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Systemic Diseases > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

What is hepatitis?

A

Inflammation of the liver

On LFTs= bilirubin increased, AST enzyme increased, ALT enzyme increased

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2
Q

What causes hepatitis?

A 
Viral 
Alcohol 
Drugs 
Ischaemia 
Toxins 
Autoimmune 
Metabolic
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3
Q

What are the causes of viral hepatitis?

A 
Hepatitis ABC 
EBV 
Herpes simplex 
Yellow fever
E and G 
Non-ABC
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4
Q

What are the clinical features of viral hepatitis?

A 
Acute 
-Jaundice
-Malaise 
-Liver dysfunction
Chronic 
-only B, C and E 
-can cause cirrhosis
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5
Q

How is hepatitis A prevented?

A

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

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6
Q

What is the incubation time of acute hepatitis B?

A

1-6 months

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7
Q

How is hep B transmitted?

A

Sexual, blood, bodily fluids

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8
Q

What is the earliest indicator of acute Hep B?

A

HBsAg

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9
Q

What is chronic hep B status?

A 
HBsAg positive (>6months) 
Active disease- raised LFTs, raised HBV DNA, liver damage 
Chronic carrier- normal LFTs, negative HBV DNA, still a risk
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10
Q

What is the spectrum of disease for hepatitis B?

A

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.

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11
Q

What is the treatment for chronic Hep B?

A

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

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12
Q

How is hepatitis C transmitted?

A

IVDU
Blood products
Body piercing/tattooing
Sexual

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13
Q

What is the clinical course of hepatitis C?

A 
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
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14
Q

What is the treatment for hepatitis C?

A

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

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15
Q

What are some examples of non-infectious hepatitis?

A

Alcoholic hepatitis- jaundice, coagulopathy
Autoimmune hepatitis
Drug induced hepatitis

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16
Q

What is the chance of developing hepatitis after acquiring a needle stick injury?

A

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

17
Q

Hepatitis summary

A

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

18
Q

What is the classification of jaundice?

A

Traditional- pre-hepatic, hepatic, post-hepatic
Biochemical- unconjugated (increased bilirubin production, impaired hepatic bilirubin uptake, impaired bilirubin conjugation) vs conjugated (biliary obstruction, hepatocellular injury)

19
Q

What are some common causes of jaundice?

A

Obstruction- malignancy, gallstones

Liver damage- alcohol, hepatitis

20
Q

What are some common symptoms that may also show with jaundice?

A

Pyrexia
Cachexia
Signs of chronic liver disease

21
Q

What liver screening blood tests are done on someone with jaundice?

A 
LFTs
FBP
Coag screen 
Hepatitis screen 
Autoimmune screen 
Immunoglobulins 
Iron studies 
HIV status
22
Q

What radiology screens should be done on someone with jaundice?

A

USS of abdomen
CT scan
MRI
PTC (percutaneous transhepatic cholangiography)

23
Q

What are the consequences of alcohol?

A 
Intoxication 
Accidents/road deaths 
Domestic violence 
Financial- can’t work and also cost the NHS money (A&E)
Psychiatric/overdoses 
Medical consequences
24
Q

What is the correlation between alcohol and liver damage?

A 
Sometimes nothing to find 
Raised liver enzymes 
Fatty liver 
Alcoholic hepatitis 
Liver fibrosis 
Cirrhosis 
Decompensated liver disease
25
Q

What are the complications of liver cirrhosis?

A

Liver decompensation
Hepatocellular carcinoma
Reduced life expectancy

26
Q

What are the features of liver decomposition?

A 
Jaundice 
Encephalopathy 
Ascites 
Hypalbuminaemia 
Coagulopathy 
Nutritional failure 
Complications of portal hypertension
27
Q

Is it safe to proceed with dental work on people with liver cirrhosis?

A

Child-Pugh score- CP A then yes, CP B or C then no

Ask for blood tests- coag screen, LFTs, FBP for platelet count

28
Q

What is the function of the liver?

A 
Protein metabolism
Carbohydrate metabolism 
Lipid metabolism 
Bile formation 
Hormone and drug inactivation 
Immunological function
29
Q

What causes acute liver failure?

A

Jaundice + encephalopathy + coagulopathy

30
Q

What is the aetiology of acute liver failure?

A 
Toxins- acetaminophen 
Hepatitis viruses 
Vascular 
Metabolic 
Malignancy
31
Q

What are the clinical features of acute liver failure?

A 
Jaundice 
Encephalopathy 
Cerebral oedema 
Ascites and hypoalbuminemia 
Bleeding 
Hypotension and tachycardia 
Sepsis

Systemic Diseases (21 decks)

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