Liver Disease Flashcards
What is hepatitis?
Inflammation of the liver
Describe the 3 important components of LFTs when diagnosing hepatitis
- Bilirubin
- AST
- ALT
Name 5 potential causes of hepatitis
- Viral
- Alcohol / Drugs
- Ischaemia
- Toxins
- Autoimmune
What are the 4 major types of viral hepatitis?
A
B
C
E
Name 3 causes of viral hepatitis outside the major 4
- Delta
- EBV
- Yellow fever
Describe 3 clinical features of a person with acute viral hepatitis
- Jaundice
- Malaise
- Liver dysfunction (rarely failure)
Describe hepatitis A
- In decline due to vaccine and sanitation
- Faecal oral transmission
- Incubation is 2-7 weeks
- Usually recover within 3 months
- Does not cause chronic liver disease
Describe 3 components of prevention of Hep A
- Sanitation
- Pre-Exposure (vaccination and immunoglobulin)
- Post-Exposure (give immunoglobulin and vaccinate)
Describe Hepatitis E
- Transmitted via faecal oral route
- Contaminated water is common source in developing countries
- Zoonotic route is common source in developed countries
What is zoonotic route of tranmission?
Consumption of meat, usually pork
Name 3 methods of transmission of Hep B
- Sexual
- Blood
- Bodily fluids
What is the earliest indicator of Hep B?
HBsAg (surface antigen) positive
Describe the progression of acute Hep B to chronic Hep B
- 5-10% adults fail to clear HBsAg from system
- Suffer from chronic Hep B
- Vertical transmission common as 90%+ of neonates cannot clear HBsAg
Describe chronic Hep B status for patients with active disease
- HBsAg positive for over 6 months
- Raised LFTs
- Raised HBV DNA
- Liver damage
Describe chronic Hep B status for patients who are chronic carriers
- HBsAg positive for over 6 months
- Normal LFTs
- Negative HBV DNA
- Risk of damage and passing on infection
What 2 regions of the world are most common for Hep B cases?
- Far East Asia
2. Sub-Saharan Africa
Describe the treatment of chronic Hep B
- Prevention most important
- Screening for hepatocellular cancer
- Could be eradicated with vaccination
- Antiviral agents
- Liver transplantation may be used
Describe 4 transmission methods of Hep C
- IV drug use
- Blood products
- Body piercings / Vertical / Sexual (uncommon methods)
Describe the clinical course of acute Hep C infection
- Mild symptoms
- < 20% are jaundiced
- HCV antibodies present
Describe the clinical course of long term sequelae in Hep C
- 80% of patients fail to clear virus (remain PCR positive)
- Over 50% develop liver disease
- 20-30% develop cirrhosis
Describe Hep C treatment
- Prevention is most important (no vaccination)
- Oral medication for 8-12 weeks clears in 98% of people
- Patients remain HCV antibody positive but PCR negative (not infectious)
Describe 3 types of non-infection hepatitis
Alcoholic - Jaundice and coagulopathy
Autoimmune - Usually on long term immunosuppression
Drug Induced - Common in flucloxacillin
Describe needle stick injuries and transmission of hepatitis A, B and C
Hep A - No risk of transmission
Hep B - 30% of transmission
Hep C - 3% of transmission
Describe the 2 classifications of jaundice
- Traditional - Pre-hepatic, hepatic, post-hepatic
2. Biochemical - Unconjugated v Conjugated
Describe 2 common causes of jaundice
- Obstruction (malignancy, gallstones)
2. Liver damage (alcohol, hepatitis)
Describe the history taking for a person with suspected liver dysfunction
- Always ask about alcohol intake
- Drug / toxins
- Assess hepatitis risk
- Any oversea travels
- Family history
- Previous surgery
Describe the examination for a person with suspected liver dysfunction
- Jaundice
- Pyrexia
- Chronic liver disease
- Xanthomas
- K-F rings
Describe common liver screening blood tests when concerned about liver dysfunction
- Repeat LFTs
- FBP / Coag screen
- Hepatitis screen
- Autoimmune screen
- Immunoglobulins
- Iron studies
Describe 4 types of radiology which can be used to assess liver dysfunction
- Ultrasound on Abdomen (first go to)
- CT Scan (gives better view of specific aspects e.g pancreas)
- MRI / MRCP
- PTC
Describe the trend in alcohol related deaths in the UK since 1991
- Deaths increasing in all age groups
- Rising consumption of alcohol
- Highest in 55-74 age group
- 85% of deaths due to cirrhosis
Describe the consequences of alcohol
- Intoxication
- Pleasure
- Road deaths
- Violence
- Financial strain on NHS
- Medical consequences
Describe 6 things which may be seen in liver damage caused by alcohol
- Nothing to find
- Raised liver enzymes
- Fatty hepatitis
- Liver fibrosis / cirrhosis
- Fatty liver
- Decompensated liver disease
Name 3 complications of cirrhosis
- Liver decompensation
- Hepatocellular carcinoma
- Reduced life expectancy
Name 5 features of liver decompensation
- Jaundice
- Encephalopathy
- Ascites
- Hypoalbuminaemia
- Coagulopathy
What classification is used to determine if someone with liver disease is at risk of complications if dental treatment is carried out?
Child-Pugh Classification
Describe 3 liver functions
- Protein / Carbohydrate and Lipid metabolism
- Bile formation
- Hormone inactivation
Describe acute liver failure
Combination of Jaundice, Encephalopathy and Coagulopathy occuring within 24 weeks of illness onset
Describe the aetiology of acute liver failure
- Toxins (paracetamol and others)
- Hepatitis viruses
- Vascular (PV thrombosis, ischaemia)
- Metabolic (Acute Fatty Liver)
- Malignancy
Describe 6 clinical features of acute liver failure
- Jaundice
- Encephalopathy
- Cerebral oedema
- Bleeding
- Hypotension and tachycardia
- Sepsis
