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Scientific Basis of Medicine > The Case Of The Yellow-Eyed Woman > Flashcards

The Case Of The Yellow-Eyed Woman Flashcards

1
Q

Primary sclerosing cholangitis - what gender is most affected?

A

Men (75%)

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2
Q

Primary sclerosing cholangitis - what condition is associated?

A

IBD - 75% have it (usually UC)

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3
Q

What are you at increased risk of with PSC?

A

Cholangicarcinoma

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4
Q

Is there any treatment for PSC?

A

No effective medical treatment

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5
Q

Biopsy shows concentric fibrosis around bile ducts - what is this condition?

A

Primary sclerosing cholangitis

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6
Q

Congenital cholestatic syndromes (PFIC/BRIC)

A
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7
Q

Cholangitis - symptoms + what does the liver scan show?

A 
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
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8
Q

Cholangitis - how to treat

A 
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
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9
Q

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…
A 
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
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10
Q

Abnormal LFTS - what to look for

A
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11
Q

Decompensated vs compensated cirrhosis

A

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

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12
Q

Acute viral hepatitis

A

More florid the attack, chronic sequelae less likely

Can progress to acute liver failure

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13
Q

Chronic viral hepatitis

A

Abnormal LFTS and positive markers for 6 months

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14
Q

Histological staging of hepatic fibrosis

A
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15
Q

HBV clinical epidemiology

A

Effective vaccine available

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16
Q

Hepatitis B - RNA or DNA?

A

DNA virus - PARTIALLY DOUBLE STRANDED

17
Q

HBV - replication

A
18
Q

Development of HbsAb provides …

A

Life long immunity

Is a neutralising antibody

19
Q

Resolved infection - hepatitis B

A

95% immunocompetent adults

Life long immunity

20
Q

Persistent hep B infection - why may this happen?

A

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

21
Q

Persistent Hep B infection - IL - …

A

IL-10

22
Q

Hep B with recovery vs hep B - chronic

A
23
Q

Chronic hep B - HBV DNA - risk factor for …

A

Cirrhosis + hepatocellular carcinoma (50% cases worldwide due to chronic HBV infection)

24
Q

EASL HBV guidelines

A
25
Q

HBV natural history

A
26
Q

Course of hep B infection - 6 factors

A
27
Q

In someone with Hep B, screen also for ..

A

Hep D

28
Q

Hep B - high chance of …

A

Mutation

29
Q

Chronic HBV treatment

A

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

30
Q

HBV take home messages

A 
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
31
Q

Hep C virus

Facts

A

RNA
Rapid rate of replication
80% chronic
Vaccine - no

32
Q

enzyme that conjugates bilirubin

A

UDP-glucuronyl transferase

Scientific Basis of Medicine (35 decks)

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