Liver Disease Flashcards
What kind of virus is Hep B
Double stranded DNA virus
What is the most common cause of hepatitis
Hep B virus
What is HbeAg
Antigen secreted by cells infected by hepatitis B (marker for acute infection)
What 3 antigens are involved in hepatitis b virus
- HbsAg= surface antigen
- HBcAg= core antigen
- HbeAg= antigen secreted by infected cells
How can hep B be transmitted
Horizontal: sexual intercourse, blood, bites from infected people
Describe the clinical presentation of chronic hepatitis
- Acutely presents as flu, anorexia, nausea, fever, malaise, jaundice, ascites
When does hepatitis B become chronic
> 6 months
What may chronic hepatitis B progress to
Liver fibrosis, cirrhosis, hepatocellular carcinoma
How may you investigate hep B
Hep B specific
General liver function tests
Other tests
What do transaminases tell us
High= acute hepatitis
What are ALT and AST markers for
Biomarkers for liver injury
What are ALP markers for
biliary tree pathology
What is HBsAg
Hep B surface antigen
What is the first marker to appear in Hep B and what does it imply
HBsAg
Implies acute disease (present for 1-6 months)
Implies patient in infective
What do anti-HBs imply
Immunity
What is HbeAg
Hep B ‘e antigen
Presents 1.5-3 months
Measures infectivity
What is Anti-HbC
Implies previous infectious
What are the 2 types of anti-HBc antibodies
IgM anti-HBs appear during acute/ recent hep B
IgG anti-HBcs persist for life
What should be avoided in hep B
Unprotected sex
Alcohol
How should chronic Hep B infections be treated
Treatment is lifelong
Antivirals
Define cirrhosis
Irreversible liver damage- the end stage of chronic liver disease
What is the most common cause of cirrhosis in the developed world, and worldwife
Developed world= alcohol
Worldwide= HBV
What genetic disorders can lead to cirrhosis
Haemochromatosis
Wilsons disease
What drugs can cause cirrhosis
Amidarone
Methyldopa
Methotrexate
How does cirrhosis come about
Liver cell necrosis leads to fibrosis and regeneration nodule formation
What cells are activated due to liver injury and what does this cause
Stellate cell activation
Leads to production of fibrogenic mediators leading to increased collagen and fibrosis
What are macronodules and when are they formed
Nodules are large and variable in size
Caused by chronic viral hepatitis
What are micronodules and why do they form
Nodules <3mm
Chronic alcohol use
What is the difference between compensated and decompensated liver cirrhosis
Compensated= liver can still undergo its function Decompensated= liver can't still do function and do normal jobs
What are the consequences of portal hypertension
Ascites
Congestive splenomegaly and oesophageal varices
What are the consequences of hepatic failure
Coagulopathy
Hepatic encepaholopathy
Describe the potential clinical presentation of somebody with liver cirrhossi
Ascites Splenomegaly Caput medusae Peripheral oedema Hair loss Testicular atrophy
What would liver function tests of somebody with liver cirrhosis show
Decreased albumin
Prolonged prothrombin time
What would the liver biochem tests of somebody with cirrhosis show
Increased bilirubin
Sometimes normal, sometimes increased AST, ALT, ALP, yGT
What would a full blood count of somebody with liver cirrhosis show
Decreased white cell count, decreased platelets, anaemia
What would an ultrasound of liver cirrhosis show
Hepatomegaly
Splenomegaly
Reversed flow in portal vein
Ascites
What are the acute symptoms of hepatitis C
Reduced appetite Fatigue Nausea Muscle/ joint pain Weight loss
What are the chronic symptoms of hepatitis C
Weight loss Reduced appetite Fatigue Bleeding Bruising Dark coloured urine Itchy skin Confusion, drowsiness
What causes hep C
Hep C virus
Spreads when blood infected
3 complications of hep C
Cirrhosis
Liver failure
Liver cancer
5 indications for liver transplantation
Alcoholic liver disease Hep C/ B Primary biliary cholangitis AI hep Paracetamol overdose
4 complications of liver transplant
Organ rejection
Primary non-function
Infections
Hepatic artery/ portal vein thrombosis
Name 3 biochemical consequences of drinking too much alcohol
- Increase in FA synthesis
- Decrease in FA oxidation
- Production of reactive oxidative species
What is hepatic steatosis
- Increased levels of NADH when drinking leads to increase in fatty acid production
- Build up of fat on the liver
- This is reversible and asymptomatic
What is alcoholic hepatitis
- Reactive oxygen species and cytokines are generated as a result of alcohol consumption
- Inflammation leads to damage of hepatocytes
- Mallory bodies form
What is cirrhosis
- Damaged hepatocytes are replaced by scar tissue forming regenerative nodules
- Micronodular
How is alcoholic hepatitis treatment
Complete abstience from drinking- life long
Vit K/ thiamine supplement
Steroids if in severe distress
What are cholesterol gallstones
Over saturation of cholesterol in bile
Large stones
What are pigment gallstones
Over-saturation of bilirubin with calcium
Small anf friable gallstones
Due to haemolysis and cirrhosis
What mixed gallstones
Combo of pigment and cholesterol gallstones
Name 4 complications of gallstones
- Biliary colic
- Acute cholecystis
- Ascending cholangitis
- Acute pancreatitis
What is biliary colic
Pain associated with temporary obstruction of CD/ CBD
Severe constant pain with crescendo pattern
Resolves after 90 minutes
What is acute cholecystis
Acute inflammation of gallbladder wall with peritoneal irritation
Well localised RUG/ epigastric pain
Fever
Guarding
What is murphys sign
Sharp pain on inspiration with pressure on gallbladder
What is ascending cholangitis
Infection of common bile duct
Can result if gallstone passes on its own
What is Charcots triad and what is it characteristic of
Severe RUG/ epigastric pain
Fever
Jaundice
Ascending cholangitis
What is acute pancreatitis
Intracellular activation of pancreatic enzymes and autodigestion
Epigastric pain which radiates to the back
What biochemical changes will be present in acute pancreatitis
Increased serum lipase and amylase
