liver the vida loca Flashcards
what is hepatitis
inflammation of the liver usually due to a virus
what can cause hepatitis
alcoholic hepatitis non-alcoholic fatty liver disease viral hepatitis auto-immune hepatitis drug induced hepatitis
how does hepatitis present
abdominal pain pruritis muscle and joint ache vomiting jaundice fever if viral
how does hepatitis A present
nausea
vomiting
anorexia
jaundice
how is hepatitis A transmitted
faecal-oral route
what is the incubation time for hepatitis A
2-3 weeks
what biomarker corresponds to hepatitis A
anti-HAV IgM
how do you treat hepatitis A
self-resolving
vaccine for travellers to endemic areas
how is hepatitis B spread
blood
sexual intercourse
needles
vertical
how long is the incubation period for hepatitis B
1-5months
what are biomarkers for an acute infection of hepatitis B
HBcAg
HBsAg
HBeAg
what are biomarkers for an early acute infection of hepatitis B
HBsAg
what are biomarkers for a resolved acute infection of hepatitis B
HBsAg
what are biomarkers for a patient after vaccination for hepatitis B
HBsAg
what are biomarkers for a chronic hepatitis B infection
HBcAg
HBsAg
how do you treat hepatitis B
education and prevention
vaccination for at-risk groups
notify public health
how is hepatitis C spread
vertical
needle
blood
how long is the incubation period for hepatitis C
6-9 weeks
what are biomarkers for hepatitis C
HCV antibody
how do you treat hepatitis C
education and prevention
anti-viral drugs
how does hepatitis D infect the body
can only co-infect with hepatitis B
contaminated needles
blood
sexual intercourse
how long is the incubation period for hepatitis D
1-5 months
what are biomarkers for hepatitis D
IgM anti-D
how do you treat hepatitis D
pegylated alpha-2a interferon
how does hepatitis E spread
faecal-oral, associated with dirty water
what is the incubation period for hepatitis E
2-3 weeks
what are biomarkers for hepatitis E
IgG and IgM anti-HEV
what is cirrhosis
irreversible scarring of the liver
blood vessels are disrupted and secreting cells are destroyed
what can cause cirrhosis
alcoholic liver disease
drugs
bile duct obstruction
genetics
what is primary biliary cholangitis
when the body attacks the interlobular bile ducts which blocks them and builds up pressure in the liver leading to fibrosis, scarring and cirrhosis
how does cirrhosis present
weakness fatigue weight loss nausea vomiting jaundice upper abdominal pain easy bruising
what clinical signs does cirrhosis have (hands and chest)
clubbing palmar erythema spider navei hair loss hepatomegaly white nails with redness at distal 1/3rd
what investigations could you do for cirrhosis
LFTs bloods - bilirubin US MRI biopsy
how could you manage cirrhosis
alcohol reduction stop NSAIDS, opiates, sedatives liver transplant treat underlying cause e.g. hepatitis B good nutrition
what is alcoholic liver disease
alcohol disrupts fat metabolism in the liver and results in fatty change of the liver
build up of fat (steatosis) > alcoholic hepatitis (steatohepatitis) > cirrhosis
how does alcoholic liver disease present
hepatomegaly tender liver jaundice malaise anorexia nausea vomiting haematemesis fever weight loss
what investigations could you do for alcoholic liver disease
bloods - elevated prothrombin, U&Es, LFT, FBC
AAT:ALT >2
CT
MRI
biopsy
fibroscan for fatty changes
CAGE questions for alcohol screening (cut down, annoyed, guilty, eye opener)
drinking audit - score of 20+ is possible dependence
how can you treat alcoholic liver disease
alcohol abstinence - detox regime
nutritional support
liver transplant
manage symptoms
what are the two types of primary liver cancer
hepatocellular 80%
cholangiocarcinoma
what are risk factors for liver cancer
hepato - HVB, HVC, alcohol, fatty liver disease
cholang - associated with primary biliary sclerosis
how does liver cancer present
weight loss abdominal pain jaundice nausea vomiting pruritis anorexia
what are tumour markers in liver cancer
HC - alpha-fetoprotein
CA - CA19-9
what investigations could you do for liver cancer
CT
US
ERCP
biopsy
how do you manage liver cancer
poor prognosis
lifestyle
liver transplant
stent in bile duct for primary sclerosing cholangitis
what is hepatic encephalopathy
as liver fails nitrogenous waste builds up in circulation and passes to brain, astrocytes clear it and glutamine is formed, has osmotic pull and causes cerebral oedema
what can cause hepatic encephalopathy
drugs infection constipation GI bleed electrolyte disturbance
how does hepatic encephalopathy present
altered mood/behaviour
sleep disturbance
dyspraxia
poor arithmetic
drowsy
confused
slurring
liver flap
coma
what investigations should you do for hepatic encephalopathy
CT - exclude intercranial bleed
exclude infection
blood sugar - exclude hypoglycaemia
how do you manage hepatic encephalopathy
laxatives - gets rid of ammonia before it can be absorbed
antibiotics - rifaximin
nutritional support
what is spontaneous bacterial peritonitis
infection of the ascitic fluid – an increased volume of peritoneal fluid
what causes SBP
e.coli
klebsiella
strep
what are warning symptoms for SBP
ascites with sudden deterioration
how do you manage SBP
IV abx
ascitic fluid drainage
IV albumin infusion
what is alcoholic hepatitis
inflammation caused by alcohol
how does alcoholic hepatitis present
maliase increased TPR anorexia diarrhoea vomiting hepatomegaly jaundice ascites encephalopathy
what investigations can you do in alcoholic hepatitis
bloods - increased WCC, decreased platelets, low albumin, raised prothrombin time, raised bilirubin, raised GGT
ascites tap - screen for infection
how do you manage alcoholic hepatitis
stop alcohol consumption
vitamin supplementation
nutritional support - VK, thiamine
airway protection
treat infection, encephalopathy if present
steroids in severe disease (jaundice/encephalopathy/coagulopathy)
what is non-alcoholic fatty liver disease
fat gets deposited in liver cells
can lead to hepatitis and cirrhosis
what are risk factors for non-alcoholic fatty liver disease
Obesity Poor diet and low activity levels Type 2 diabetes High cholesterol Middle age onwards Smoking High blood pressure
what Ix can you do for NAFLD
usually asymptomatic
fatty liver on US
biopsy
raised AAT
how do you manage NAFLD
lifestyle changes - weight loss, diet and exercise
