Liver disorders Flashcards
Common causes of abnormal LFTS impossible to explain
- drugs -eg stat……
- Gall sto…….
- alc……. excess
- Fatty …… disease
- Viral (e.g. hepatitis) infe………
- Haemach…………..
- Wil…… disease
Transient mild abnormalities which are simply impossible to explain Drugs – eg Statins Gall stones Alcohol excess Fatty Liver Disease Viral (e.g. hepatitis) infections Haemachromotasis Wilson’s disease
Typical patterns of liver dysfunction
Liver dysfunction
- Hepat……. inte……
- Chole……..
- Liver function mass changes ie impaired synthetic capa…..
Biochemical markers
- AST, ALT, GGT, conjugated bilirubin
- ALP, GGT, conjugated bili……..
- Prothrombin time, Albumin, liver enzymes may ………
Typical patterns of liver dysfunction
Liver dysfunction
- Hepatocyte integrity
- Cholestasis
- Liver function mass changes ie impaired synthetic capacity
Biochemical markers
- AST, ALT, GGT, conjugated bilirubin
- ALP, GGT, conjugated bilirubin
- Prothrombin time, Albumin, liver enzymes may be raised or normal/low
Hepa titis - causes
Caused by:
- Infectious agents:
-
-
Non-infectious agents:
Ioni…. radiation, Dru…, Herbal reme….., Alco…., Autoim……. diseases, Metal …toxicity (iron ,copper)
Hepatitis: Liver cell Inflammation
Caused by:
Infectious agents:
Bacterial
Viral
Noninfectious agents:
Ionizing radiation, Drugs, Herbal remedies, Alcohol, Autoimmune diseases, Metal ion toxicity (iron, copper)
Hepatitis -Types
Acute hepatitis: Inflammation develops quickly and lasts for a short period.
- Viral (Type ..,..,..also E..,C..,sometimesC) – Characterised by …… cell injury with swelling and spotty ……..
- Alcohol-related – Characterised by cellular …….., spotty necrosis and ……. bodies with a variably intense ………. infiltrate.
Chronic Hepatitis: Lasts for more than 6 months
Viral (Type ..,..,..), autoimmune, alcohol.
Acute Hepatitis: Inflammation develops quickly and lasts for a short period.
Viral (Type A,B, E,also EBV,CMV,sometimesC) – Characterised by diffuse cell injury with swelling and spotty necrosis.
Alcohol-related – Characterised by cellular swelling, spotty necrosis and Mallory bodies with a variably intense neutrophil infiltrate.
Chronic Hepatitis: Lasts for more than 6 months
Viral (Type B, C, D), autoimmune, alcohol.
Viral Causes
Hepatitis viruses primarily infect the liver.
…&.. - food borne
(Acute infection short incubation)
..,..,.. Blood borne
(Acute and …….. infection, longer incubation)
Viral Causes
Hepatitis viruses primarily infect the liver.
A&E - food borne
(Acute infection short incubation)
B,C,D Blood borne
(Acute and chronic infection, longer incubation)
Hepatitis A
- Also known as ……… hepatitis and …..-……. hepatitis
Transmitted by:
- Close Personal Contact (e.g. household contact, sexual …….
- Contaminated ….. and …….
- Blood exposure (rare) e.g. ………. drug use, rarely by ………
Hepatitis A
- Also known as infectious hepatitis and short - incubation hepatitis
Transmitted by:
- Close Personal Contact (e.g. household contact, sexual contact
- Contaminated Food and Water
- Blood exposure (rare) e.g. injection drug use, rarely by transfusion
Hepatitis A - Clinical Features
….NA virus, single ….type
Acute disease and asy……… infection
W………. distribution
Inf…./Chi…….
Faecal shedding of hepatitis antigen (Ag), but appearance of Ag is ….. and disappears as liver enzymes ….. (virus in stool 2- 3 weeks before and. ….. week after onset of jaundice)
Jaundice: …-80%
Incubation period:
Average ……. days
(range 15-50 days)
Rare complications:
Fulm………….. hepatitis
Chol……. hepatitis
relap….. hepatitis
RNA virus, single serotype
Acute disease and asymptomatic infection
Worldwide distribution
Infants/Children
Faecal shedding of hepatitis antigen (Ag), but appearance of Ag is transient and disappears as liver enzymes peak (virus in stool 2-3 weeks before and 1 week after onset of jaundice).
Jaundice: 70-80%
Incubation period: Average 30 days
(range 15-50 days)
Rare Complications: Fulminant hepatitis
Cholestatic hepatitis
Relapsing hepatitis
Hepatitis A
In HepA, elevations in … (2-5 weeks after exposure) precedes the development of jaundice (4-6 weeks after exposure).
Diagnosis: Serologic detection of hepatitis A anti…… using EI.. or sto….analysis.
IgM and IgG appear in stool at different times of infection.
IgM appearance in stool: Signs of … infection 4 - … weeks and declines by week 1….
IgG appears at week 5-]…. and stays high for a long time – Sign of the past infe……..
In HepA, elevations in AST (2-5 weeks after exposure) precedes the development of jaundice (4-6 weeks after exposure).
Diagnosis: Serologic detection of hepatitis A antibody using EIA or stool analysis.
IgM and IgG appear in stool at different times of infection.
IgM appearance in stool: Signs of acute infection 4 - 7 weeks and declines by week 10.
IgG appears at week 5-6 and stays high for a long time – Sign of the past infection.
Concentration of Hepatitis B virus in Various Body fluids
-
-
- -
Low/Not detectable - - - - -
Concentration of Hepatitis B virus in Various Body fluids
High
- blood serum
- serum
- wound exudates
Morderate
- semen
- vaginal fluid
- saliva
Low/Not detectable
- urine
- faeces
- sweat
- tears
- breast milk
Hepatitis B
The virus consists of a 42-cm double-shelved spherical particle with a central core of … surrounded by a protein …..
Incubation 8-…. weeks Average …. days (45-180 days).
~ 2/3rd cases may be asy……. or produce mild …. like symptoms.
1/3rd patients - mal…., irregular f……, tenderness in the right upper abdomen, jau….., dark urine.
~90% patients recover within …. months. Mortality in ~ …%.
10% patients develop …… hepatitis.
The virus consists of a 42-cm double-shelved spherical particle with a central core of DNA surrounded by a protein coat.
Incubation 8-26 weeks Average 60 days (45-180 days).
~ 2/3rd cases may be asymptomatic or produce mild flu like symptoms.
1/3rd patients - malaise, irregular fevers, tenderness in the right upper abdomen, jaundice, dark urine
~90% patients recover within 6 months. Mortality in ~ 1%.
10% patients develop chronic hepatitis
HBV infection
Acute
- Fu………then >
Death/ Recovery
- Re…….
Chronic
- Mild> ……..
Severe > …………..
HBV infection
Acute
- Fulminant then >
Death/ Recovery
- Recovery
Chronic
- Mild> Cirrhosis
Severe > Cancer
Hepatitis D
Also known as ……. hepatitis.
Causes disease in patients who have …… virus infected disease present.
A defective ……virus that has a ba.. pa.. homology with Hep.. virus and uses it for repli…….
Patients with co-infection of HepB and HepD infection show a high rate of progression to chronic hepatitis.
High risk of chronic ….. disease.
Hepatitis D
Also known as delta hepatitis.
Causes disease in patients who have HepB virus infected disease present.
A defective RNA virus that has a base pair homology with HepB virus and uses it for replication.
Patients with co-infection of HepB and HepD infection show a high rate of progression to chronic hepatitis.
High risk of chronic liver disease.
Hepatitis C
- Hepatitis C unstable …virus with multiple types and subtypes
- HepC is different from A and B in that people with HepC …….. of developing ……… do not get complete ……………
Hepatitis C
Hepatitis C unstable RNA virus with multiple types and subtypes.
HepC is different from A and B in that people with HepC inspite of developing antibodies do not get complete protection.
Exposures Known to be Associated With HCV Infection
- Iatrogenic, Infected …… (injecting drug use, tattoos, body piercing)
- Transfusion, transplant from infected …………
- Occupational ………… to ………. - Mostly needle sticks
- Birth to ……….- …….. mother
- sex with i………. ……. - multiple sex partners
Exposures Known to Be Associated With HCV Infection
Iatrogenic, Infected needles (Injecting drug use, tattoos, body piercing).
Transfusion, transplant from infected donor.
Occupational exposure to blood- Mostly needle sticks
Birth to HCV-infected mother
Sex with infected partner
Multiple sex partners
Features of Hepatitis C virus Infection
-
Acute illness (jaundice) - MIld ...%
Case fatality rate ..-..%
Chronic infection ..-..%
Chronic hepatitis ..-..%
Cirrhosis ..-..%
Mortality from CLD..-..%
Incubation period Average 6-7 weeks
Range 2-26 weeks
Acute illness (jaundice) Mild (<20%)
Case fatality rate Low Chronic infection 60%-85% Chronic hepatitis 10%-70% Cirrhosis <5%-20% Mortality from CLD 1%-5%
