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Yr 5 GI & Breast > Liver pathology > Flashcards

Liver pathology Flashcards

1
Q

Describe the presentation of hepatitis A

A

INITIAL: Fever, Malaise, Anorexia, Arthralgia
THEN: Jaundice, tender hepatomegaly, lymphadenopathy, diarrhoea

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2
Q

How is Hep A treated?

A

Supportive: Fluids, anti-emetics
Chlorphenamine- pruritus
Avoid OH-
Immunisation- Harvix

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3
Q

What are the investigations for Hep A?

A 
↑↑ALT
↑AST (22-40d post-exposure, ALT often > 1000 u/L, normal over 5-20 wks) 
↑Conj + unconj bili
↑IgM (ACUTE INFECTION)
↑IgG for life (RECOVERY/VACCINATION)
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4
Q

Describe the presentation of acute hepatitis B

A

INITIAL: Fever, malaise, arthralgia, URTICARIA
Jaundice: Dark urine + pale stools

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5
Q

Describe the presentation of chronic hepatitis B

A

Fatigue
Anorexia
Nausea
Abdo/RUQ pain

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6
Q

What are the complications of Hep B?

A

Fulminant hepatitis
Decompensated liver disease
Chronic HBV

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7
Q

What are the signs of decompensated liver disease?

A

Ascites
Encephalopathy
GI Haemorrhage
Hepatosplenomegaly

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8
Q

What are the investigations for HBV?

A 
HBsAg +ve: Surface antigen
HBcAg +ve: Core antigen
HBeAg: +ve e antigen
Anti-HBc +ve:
Anti-Be Anti-HBs +ve: Prev/ongoing infection
Liver biopsy
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9
Q

What is the significance of a HBsAg +ve antigen?

A

Key screening antigen
1-6m post-exposure = ACUTE will be IgM +ve too
>6m = CARRIER (may be chronic), IgG -ve
+ve HBsAg alone= VACCINATION

IF +ve CHECK Anti-HDV Ab

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10
Q

How is HBV treated?

A

-Active immunisation of high risk
-REFER to liver specialist
MODERATE disease/ ALT >30 =
-PEG Interferon + Iamivudine + protease inhibitor: Aim to prevent cirrhosis = monitor response using Anti-HBs

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11
Q

Is there any follow-up required for HBV?

A

6month serology test + HCC screen

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12
Q

Describe the presentation of chronic hepatitis C

A 
Early= asymptomatic
Jaundice
Fatigue
Arthralgia
CIRRHOSIS: 25% after 20years
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13
Q

What is a major complication of HCV?

A

Hepatocellular Carcinoma

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14
Q

What are the investigations for HCV?

A

Bloods: Transient ↑↑AST:ALT < 1:1, until cirrhosis develops
Anti-HCV Ab +ve: Exposure
HCV RNA PCR +ve: DIAGNOSTIC
Liver biopsy= ongoing infection

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15
Q

How is HCV treated?

A

PEG Interferon a-2a/2b + protease inhibitor + Ribavirin

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16
Q

Describe the presentation of chronic hepatitis D

A

Similar to HBV

Usually present simultaneously (co-infection) or after (Superinfection)

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17
Q

How is HDV investigated?

A

Bloods
HBsAg +ve
Anti-HDV Ab

18
Q

How is HDV treated?

A

Interferon-a: limited success

Liver transplant

19
Q

Which group of people should be watched closely with HEV?

A

Pregnant women- significant mortality

20
Q

How is HEV investigated?

A

Bloods
IgM +ve= ACUTE
IgG +ve= RECOVERY detectable for life
HEV Serology= DIAGNOSTIC

21
Q

How is HEV treated?

A

Same as HAV

22
Q

What is fulminant liver failure?

A

Necrosis of liver leading to sever liver function impairment
HYPER-ACUTE: Encephalopathy with 7d of jaundice
ACTUE: week-month
SUB-ACUTE: 5-26weeks

23
Q

What are the causes of fulminant liver failure?

A

INFECTION: Hep B/C, haemochromatosis, AI hepatitis, Wilson’s, Vasc (Budd-Chiari)
DRUGS: Paracetamol OD, Isoniazid, Methotrexate, Azathioprine, Tetracyclines

24
Q

How does liver failure present?

A 
Jaundice
Ascites
Fetor hepaticus- pear drop breath
Renal failure
Hypoalbuminaemia
25
Q

What are the features of hepatic encephalopathy?

A 
Ascites
Altered mood/behaviour
Sleep disturbance
↓GCS, drowsy, slurred speech
Liver flap/Asterix
Incoherent, confusion, restless
26
Q

How is liver failure investigated?

A

FBC – ↑Neut (inf), ↓Hb (bleed)
U+E + LFTs (↑AST/ALT; ↑PT/INR, ↓Alb)
Blood/urine/ascitic culture

27
Q

What is the Kings College Criteria for liver transplant?

A 
PT >100
3/5 of following:
-Drug induced failure
-Age <10 >40
- >1week from 1st jaundice to encephalopathy
- PT >50
- Bilirubin >300
28
Q

What is cirrhosis?

A

Diffuse hepatic inflammation characterised by fibrosis & conversion of normal liver architecture to structurally abnormal nodules

29
Q

How does portal HTN occur?

A

1) Fibrosis leads to distorted hepatic vasculature
2) Inc intrahepatic resistance = portal HTN
3) Leads to porto-systemic shunt

30
Q

What are the signs of portal HTN?

A 
Oesophageal varices
Hypo-perfusion of kidneys = water/Na+ retention
Ascites
Transudative pleural effusion
Splenomegaly
Caput medusae
31
Q

What can damage to hepatocytes lead to?

A

↓clotting factors + Albumin

32
Q

What are causes of cirrhosis?

A 
OH- abuse
NAFLD
Hep B/C
NASH
Autoimmune: Biliary cirrhosis
Haemochromatosis
33
Q

How does cirrhosis present?

A

Asymptomatic- compensated
VAGUE: Fatigue, malaise, anorexia, nausea
SIGNS: Jaundice, hair loss, spider nave, leukonychia, palmar erythema, gynaecomastia, xanthelasma

34
Q

What are the signs of decompensated liver failure?

A 
Oedema + ascites
Jaundice
Easy bruising
Oesophageal varices rupture
Spontaneous bacterial peritonitis
Hepatic encephalopathy
35
Q

How is cirrhosis investigated?

A 
Bloods:
LFTs – ↑Bil ↑↑AST >↑ALT ↑ALP ↑yGT 
After loss of liver function - ↓Albumin ↑PT/INR 
↓WCC ↓Platelets (hypersplenism) 
↓Clotting factors 
↓Hb (if occult bleeding) 
Blood film – non-megaloblastic macrocytic anaemia 
Child-Pugh score
36
Q

What are the components of a non-invasive liver screen?

A

NILS

1) Liver USS + duplex
2) Viral serology: Hep B/C
3) Autoimmune: IgA/M/G, ANA, ANCA
4) Genetic: A1-Antitrypsin, serum caeruloplasmin, serum Cu - IF <40yo

37
Q

What is diagnostic of spontaneous bacterial peritonitis?

A

Ascitic tap for MC&S:

Neut >250

38
Q

How are ascites treated?

A

-Fluid restriction <1.5L/day
-Na restriction
-Spironolactone: 100mg OD
MONITOR WEIGHTS DAILY
-Poor response = Furosemide

39
Q

How is hepatic encephalopathy treated?

A

Lactulose

40
Q

How is spontaneous bacterial peritonitis treated?

A

Commonly: E.Coli, Strep, Klebsiella
Tx: IV Cefotaxime OR Tazocin
Recent instrumentation = Metronidazole

41
Q

What is Budd-Chiari?

A

Hepatic vein thrombosis due to hypercoagulable state or obstruction
Sx: Abdo pain, ascites, jaundice, vomiting, hepatomegaly

42
Q

What is Wilson’s disease?

A

↓Caeruloplasmin
Sx: Behaviour & speech problems, hepatitis/cirrhosis, asterixes, chorea, dementia and blue nails, Kaiser-Fleischer rings
Tx: Penicilliamine

Yr 5 GI & Breast (13 decks)

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