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GERR > Lecture 15: Infections Causing Jaundice > Flashcards

Lecture 15: Infections Causing Jaundice Flashcards

1
Q

3 ways that infectious diseases can cause jaundice

A
  • obstructive jaundice
  • hyperbilirubinaemia –> inflammation of hepatocytes –> hepatitis
  • haemolysis –> RBC destruction –> excess Hb metabolism –> bilirubin end product
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2
Q

what way does malaria cause jaundice

A

haemolysis

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3
Q

what is a notifiable disease

A

disease that have potential risks to populations or public health and must be reported to public health authorities

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4
Q

name two viral infections that can cause hepatitis

A
  • Epstein Barr Virus (EBV)

- Cytomegalovirus (CMV)

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5
Q

what is the most notable bacterial pathogen to cause bacterial hepatitis

A

leptospirosis

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6
Q

how are the different hep viruses spread

A
  • A and E are faecal oral

- B C and D are blood borne spread by sexual contact, blood contaminated equipment or vertical transmission

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7
Q

which hep virus is a worldwide endemic

A

Hep A

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8
Q

how is Hep A transmitted

A
  • faecal-oral
  • food borne
  • person to person in crowded circumstances
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9
Q

how is Hep A/Hep E diagnosed

A
  • serological tests looking for HAV/HEV specific IgM
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10
Q

how is the spread of Hep A controlled

A
  • improved sanitation

- vaccination

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11
Q

where in the world is Hep E more prevalent

A

Asian countries

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12
Q

how can Hep E be transmitted

A
  • faecal-oral

- water borne

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13
Q

which people are particularly at risk of developing more severe hepatitis or persistent infection from Hep E

A
  • pregnant women particularly at the end of pregnancy

- immunocompromised patients

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14
Q

how is Hep E treated

A
  • no specific treatment

- no licensed

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15
Q

how is Hep C transmitted

A
  • spread through blood

- blood contaminated equipment

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16
Q

what type of virus is Hep C and Hep A

A

RNA

  • C –> enveloped RNA
  • A –> single stranded RNA
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17
Q

why do many patients not know they are infected with Hep C/ infectious

A

Hep C causes notable jaundice in around 25% of ACUTE infections, and most people go on to have CHRONIC HCV infection

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18
Q

how is Hep C diagnosed

A
  • serological w/ assays for both HCV antigens and antibodies
  • HCV RNA can also be detected using PCR
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19
Q

how is Hep C treated

A
  • treatment aims to reduce viral RNA detection in blood which reduces long term sequelae of chronic infection
  • treatment still developing and is dependent on serotype patient is infected with
  • pegylated interferon alpha sometimes used as part of primary treatment for HCV
  • range of direct acting antiviral (DAA) drugs that target HCV specific enzymes e.g. viral protease
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20
Q

what type of virus is Hep B

A

double stranded DNA virus w/ reverse polymerase

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21
Q

how is Hep B transmitted

A
  • blood borne
  • vertical transmission (majority)
  • sexual contact
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22
Q

what is the most prominent symptom of acute Hep B

A

jaundice –> occurs in 90% of people

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23
Q

how is Hep B capable of chronic carrier condition

A

has reverse transcriptase enzyme that allows integration of viral DNA unto human genome

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24
Q

what are the 3 important antigens of HBV

A
  • HBsAg
  • HBcAg
  • HBeAg
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25
Q

what is looked for when doing blood tests for HBV

A
  • 3 important antigens
  • antibodies raised against antigens
  • HBV DNA tested by PCR
26
Q

what does the presence of HBsAg indicate

A

confirms infection and indicates infectivity of blood

27
Q

what does presence of HBeAg indicate

A

signifies high infectivity and maybe be seen in acute infection or chronic carriers

28
Q

what indicates successful vaccination against HBV

A

presence of HBsAb

  • seen in patients who have recovered from acute infection and cleared virus from body
29
Q

when does HBcAb develop

A

shortly after acute infection and persist in all patients

30
Q

how is HBV prevented

A
  • vaccination of at risk groups
  • using single-use instruments e.g. needles
  • decontamination of multiple use instruments
  • screening pregnant women for HBsAg
  • babies born to HBsAg +ve moms given prophylaxis w/ HBV immune globulin (passive immunisation)
31
Q

how is HBV treated

A
  • supportive and symptom relief measures
  • pegylated interferon alpha
  • nucleoside analogue drugs e.g. Entacavir and reverse transcriptase inhibitors e.g. Tenovovir
32
Q

what is the aim of HBV treatment

A

prevention of liver cirrhosis + failure and hepatocellular carcinoma

33
Q

how can HDV cause infection

A

can only replicate in cells already infected with HBV

  • requires shell of HBsAg in order to bud from infected hepatocytes
34
Q

how is HDV spread

A
  • blood borne (same as B and C)
35
Q

what does the presence of HDV in HBV infected patients indicate

A

disease is more severe

36
Q

what type of jaundice occurs with biliary tree infection

A

obstructive jaundice

37
Q

what makes the biliary tree vulnerable to infection

A

anatomy: gall bladder attached to duodenum which has a rich microbiome

38
Q

what can cause obstruction of flow of bile

A
  • gall stones
  • intrinsic narrowing of biliary draining ducts
  • extrinsic narrowing of biliary tree
  • bile stasis –> bile does not flow or becomes thickened –> could occur in response to stress responses seen in sepsis/starvation/burns/trauma/major surgery
39
Q

what organisms are most commonly seen assc. w/ biliary tree infection

A
  • enterobacteriaceae e.g. E.coli
  • enteric gram +ves e.g. enterococcus species
  • anaerobes incl. bacteriodes species
40
Q

how can biliary tree infection present as a public health risk

A
  • salmonella (specific enterobacteriaceae) can colonise biliary tree
  • may lead to chronic carrier states of salmonella species
  • salmonella typhi (cause of typhoid fever) can be one
41
Q

define cholecystitis

A

inflammation of gallbladder

42
Q

define cholangitis

A

inflammation of biliary tract

43
Q

give 2 clinical presentations of biliary tract infection

A
  • cholecystitis

- cholangitis

44
Q

give some risk factors for gallstones in biliary sepsis

A
  • older age
  • female
  • low fibre diet
  • obesity
45
Q

name some characteristic symptoms of biliary infection

A
  • pain localising to right upper quadrant
  • pain may be severe and radiate to the back
  • referred pain to right shoulder tip
  • nausea and vomiting
  • fever
  • abdominal tenderness
  • local peritonitis –> both reflex guarding and rebound tenderness
  • Murphy’s sign –> patient can’t breathe in comfortably when examiner’s hand placed along right costal margin (suggests cholecystitis)
46
Q

management of biliary tract infection

A
  • source control
  • endoscopic retrograde cholangio-pancreatography (ERCP)
  • antibiotics e.g. beta-lactam/ beta-lactase inhibitor combinations are first line treatment –> Co-amoxiclav and Piperacillin inhibitor
  • Piperacillin-tazobactam reserved for more severe presentations
  • vancomycin, aztreonam, and metronidazole may be used for penicillin-allergic patients
47
Q

define abscess

A

destruction of normal tissue structure due to infection, and replacement of normal structure with pus and necrotic tissue

48
Q

why can antibiotics not reach therapeutic level within abscess collections

A

collections are relatively avascular and tend to have low pH

49
Q

name 3 infective aetiologies that can cause liver abscess

A
  • bacteria –> when infection drains into liver via portal system
  • amoeba –> food/water borne
  • helminths –> worms e.g. dog tapeworm
50
Q

liver abscess management

A
  • management follows aetiology
  • source control
  • drainage
  • polymicrobial infection without drainage needs long course of high dose broad spectrum antibiotics
  • amoeba treated w/ metronidazole
51
Q

why does drainage of hydatid cysts require specialist management

A

contents can lead to anaphylaxis and death

52
Q

define zoonosis/zoonotic

A

infectious disease that is transmissible from animals to humans e.g. anthrax, brucellosis

53
Q

define vector

A

a living intermediary that carries an agent from reservoir to a susceptible host e.g. mosquitoes, fleas or ticks

54
Q

name some key vector borne diseases and zoonoses

A
  • malaria
  • dengue
  • lyme
  • plague
  • q-fever (caused by Coxiella Burnetti)
  • brucellosis (caused by brucella species, notably brucella abortus)
  • leptospirosis (most common bacterial cause of primary jaundice)
55
Q

how does leptospirosis cause human infection

A
  • assc. w/ contaminated water/food –> water contaminated w/ rat urine
  • organisms enter through skin breaks or mucosae
56
Q

clinical infection of leptospirosis

A
  • ‘bi-phasic illness’
  • pyrexial or flu-like illness
  • more severe cases involve immune mediated haemorrhagic complications –> Weil’s disease –> haemorrhagic complications due to low platelets, kidney and liver failure –> hepatitis, jaundice, haemorrhage, meningitis
57
Q

how to diagnose leptospirosis

A

serology

58
Q

leptospirosis treatment

A

doxycycline

penicillins also effective

59
Q

Weil’s disease triad

A
  • thrombocytopenia
  • jaundice
  • renal failure
60
Q

what kind of diseases are notifiable

A
  • those w/ epidemic potential
  • food-borne threats
  • rare, serious and imported infections

GERR (46 decks)

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