Viral hepatitis Flashcards
On a scan of the liver, what is usually big?
Right lobe is always bigger
Describe the flow of blood in the liver vs bile secretion
Central vein
Portal vein travel into central vein, whereas bile secretions go in the opposite direction to the bile ducts
Hypoxic injury is more likely to be in which zone?
Near central vein
Zone 1 - oxygenated well
Zone 3 - high in glucose
What is Hep A&E
Hepatitis caused by RNA virus that follows an acute course without progression to chronic carriage
Which virus causes Hep A
Picornavirus
Transmission is via
Faecal oral route
Pathophysiology
Replicate inside hepatocytes and are secreted into bile
Prodromal phase
viral infection in blood, like flu - malaise, anrexia, fever, nause and vomiting, RUQ pain
Hepatitis phase
Hepatic inflammation causes
Unconjugated bilirubin increases
Therefore:
dark urine
Damage to bile duct, therefore:
pale stool
What signs are not present?
No signs of chronic liver disease e.g. asterixis or leuconychia
Recovery
1-2 months
What is the recovery like in children?
Less severe in children
Investigations
LFTS -high AST< ALP, ALT, Bilirubin High ESR Low albumin and high platelets Serology Urine - Increased urobilinogen and dark urine
Serology
HAV / H
IgM (acute)
IgG (over 6 months ago)
Management
Bed rest Symptomatic Antipyretic antiemetic Cholestyramine (for pruritis)
Prevention and control
Notifiable disease
Safe water, sanitation, food hygiene
for HAV - passive or active vaccines
Prognosis
Recovery after 1-2 months
If fulminant - hepatic failure, 80%
Another name for acute hepatic failure and who is more likely to get this during HAV or HEV
Fulminant - more likely if patient is pregnant
Complications
Fulminant hepatic failure Cholestatic hepatitis (inflammation of bile ducts, jaundice and pruritis)
Post hepatic syndrome (malaise)
Transmission of Hep A/E
Faecal-oral route
Hep E most common way of transmission
Undercooked pork
Hep A most common way of transmission
Travel
Symptoms of hepatitis
Dark urine (icteric phase - 3-10 days after the jaundice)
Pale clay coloured stools
Pruritis
Jaundice
