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Gastrointestinal System > Viral and Autoimmune Hepatitis > Flashcards

Viral and Autoimmune Hepatitis Flashcards

1
Q

how is hepatitis A transmitted

A

faecal-oral route through contaminated water or food

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2
Q

what are risk factors of hepatitis A contraction?

A

consumption of contaminated food/water
shellfish consumption
overseas travel (esp. Africa, Central + South America)

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3
Q

clinical features of hepatitis A infection

A 
malaise 
low grade fever
nausea 
abdominal pain 
jaundice (later in disease)
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4
Q

once jaundice develops in those infected with hepatitis A, what can progress?

A

may develop intrahepatic cholestasis which leads to darkened urine, pale stools and splenomegaly

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5
Q

investigations for hepatitis A and results

A

blood tests - viral serology and LFTs

  • +IgM anti-HAV
  • ⬆️ AST:ALT
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6
Q

management of hepatitis A

A

usually self limiting

  • advise against sexual contact for 7 days once jaundice eases
  • provide reassurance and recommend avoiding alcohol due to affected liver function
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7
Q

describe the vaccination process for hepatitis A

A

if travelling to at risk country or known to be infection free following contraction

  • initial dose 4-6 weeks before travel for 12mnth protection
  • booster dose 6-12mnths later for 10yr immunity
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8
Q

common complications of hepatitis A infection

A

renal failure
myocarditis
arthritis
acute fulminant liver failure

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9
Q

what is hepatitis B?

A

HBV is a DNA virus that is transmitted via direct contact with infected bodily fluid

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10
Q

risk factors of hepatitis B

A

IV drug use
unprotected sex
blood transfusions

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11
Q

clinical features of hepatitis B

A 
low grade fever
malaise and lethargy
nausea
steatorrhoea and dark urine
jaundice
hepatomegaly
RUQ tenderness + pain
pruritus
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12
Q

investigations for HBV

A

blood test - FBC, CRP, ESR, LFTs and viral serology

  • ⬆️ CRP, ESR and WCC
  • ⬆️ bilirubin, ALT:AST and ALP
  • +ve HBsAg
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13
Q

describe the serology results for hepatitis B infection

A

HBsAg +ve = active infection
HBeAg = E antigen that indicates high infectivity
HBcAb or HBsAB = surface antibodies for either current or past infection

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14
Q

what are the situations that may explain the presence of HBcAB or HBsAB in serology

A

current infection
past infection
due to vaccination

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15
Q

management of HBV

A

screen for other blood-borne viruses and STIs
advise to stop smoking and avoid alcohol
educate about risks and transmission means
advise to undertake vaccine

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16
Q

management of HBV complications

A

provide anti-viral medication (NRTI) to slow progression and ⬇️ infectivity
investigate and manage complications appropriately

17
Q

common complications of HBV

A

hepatic failure
cirrhosis
cholangiocarcinoma

18
Q

describe hepatitis C (HCV)

A

an RNA virus spread through bodily fluids that can incubate for 6-9 weeks and result in lifelong infectious carrier state

19
Q

describe the types of HCV

A 
acute= asymptomatic
chronic = symptomatic with severe liver disease
20
Q

risk factors of HCV

A 
IV drug use
unprotected sex
vertical transmission
co-existing HIV
haemodialysis
21
Q

clinical features of HCV

A

most patients asymptomatic and only discovered after raised ALT but can present with

jaundice 
low grade fever
malaise + lethargy
weight loss
abdominal pain
nausea
22
Q

lab investigations for HCV

A

bloods - FBC, U+E, LFTs, platelets and viral serology

⬇️ RBC, ferritin and platelets
⬆️ ALT, bilirubin and INR
+ve anti-HCV antibodies

23
Q

clinical investigations for HCV

A

fibroscan and US liver
gastroscopy to exclude varices
bone densiometry

24
Q

conservative management of HCV

A

screen for other blood-borne viruses and STIs
educate about transmission methods and risk factors/contact
advise safe drinking or alcohol abstinence
advise to stop smoking
refer to specialist if require more management

25
Q

medical management of HCV

A

oral antiviral therapy (e.g. interferon or direct-acting antivirals, DAA)

  • 8-12 week run that depends upon HSV genotype
  • some tolerated side effects (e.g. headache, nausea, insomnia an fatigue)
  • requires 12 week follow up blood test to check success
26
Q

common complications of HCV

A

cirrhosis
renal dysfunction
liver failure
hepatocellular carcinoma

27
Q

describe autoimmune hepatitis

A

a chronic disease of unknown cause, characterised by continuous hepatocellular inflammation and necrosis

28
Q

name the types of autoimmune hepatitis

A

Type I = associated with presence of anti-smooth muscle antibodies (ASMA) and antinuclear antibodies (ANA)
Type II = associated with presence of either anti-LKM-1 or anti-liver cytoscolic-1 (anti-LC-1 antibodies)

29
Q

risk factors of autoimmune hepatitis

A

young-middle age women

PMH of autoimmune disorder

30
Q

clinical features of autoimmune hepatitis

A 
jaundice 
fatigue and mild pruritus
upper abdominal discomfort
weight loss 
skin rask
ameorrhoea
31
Q

findings on clinical examination in autoimmune hepatitis

A

hepatomegaly
jaundice
splenomegaly
ascites

32
Q

investigations of autoimmune hepatitis

A

blood tests

  • serum antibody titres (ANA, SMA, LMK-1 and LC-1)
  • serum globulins
  • LFTs
33
Q

gold standard investigation for autoimmune hepatitis

A

liver biopsy - histology shows characteristic portal mononuclear cell inflammatory infiltrate extending into liver lobules

34
Q

common blood results in autoimmune hepatitis

A

presence of ANA and SMA
⬆️ gammaglobulin and IgG
⬆️ AST and ALT

35
Q

management of autoimmune hepatitis

A

prednisolone in conjunction with azathioprine for 2 years before considering stopping
advise undertaking Hep A and Hep B vaccinations
regular blood testing - FBC, LFTs and glucose

36
Q

can azathioprine be used when pregnant?

A

yes

37
Q

common complications of autoimmune hepatitis

A

hyper-viscosity syndrome

hepatocellular carcinoma development

Gastrointestinal System (9 decks)

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