Liver Disease Flashcards
What is hepatitis?
Inflammation of the liver
On LFTs= bilirubin increased, AST enzyme increased, ALT enzyme increased
What causes hepatitis?
Viral Alcohol Drugs Ischaemia Toxins Autoimmune Metabolic
What are the causes of viral hepatitis?
Hepatitis ABC EBV Herpes simplex Yellow fever E and G Non-ABC
What are the clinical features of viral hepatitis?
Acute -Jaundice -Malaise -Liver dysfunction Chronic -only B, C and E -can cause cirrhosis
How is hepatitis A prevented?
Sanitation
Pre-exposure- vaccination (works within 4 weeks) and immunoglobulin (lasts 4-6 months)
Post-exposure- give immunoglobulin within 2 weeks, if repeated exposure likely then vaccinate aswell
What is the incubation time of acute hepatitis B?
1-6 months
How is hep B transmitted?
Sexual, blood, bodily fluids
What is the earliest indicator of acute Hep B?
HBsAg
What is chronic hep B status?
HBsAg positive (>6months) Active disease- raised LFTs, raised HBV DNA, liver damage Chronic carrier- normal LFTs, negative HBV DNA, still a risk
What is the spectrum of disease for hepatitis B?
Acute HBV infection, then 90% of neonates and <10% of adults will go on to develop a chronic infection, while around 2% of people will go on to develop fulminant hepatic failure and the rest will go into an inactive carrier state (these people are still at risk of HCC (hepatocellular carcinoma- liver cancer)). 15-40% of the people who develop chronic infection will have progressive chronic hepatitis and then these patients will go on to have liver cirrhosis and these patients could potentially develop serious liver damage including decompensation, HCC and even potentially death.
What is the treatment for chronic Hep B?
Prevention (education, vaccination)
Refer all chronic HBV cases to RVH clinic- assess LFTs, antigen and antibody status
Screen for hepatocellular cancer- USS and alpha fetoprotein every 6-12 months if cirrhotic
Antiviral agents- lamivudine, entecavir, tenofovir, Peg interferon
Liver transplantation
How is hepatitis C transmitted?
IVDU
Blood products
Body piercing/tattooing
Sexual
What is the clinical course of hepatitis C?
Acute infections (=HCV antibodies), mild symptoms, <20% have jaundice Long term- 80% of patients fail to clear the virus (remain PCR positive for HCV RNA), >50% develop chronic liver disease, 20-30% develop cirrhosis over 20 years, 1-4% annual risk of hepatoma (HCC) in cirrhotic patients
What is the treatment for hepatitis C?
Prevention (education)
No vaccine yet
Oral medication for 8-12 weeks
Cure in 98% of patients (PCR HCV negative)
Patients can remain HCV antibody positive but are not infectious
What are some examples of non-infectious hepatitis?
Alcoholic hepatitis- jaundice, coagulopathy
Autoimmune hepatitis
Drug induced hepatitis
What is the chance of developing hepatitis after acquiring a needle stick injury?
Hep A- not an issue
Hep B- 30% chance of submission (dentists should be vaccinated, if not give immunoglobulin)
Hep C- 3% chance of submission
Hepatitis summary
Hep A- acute infection can be serious, vaccination, immunoglobulin and prevention
Hep B- detection is increasing, treatment can control, vaccination and immunoglobulin
Hep C- detection is increasing, treatment can cure, no vaccination or immunoglobulin, oral antivirals
What is the classification of jaundice?
Traditional- pre-hepatic, hepatic, post-hepatic
Biochemical- unconjugated (increased bilirubin production, impaired hepatic bilirubin uptake, impaired bilirubin conjugation) vs conjugated (biliary obstruction, hepatocellular injury)
What are some common causes of jaundice?
Obstruction- malignancy, gallstones
Liver damage- alcohol, hepatitis
What are some common symptoms that may also show with jaundice?
Pyrexia
Cachexia
Signs of chronic liver disease
What liver screening blood tests are done on someone with jaundice?
LFTs FBP Coag screen Hepatitis screen Autoimmune screen Immunoglobulins Iron studies HIV status
What radiology screens should be done on someone with jaundice?
USS of abdomen
CT scan
MRI
PTC (percutaneous transhepatic cholangiography)
What are the consequences of alcohol?
Intoxication Accidents/road deaths Domestic violence Financial- can’t work and also cost the NHS money (A&E) Psychiatric/overdoses Medical consequences
What is the correlation between alcohol and liver damage?
Sometimes nothing to find Raised liver enzymes Fatty liver Alcoholic hepatitis Liver fibrosis Cirrhosis Decompensated liver disease
What are the complications of liver cirrhosis?
Liver decompensation
Hepatocellular carcinoma
Reduced life expectancy
What are the features of liver decomposition?
Jaundice Encephalopathy Ascites Hypalbuminaemia Coagulopathy Nutritional failure Complications of portal hypertension
Is it safe to proceed with dental work on people with liver cirrhosis?
Child-Pugh score- CP A then yes, CP B or C then no
Ask for blood tests- coag screen, LFTs, FBP for platelet count
What is the function of the liver?
Protein metabolism Carbohydrate metabolism Lipid metabolism Bile formation Hormone and drug inactivation Immunological function
What causes acute liver failure?
Jaundice + encephalopathy + coagulopathy
What is the aetiology of acute liver failure?
Toxins- acetaminophen Hepatitis viruses Vascular Metabolic Malignancy
What are the clinical features of acute liver failure?
Jaundice Encephalopathy Cerebral oedema Ascites and hypoalbuminemia Bleeding Hypotension and tachycardia Sepsis
