Liver Problems Flashcards
What are differentials for fever, abdominal pain and jaundice?
- Malaria
- Acute cholecystitis
- Ascending cholangitis
- Acute viral hepatitis
- Liver abscess
What would a liver abscess present like?
Acute RUQ abdominal pain and tenderness, fever and abnormal LFTs with increased CRP - abdominal USS would be useful
What would Hep B immunity show as?
-ve HBsAg
-ve anti-HBc
+ve anti HBs
How do you determine if there is active Hep C?
- Send blood for HCV RNA (viral load) quantification by PCR testing
- Detectable RNA then active HCV
- Undetectable and antibody positive - previous infection
What would present as a round, hypoechoic liver lesions on USS?
- Hepatocellular carcinoma
- Metastases
- Psychogenic liver abscess
- Hydatid cyst
- Amoebic liver abscess
What are the investigations for pyogenic/amboeic liver abscess?
- Serology for antibodies to Entamoeba histolytica
- Commence broad spectrum abx
- Blood cultures
- Arrange imaging guided percutaneous drainage of the abscess
How is Hep C transmitted?
HCV is a blood borne virus. Transmission occurs most commonly through sharing injecting equipment for illicit drugs, transfusion of unscreened blood and reuse of contaminated healthcare equipment. Sexual and vertical transmission are less common.
What is the natural course of Hep C?
Incubation period is 2 weeks to 6 months over 2/3 are asymptomatic in the acute phase; acute HCV is usually mild and very rarely leads to fulminant liver failure. Symptoms can include right upper abdo pain, fever, lethargy, jaundice, joint pain and confusion. Serum transaminases are often 10-20x the upper limit of normal and raised bilirubin concentration is common. Chronic infection is common: only 15-45% clear the virus within 6 months of acquisition
How do you diagnose Hep C?
In chronic infection, anti-HCV antibody is the best initial test, followed by HCV RNA detection in the blood by PCR tests to identify chronic active infection. In acute infection, within the first few weeks from exposure, anti-HCV may be negative, so HCV RNA may be more useful.
What is the treatment for Hep C?
For some time, interferon and ribavirin were mainstay of therapy but now several directly acting antiviral drugs are being used, with higher virological response rates.
What is the prognosis of Hep C?
Liver cirrhosis develops in 15-20% over 20yrs (higher risk with alcohol intake and various other factors). Following this, hepatocellular carcinoma is much more common (up to 3% per year in those with cirrhosis) and survival is impaired: 20% 10yr mortality, increasing to 50% in decompensated cirrhosis.
What is the prevention against HCV?
There is no vaccine against HCV. Promotion of clean needle use for illicit drugs and in healthcare settings, screening all blood for transfusion and targeted screening programmes may be useful in primary prevention. Secondary prevention measures include early treatment and prevention of transmission to others through blood or sexual routes.
What is the cause of amoebic liver abscesses?
ALB are caused by Entamoeba histolytica parasite. E. histolytica is endemic in India, Africa, Mexico, Central and South America. The parasite is transmitted via the faecal oral route. Incubation periods can vary from weeks to years but patients usually present at around 12 weeks from infection.
What is the pathogenesis of amoebic liver abscess?
Once ingested, trophozoites colonise the small intestine and invade the colonic mucosa. These can then spread via the portal circulation to the liver, the most common extra-intestinal site, or other sites.
What is the clinical presentation of amoebic liver abscesses?
RUQ pain and fever is the most common presentation. A recent hx of diarrhoea or dysentery can also occur. Jaundice is rare, occurring in <10%.
