L4: Chronic Viral Hepatitis & Cirrhosis Flashcards
Characters of The Liver
Functions of The Liver
Def of chronic hepatitis
- Inflammation of the liver.
- Persistence more than 6 months → chronic
Cause of Chronic Hepatitis
Etiology of Viral Hepatitis
Compare between Hepatitic viruses in terms of:
- Trnasmission
- Classification
- Antigens
- Incubation Period
- Severity/Chronicity
- Vaccine
MOT of HBV
HBV is transmitted hematogenously and sexually.
HBV Patients can have either an acute symptomatic disease or an asymptomatic disease.
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antigen-antibody system in HBV
HBs Ag
- The marker of infectivity.
- It can be found in blood and body secretions: salive, urine, semen, vaginal secretion, tears, sweat.and breast milk.
Anti-HBs
- Protective antibody.
- can persist for many years
- Appears after HBAg disappearance several weeks (or months).
HBc Ag
A marker of replication.
Anti-HBc IgM
A marker of acute infection and acute attack of chronic infection.
Anti-HBc IgG
A marker of past infection.
Hbe Ag
A marker of active replication.
Anti-Hbe
A marker of reduced infectivity.
HBV-DNA
- The direct indicator of HBV infection
- It can integrate into the genome of hepatocytes.
Dx of HBV
- Clinical picture.
- Laboratory investigations.
- Radiological investigations.
- Pathological investigations.
CP of HBV
- Persistent / intermittent fatigue
- Upper right quadrant pain
- Jaundice
- Weakness
- Anorexia
- Muscle & joint pain
- Often asymptomatic
If progressive liver disease, the following symptoms may appear
Signs of chronic liver disease include the following:
Lab tests for HBV
Radiological tests for HBV
Complications of HBV
Prevention of HBV
MOT of HBV
Parenteral through blood and body secretions as saliva, urine, semen, vaginal secretion, tears, sweat. And breast milk.
TTT of HBV
what is the most common cause of liver transplantation?
HCV
Characters of HCV
- Flaviviral etiology discovered in 1989
- Formerly “non-A non-B hepatitis”: NANBH
- Unlike HBV, persistence and chronic progressive disease is usual outcome in adult infection
Antigen-antibody system in HCV
- The concentration of HCV in blood is low.
- Anti-HCV is the indicator of infection and the marker of infectivity
- HCV-RNA may be detected from blood or liver tissue, It’s the direct evidence of infectivity
Signs & Symptoms of HCV
Physical findings in HCV
Other common extrahepatic manifestations in HCV
General baseline studies in patients with suspected hepatitis C include the following
- Complete blood cell count with differential
- Liver function tests, including alanine aminotransferase level
MOT of HCV
HCV Cannot be transmitted by:
Complications of HCV
TTT of HCV
Direct-acting antiviral agents
Def of Cirrhosis
Pathological Classification of Cirrhosis
Examples of causes of Micronodular Cirrhosis
alcohol and hemochromatosis.
Examples of causes of Macronodular Cirrhosis
chronic hepatitis B,C and alpha-1 antitrypsin deficiency.
Etiological types of Cirrhosis
- Mixed
- Post-Hepatitis
- Congestive
- Metabolic
- Biliary
- Alcoholic
- Drugs, Toxins & Chemicals (Methotrexate & Amioradone)
- Immunologic (Autoimmune)
what is the commonest type of cirrhosis in Egypt?
Mixed Cirrhosis
Mixed Cirrhosis
- It is a combination of hepatic schistosomiasis with chronic viral hepatitis, drug induced or malnutrition.
- pure hepatic schistosomiasis produces periportal fibrosis without parenchymal affection.
Post-Hepatitis Cirrhosis
- It complicates chronic viral e.g. chronic hepatitis B and C. also it can complicate non-viral hepatitis.
Congestive Cirrhosis
- It complicates chronic hepatic congestion as in right-sided heart failure, constrictive pericarditis and Budd-Chiari syndrome.
Metabolic Cirrhosis
- It occurs in generalized diseases with inborn errors of metabolism as in hemochromatosis and Wilson’s disease.
Biliary Cirrhosis
- It is either primary or secondary to prolonged extrahepatic obstruction.
Alcoholic Cirrhosis
- It develops after many years of alcohol consumption.
- The commonest type of cirrhosis in the western countries but is rare in Egypt
what causes Complications of liver cirrhosis?
Complications of liver cirrhosis are due to two major events, portal hypertension and parenchymal dysfunction.
Portal hypertension is due to …..
obstruction of the portal blood flow within the cirrhotic liver.
Parenchymal dysfunction is due to ……
progressive necrosis or degeneration of the hepatic cells.
Complications due to portal hypertension
Complications due to parenchymal dysfunction
CP of Liver Cirrhosis
Investigations for Cirrhosis
- Lab
- Rad
- Cyto
Lab tests for Cirrhosis
Radiological Tests for Cirrhosis
- Abdominal ultrasonography
- Computed tomography (CT)
- Magnetic resonance imaging (MRI)
- Radionucleotide studies
Pathological test for Cirrhosis
Liver biopsy: the gold standard for the diagnosis of cirrhosis
what is the gold standard for the diagnosis of cirrhosis?
Liver Bx
TTT of Cirrhosis
Specific TTT in Cirrhosis
- Phlebotomy for hemochromatosis
- d-Penicillamine for Wilson’s disease
- alcohol avoidance for alcohol-induced cirrhosis
- antiviral agents such as interferon alpha for chronic viral hepatitis C
Symptomatic TTT of Cirrhosis
- diuretic therapy and salt restriction for ascites
- lactulose, neomycin and protein restriction for encephalopathy
Liver Transplantation in Cirrhosis
it is indicated in end-stage cirrhosis
Screening for hepatocellular carcinoma
indicated in all cases of liver cirrhosis with serial ultrasonographic examination and serum alpha fetoprotein every six months.
