Liver pathology Flashcards by Amy Spicer

Describe the presentation of hepatitis A

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

How well did you know this?

Not at all

Perfectly

How is Hep A treated?

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

How well did you know this?

Not at all

Perfectly

What are the investigations for Hep 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)

How well did you know this?

Not at all

Perfectly

Describe the presentation of acute hepatitis B

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

How well did you know this?

Not at all

Perfectly

Describe the presentation of chronic hepatitis B

Fatigue
Anorexia
Nausea
Abdo/RUQ pain

How well did you know this?

Not at all

Perfectly

What are the complications of Hep B?

Fulminant hepatitis
Decompensated liver disease
Chronic HBV

How well did you know this?

Not at all

Perfectly

What are the signs of decompensated liver disease?

Ascites
Encephalopathy
GI Haemorrhage
Hepatosplenomegaly

How well did you know this?

Not at all

Perfectly

What are the investigations for HBV?

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

How well did you know this?

Not at all

Perfectly

What is the significance of a HBsAg +ve antigen?

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

How well did you know this?

Not at all

Perfectly

How is HBV treated?

-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

How well did you know this?

Not at all

Perfectly

Is there any follow-up required for HBV?

6month serology test + HCC screen

How well did you know this?

Not at all

Perfectly

Describe the presentation of chronic hepatitis C

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

How well did you know this?

Not at all

Perfectly

What is a major complication of HCV?

Hepatocellular Carcinoma

How well did you know this?

Not at all

Perfectly

What are the investigations for HCV?

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

How well did you know this?

Not at all

Perfectly

How is HCV treated?

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

How well did you know this?

Not at all

Perfectly

Describe the presentation of chronic hepatitis D

Similar to HBV

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

How well did you know this?

Not at all

Perfectly

How is HDV investigated?

Bloods
HBsAg +ve
Anti-HDV Ab

How is HDV treated?

Interferon-a: limited success

Liver transplant

Which group of people should be watched closely with HEV?

Pregnant women- significant mortality

How is HEV investigated?

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

How is HEV treated?

Same as HAV

What is fulminant liver failure?

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

What are the causes of fulminant liver failure?

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

How does liver failure present?

Jaundice
Ascites
Fetor hepaticus- pear drop breath
Renal failure
Hypoalbuminaemia

What are the features of hepatic encephalopathy?

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

How is liver failure investigated?

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

What is the Kings College Criteria for liver transplant?

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

What is cirrhosis?

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

How does portal HTN occur?

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

What are the signs of portal HTN?

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

What can damage to hepatocytes lead to?

↓clotting factors + Albumin

What are causes of cirrhosis?

``` OH- abuse NAFLD Hep B/C NASH Autoimmune: Biliary cirrhosis Haemochromatosis ```

How does cirrhosis present?

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

What are the signs of decompensated liver failure?

``` Oedema + ascites Jaundice Easy bruising Oesophageal varices rupture Spontaneous bacterial peritonitis Hepatic encephalopathy ```

How is cirrhosis investigated?

``` 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 ```

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

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

What is diagnostic of spontaneous bacterial peritonitis?

Ascitic tap for MC&S: | Neut >250

How are ascites treated?

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

How is hepatic encephalopathy treated?

Lactulose

How is spontaneous bacterial peritonitis treated?

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

What is Budd-Chiari?

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

What is Wilson's disease?

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