Liver Problems Flashcards
List possible differentials for the following presentation; Fever, RUQ pain, jaundice
- Malaria - returning travellers
- Acute cholecystitis
- Ascending cholangitis
- Acute viral hepatitis
- Liver abscess
When someone presents with a liver abscess, what investigations should be performed?
- ECG
- Plain CXR
- Abdominal USS
- Tests for Hep B and C viruses
What does the presence of the following mean; Hepatitis A virus IgM?
Current or recurrent hepatitis A infection
What does the presence of the following mean; Hepatitis C antibody?
Exposure to Hepatitis C
What does the presence of the following mean; Antibody to hepatitis B surface antigen (anti-HBs)?
Immunity to Hepatitis B
What does the presence of the following mean; Hepatitis A virus IgG?
Immunity to hepatitis A
What does the presence of the following mean; Hepatitis B surface antigen (HBsAg)?
Active hepatitis B infection
What does the presence of the following mean; Antibody to hepatitis B core antigen (anti-HBc)?
Exposure to Hepatitis B
Who is most at risk of Hepatitis C infection?
IV drug users
Where are the high prevalence Hepatitis C areas in the world?
- Central and Eastern Asia
- Middle East
- Northern Africa
How is Hep C transmitted?
It is a blood-borne virus
What is the hepatitis C incubation period?
2 weeks - 6 months
How do 2/3 of people with HepC present in the acute phase?
Asymptomatically
What happens to serum transaminases in someone with HepC infection?
They can be 10-20 times the upper limit of normal
How do we diagnose chronic HepC?
anti-HCV antibody is the best initial test, followed by HCV RNA detection in the blood by PCR to detect any chronic active infection
What treatment is available to someone with a chronic HepC infection?
- Interferon (weekly injection)
- Ribavirin (oral)
- New novel treatments emerging
What percentage of patients with Chronic HepC go on to develop liver cirrhosis over 20 years?
15-50%
If liver cirrhosis develops, what does this put the patient at further risk for developing?
Hepatocellular carcinoma
Which parasite causes amoebic liver abscesses?
Entamoeba histolytica
Where is E.histolytica an endemic?
India
Mexico
Africa
Central and South America
How is E.histolytica transmitted?
Faecal oral route
How do trophozoites reach the portal circulation?
They colonise the small intestine, once ingested, and then invade the colonic mucosa. They can then spread via the portal circulation and reach the liver.
What is the common clinical presentation of someone with an amoebic liver abscess?
- Fever
- RUQ pain
- Recent diarrhoea/dysentery history
What would be found on LFT and FBC in an amoebic liver abscess?
- Elevated ALP
- Elevated WCC
- NO eosinophilia (which is common in other parasitic infection)
What would be seen on a liver USS in someone with an amoebic liver abscess?
A single, hypoechoic lesion
Often in the right lobe
If an amoebic liver abscess is aspirated, what would it produce?
Thick, brown fluid
“anchovy paste”
What is the treatment of an amoebic liver abscess?
Metronidazole for 7-10 days
Drainage is NOT indicated in most unless there is risk of significant complications
