic hepatitis or acute B hepatitis in pregnancy be given

A

full course of vaccine + HBIG

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21
Q

can hep B patients breast feed

A

yes

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22
Q

what is the antigen and antibody in hep B

A

antigen = HBsAg // antibody = anti HBs

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23
Q

what antigen/ antibody is raised in acute hep B infection (1-6 months)

A

HBsAg

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24
Q

what antigen/ antibody would show chronic hep B disease ie is a disease carrier, how long would it be raised for

A

HBsAg >6months

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25
Q

what antibody indicates immunity from hep B

A

anti HBs (negative in chronic disease)

26
Q

how can immunity from hep B be acquired

A

exposure or vaccine

27
Q

what antibody indicates previous (or current) infection in hepatitis

A

anti-HBc // (remember c for caught by the virus)

28
Q

what antigen is a marker of hep B infectivity

A

HbeAg

29
Q

what hep B serology would be seen in an immunised hep B person

A

anti-HBs +ive // all negative

30
Q

what hep B serology would be seen in a patient with previous hep B infection who is not a carrier

A

anti-HBc +ive // HBsAg negative

31
Q

what hep B serology would be seen in a patient with previous hep B infection who is a carrier

A

anti-HBc +ive // HBsAG positive

32
Q

how is Hep C spread

A

parenteral (blood) // sexual // vertical

33
Q

what vaccine for hep C

A

none!!

34
Q

symptoms of hep C

A

transient rise in ALT // jaundice // fatigue // arthralgia

35
Q

invx hep C

A

HCV RNA

36
Q

what is a very common complication of acute hep C illness

A

chronic hep C (50%+)

37
Q

how is chronic hep C diagnosed

A

HCV RNA +ive for 6 months

38
Q

liver problems with chronic hep C

A

cirrhosis // hepatocellular cancer

39
Q

extraliver problems with chronic hep C

A

rheum // eyes // cryoglobulinaemia // PCT // GN

40
Q

mx of chronic hep C

A

protease inhibitors -vir +/- ribavirin

41
Q

s/e ribavirin

A

haemolytic anaemia // teratogenic

42
Q

how is hep D transmitted

A

via bodily fluids

43
Q

what is hep D always seen with AKA coinfection

A

hep B (co infection) at the same time

44
Q

what is hep D super infection

A

chronic infected hep B patients (HBsAg) develops hep D

45
Q

invx hep D

A

PCR

46
Q

mx hep D

A

interferon alpha

47
Q

how is hep E spread

A

faecal oral

48
Q

where is hep E common

A

SE asia, africa, mexico

49
Q

who does hep E raise mortality in

A

pregnancy

50
Q

who commonly gets autoimmune hepatitis

A

young females

51
Q

what conditions are assoc with autoimmune hepatitis

A

HLA // hypergammaglobulinaemia

52
Q

what antibodies are in type 1 autoimmune hepatitis and who is affected

A

ANA or anti smooth muscle (SMA) // adults and kids

53
Q

what antibodies are in type 2 autoimmune hepatitis and who is affected

A

anti liver/ kidney (LKM1) // children onlu

54
Q

what antibodies are in type 3 autoimmune hepatitis and who is affected

A

soluble liver kidney // adults only

55
Q

how does autoimmune hepatitis present

A

chronic liver disease // acute hepatitis (fever, jaundcice) // AMENORRHEA

56
Q

invx for autoimmune hepatitis

A

antibodies // IgG // liver biopsy –> bridging necrosis

57
Q

mx autoimmune hepatitis

A

steroids // immunosuppressants eg azathioptine // liver transplant

58
Q

what causes ischaemic hepatitis

A

hypoperfusion (not inflammation)

59
Q

what is a common cause of ischaemic hepatitis.

A

cardiac arrest

60
Q

what LFTs are seen in ischaemic hepatitis

A

ALT massively increased (>1000)

61
Q

what other organ dysfunction is common in ischaemic hepatitis

A

AKI (tubular necrosis)

62
Q

which hepatitis causes ground glass hepatocytes

A

hep B

FINALS - GI (18 decks)

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