The Case Of The Yellow-Eyed Woman Flashcards
Primary sclerosing cholangitis - what gender is most affected?
Men (75%)
Primary sclerosing cholangitis - what condition is associated?
IBD - 75% have it (usually UC)
What are you at increased risk of with PSC?
Cholangicarcinoma
Is there any treatment for PSC?
No effective medical treatment
Biopsy shows concentric fibrosis around bile ducts - what is this condition?
Primary sclerosing cholangitis
Congenital cholestatic syndromes (PFIC/BRIC)
Cholangitis - symptoms + what does the liver scan show?
Jaundice, rigours and RUQ pain Liver USG shows dilated CBD Commonest cause is gallstones Give antibiotics ERCP with sphincterotomy and stone removal Semi elective cholecystectomy
Cholangitis - how to treat
Jaundice, rigours and RUQ pain Liver USG shows dilated CBD Commonest cause is gallstones Give antibiotics ERCP with sphincterotomy and stone removal Semi elective cholecystectomy
Case study
Bilirubin - 240 ALT - 1157 Alp - 263 TP - 87 Alb - 30 INR - 1.5 (less than 2) Acute cholestatic hepatitis, no liver failure, imaging shows no biliary obstruction ANA positive, elevated IgG Liver biopsy consistent with…
Bilirubin - 240 ALT - 1157 Alp - 263 TP - 87 Alb - 30 INR - 1.5 (less than 2) Acute cholestatic hepatitis, no liver failure, imaging shows no biliary obstruction ANA positive, elevated IgG Liver biopsy consistent with autoimmune hepatitis
Abnormal LFTS - what to look for
Decompensated vs compensated cirrhosis
Ascites or hepatic encephalopathy or jaundice or variceal bleeding = decompensation
Bilirubin really high/elevated = acute on chronic liver failure
INR above 2.5 = acute on chronic liver failure
Acute viral hepatitis
More florid the attack, chronic sequelae less likely
Can progress to acute liver failure
Chronic viral hepatitis
Abnormal LFTS and positive markers for 6 months
Histological staging of hepatic fibrosis
HBV clinical epidemiology
Effective vaccine available
Hepatitis B - RNA or DNA?
DNA virus - PARTIALLY DOUBLE STRANDED
HBV - replication
Development of HbsAb provides …
Life long immunity
Is a neutralising antibody
Resolved infection - hepatitis B
95% immunocompetent adults
Life long immunity
Persistent hep B infection - why may this happen?
Age at infection - HbeAg only antigen that crosses the placenta, induces tolerance to HbcAg (most immunogenicity) suppress immune mediated elimination of infected cells, switches immune response to Th2
Immunosuppression - inadequate cell mediated immunity
- high viral load
Persistent Hep B infection - IL - …
IL-10
Hep B with recovery vs hep B - chronic
Chronic hep B - HBV DNA - risk factor for …
Cirrhosis + hepatocellular carcinoma (50% cases worldwide due to chronic HBV infection)
EASL HBV guidelines
HBV natural history
Course of hep B infection - 6 factors
In someone with Hep B, screen also for ..
Hep D
Hep B - high chance of …
Mutation
Chronic HBV treatment
Tenofovir/Entecavir
Peggy lasted interferons
Cure defined by loss of HBsAg - rare, reactivation can occur and cccDNA still detected in liver
Immunosuppressive or chemo should be screened for prior HBV infection - HBsAg positive and HBsAg-neg
HBV take home messages
HBV evades innate immune responses Early priming of CD4 cell - CD8 cells activation Humoral response is late 90% neonates develop chronic infection 95% of adults can clear it
Hep C virus
Facts
RNA
Rapid rate of replication
80% chronic
Vaccine - no
enzyme that conjugates bilirubin
UDP-glucuronyl transferase
