Liver problems Flashcards
Viral hepatitis test results
Significantly raised ALT
Liver abscess features/test results
Acute RUQ pain
Fever
Abnormal LFTs (esp ALP)
Raised CRP
Hep C screen
Hep C antibody
Check for active Hep C after positive screen
HCV RNA (‘viral load’) quantification by PCR testing
Causes of hypoechoic, round lesion in liver
Carcinoma Metastases Pyogenic liver abscess Hyatid cyst Amoebic liver abscess
Treat amoebic liver abscess
Metronidazole 7-10 days
Follow up with lumen active agent eg paromomycin
Drainage not necessary unless complications eg risk of rupture or failure to respond to antimicrobial therapy
High prevalence Hep C areas
Central and eastern Asia
Middle East
Northern Africa
(IVDU)
Incubation Hep C
2 weeks to 6 months
Symptoms Hep C
RUQ pain Fever Lethargy Jaundice Joint pain Confusion
Hep C blood test results
ALT/AST 10-20x upper limit of normal
Raised bilirubin is common
Detect chronic Hep C infection
Anti-HCV antibody
then HCV RNA detection for chronic active infection
Original Hep C treatment
Interferon
Ribavirin
Amoebic liver abscesses caused by
Entamoeba histolytica
E. histolytica endemic where
India
Africa
Mexico
Central and South America
Amoebic liver abscess incubation/presentation
Incubation weeks to years
Usually present 12 weeks
Amoebic liver abscess symptoms
RUQ pain
Fever
Maybe: recent diarrhoea or dysentery
jaundice rare, in approx 10%
Amoebic abscess vs pyogenic on radiology
Tend to have single amoebic
Can have multiple pyogenic
Amoebic liver abscess blood tests
Disproportionally elevated ALP and raised WCC
NOT eosinophilia
Aspiration of amoebic liver abscess
Thick, brown fluid
“anchovy paste”
