liver middle tier Flashcards
acute vs chronic hepatitis time-wise
acute = <6m chronic = 6m +
signs and symptoms of acute hepatitis
- none/few
- malaise
- lethargy
- myalgia
- GU/ abdom pain - RUQ
- jaundice (pale stool, dark urine, itch)
- ascites
- tender hepatosplenomegaly
- bleeding
- encephalopathy
- high bilirubin
- high ALT/AST
signs and symptoms of chronic hepatitis
- none/few
- clubbing
- palmar erythema
- spide naevi
- signs of decompensated liver
- – coagulopathy, jaundice, low albumin, ascites, encephalopathy
causes of hepatitis
- split into acute and chronic
ACUTE
infectious
- hepatitis A,B,C,D,E (c= less so, more chronic)
- herpes, EBV, CMV, VZV
- non viral - toxoplasmosis, coxiella, leptospirosis
non infectious
- alcohol, drugs
- toxins / poisons
- pregnancy
- autoimmune
- metabolic, heridatry - Wilsons, A1AT def
CHRONIC infectious - hepatitis B,C,D (A+ E= acute only) non infectious - alcohol, drugs - autoimmune - metabolic, heridatry - Wilsons, A1AT def
hepatitis LFTs
hepatitis complications
may be normal! may be high in acute
hepatocellular carcinoma
portal hypertension
– varices, bleeding, ascites
hep A epidemiology
- where
- commonness
LIC, poor sanitation (Africa, S america)
most common Hep worldwide
hep A risk factors
travel food handler sexual shellfish poor sanitation, overcrowding drug use, lick needle first household contacts of infected
hep A pathophysiology
- spread
- incubation
- virus
- acute/ chronic
- other features
- faeco-oral spread
- short incubation period - 2-6w
- RNA
- self limiting, ONLY acute. + 100% immune once had
- rarely results in liver failure
hep A diagnosis
anti HAV antibodies IgM - acute marker I gG = marker of past infection / vaccine + immunity \+ billirubinuria \+ nausea \+ fever
hep A management / prevention
- good prognosis
- supportive treatment
- – close contacts –> vaccine, immunoglobulins
- – avoid alcohol
- – monitor liver function
- notify public health
- hygiene inc boil water
- vaccine
hep E epidemiology
- age
- gender
- where
- mortality
indonesia
endemic in UK
older men
mortality high in preg
hep E pathophysiology
- spread
- incubation
- virus
- acute/ chronic
- other features
- two strands. GT1/2 spread in contaminated food/water (faecooral). GT3/4 spread in undercooked meat, pigs, rodents, dogs
- RNA virus
- self limiting - only chronic in immunosuppressed and GT3/4. 100% immune after infection
hep E diagnosis
anti HEV antibodies
IgM - acute marker
I gG = marker of past infection / vaccine + immunity
+ neurological manifestations
hep E management/ prevention
- supportive treatment
- – close contacts –> vaccine, immunoglobulins
- – avoid alcohol
- – monitor liver function
- notify public health
vaccine
thorough meat cooking, sanitation/hygiene
dont be immunocomprimised
hep B epidemiology
worldwide - esp Africa, mediterranean, Far East, common
hep B pathophysiology
- spread
- incubation
- virus
- acute/ chronic
- other features
- very infectious
- blood
— sex esp MSM
— needle (needle stick , IV drug use, dialysis, tattoos)
— vertical (mum to baby)
+ semen/saliva - incubation period 1-6m
- DNA!! only one not rna
- can cause acute + chronic (most resolves alone though)
hep B AND D risk factors
healthcare/ emergency proffesion dialysis - CKD travellesrs tattoo lads MSM IV drug use
Hep B diagnosis
anti HBV antibodies
IgM - acute marker
I gG = marker of chronic infection/ previous infection (may not be resolved)
+ HBsAG (hep B surface antigen - produced by hepatocytes)
+ rashes
+ anorexia
hep B AND D management/ prevention
- supportive treatment
— close contacts –> vaccine, immunoglobulins
vaccine for hep B. (NO vaccine for hep D)
— sex contacts/ preg mum –> vaccine
— avoid alcohol
— monitor liver function - notify public health
pegylated interferon subcut if chronic
nucleotide analogues - inhibit viral replication
hep D epidemiology
where
E europe, N africa
hep D pathophysiology
- spread
- incubation
- virus
- acute/ chronic
- other features
- blood borne (sex, needles, vertical)
- RNA (but incomplete)
- needs hep B to be present to exist (activation, assembly, replication)- so acquired with hep b
- can be acute or chronic
hep B and D - coinfection/ superinfection
coinfection = hep b acute + hep D
- indistinguishable from hep b acute
- igM present got anti HBV and HDV
superinfection = hep B chronic + hep D
- severe - risk of fulmiant hepatitis –> liver failure
- fibrosis
- high AST/ALT
- secondary acute hep
hep C epidemiology
-where
Egypt
hep c risk factors (inc transmission type)
- blood : IV drug users, blood transfusion before 1991 (before blood product screening),
- limited sex transfusion but MSM more severe infection
- alcohol –> more severe infection