Y3 Conditions > Hepatitis > Flashcards

Hepatitis Flashcards

(59 cards)

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1
Q

Hepatitis

What are the main risk factors for alcoholic hepatitis?

4

A
  • Chronic and heavy alcohol consumption
  • Malnutrition
  • Obesity
  • Genetic factors
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2
Q

Hepatitis

What are the key symptoms associated with alcoholic hepatitis?

5

A
  • Jaundice
  • Nausea/vomiting
  • Loss of appetite
  • Abdominal pain or discomfort, especially in the upper right part of the abdomen
  • Weight loss
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3
Q

Hepatitis

How might a very severe case of alcoholic hepatitis present?

A
  • Ascites (accumulation of fluid in the abdomen)
  • Hepatic encephalopathy (confusion, drowsiness and slurred speech)
  • Kidney failure
  • Liver failure
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4
Q

Hepatitis

In examination, how might a pt with alcoholic hepatitis present?

5

A
  • Hepatomegaly (enlarged liver)
  • Spider angioma (small, dilated blood vessels with a central red spot and radiating vessels)
  • Jaundice
  • Ascites
  • Features of liver failure such as hepatic encephalopathy, coagulopathy (bleeding or bruising easily) and renal impairment
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5
Q

Hepatitis

What are the 1st line investigations for alcoholic hepatitis?

6

A
  • LFTs
  • FBC
  • U&Es
  • Coagulation profile
  • Abdo USS
  • Testing for other causes of liver disease such as hepatitis B and C.
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6
Q

Hepatitis

What might the LFTs show in alcoholic hepatitis?

A

raised GGT and AST
raised ALP and bilirubin
AST is usually higher than ALT

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7
Q

Hepatitis

What might the FBC show in alcoholic hepatitis?

A

macrocytosis often seen in those with hx of alcohol abuse

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8
Q

Hepatitis

What might the U&Es show in alcoholic hepatitis?

A

raised urea and creatitine in case of kidney injury

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9
Q

Hepatitis

What might the coagulation show in alcoholic hepatitis?

A

longer PT -> impaired liver synthetic function

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10
Q

Hepatitis

What other investigations might you consider to do for alcoholic hepatitis after 1st line?

4

A
  • CT/MRI abdomen
  • Liver biopsy
  • Fibroscan
  • Testing for other alcohol-related damage, such as pancreatitis and heart or nervous system damage.
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11
Q

Hepatitis

What is a fibroscan? (Aka transient elastography)

A

a non-invasive test that measures liver stiffness, helping to estimate the extent of liver scarring

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12
Q

Hepatitis

How do we manage alcoholic hepatitis?

3

A
  • Steroids – Prednisolone is used in patients with severe disease to* reduce inflammation*.
  • Abstinence from alcohol – most critical part of treatment
  • Nutritional support
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13
Q

Hepatitis

What is the most common liver infection worldwide?

A

hepatitis B virus

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14
Q

Hepatitis

HBV is a ____ DNA virus which can be transmitted by ____, ____ or ____ routes.

A

double-stranded

percutaneous, permucosal or sexual routes

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15
Q

Hepatitis

Acquiring HBV at what age provides a pt with the greatest risk?

2

A

perinatal or early childhood

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16
Q

Hepatitis

What are then main risk factors for HBV infection?

7

A
  • Perinatal exposure
  • Sexual transmission
  • IV drug use
  • Living or travel to a highly endemic region (Asia and Africa)
  • Incarceration
  • FHxof HBV infection
  • FHx of chronic liver disease and/or HCC
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17
Q

Hepatitis

What are the key symptoms indicative of hepatitis?

A
  • Fever
  • Chill
  • Malaise
  • Arthralgia
  • Maculopapular or urticarial rash

other possible:
* Jaundice
* Nausea/vomiting
* Right upper quadrant pain

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18
Q

Hepatitis

70% if people with HBV are asymptomatic, but symptoms may appear when the following complications occur:

3

A
  • Cirrhosis
  • Hepatocellular carcinoma
  • Liver failure
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19
Q

Hepatitis

On examination, patients with acute symptomatic HBV infection have the key findings of:

2

A

Tender hepatomegaly
Jaundice

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20
Q

Hepatitis

Some chronic patients who have developed liver cirrhosis may have findings including:

5

A
  • Palmar erythema
  • Spider angioma
  • Ascites
  • Jaundice
  • Asterixis
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21
Q

Hepatitis

What are the 1st line investigations for someone with HBV?

A
  • LFTs
  • FBC
  • U&Es
  • Coagulation profile
  • Serum hepatitis B testing
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22
Q

Hepatitis

LFTs:

Elevated ____, ____, and ____ with a low ____ is suggestive of HBV infection

A
  • elevated aminotransferases (ALT/AST),

*elevated ALP and bilirubin with a **low albumin level **

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23
Q

Hepatitis

What might the FBCs of a pt with HBV be like?

A

microcytic anaemia and/or thrombocytopenia due to HBV-related cirrhosis

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24
Q

Hepatitis

What might the U&Es of a pt with HBV be like?

Study These Flashcards
A

hyponatraemia and raised urea levels are caused by HBV-related cirrhosis

25
# Hepatitis What might the coagulation profile of a pt with HBV be like?
**normal or elevated** in presence of HBV infection and associated manifestations
26
# Hepatitis Explain serum HBV testing. - Serum hepatitis B surface antigen - Serum antibody to hepatitis B surface antigen - Serum antibody to hepatitis B core antigen - Serum hepatitis B e antigen - Serum HBV DNA
* **Serum hepatitis B surface antigen** – can be detected on average of 4 weeks post-viral exposure, will usually become undetectable after 4-6 months in self-limiting acute cases, persistent raise >6 months implies a chronic HBV infection * **Serum antibody to hepatitis B surface antigen** – appears several weeks post hepatitis B surface antigen suggesting infection resolution, also detectable in immunised patients, provides life-long immunity in most cases * **Serum antibody to hepatitis B core antigen** – IgM and IgG antibodies to hepatitis B core antigen provide the best single test for screening household contacts of HBV infected individuals to determine vaccination need * **Serum hepatitis B e antigen** – provides further information regarding likelihood of development from acute to chronic infection * **Serum HBV DNA** – the level is commonly used to assess a patient’s candidacy for antiviral therapy and to subsequently monitor therapy response
27
# Hepatitis What do we use a USS for in HBV infection?
evaluate liver for **fibrosis**, **cirrhosis**, **portal hypertension** and **HCC**
28
# Hepatitis Why might we do a MRI/CT in HBV infection?
check for HCC
29
# Hepatitis What is a Transient elastography? (Fibroscan) What is the purpose of it?
non-invasive alternative to liver biopsy, evaluates liver injury measuring stiffness on US, popular choice in identifying cirrhosis
30
# Hepatitis What do we use Alpha-fetoprotein for?
used to screen for HCC, elevated levels found in 75% of patients with HCC
31
# Hepatitis For a pt with HBV, what other infections might we also test for and why?
HIV, hepatitis C/D status as management options are affected
32
# Hepatitis How do we manage HBV?
usually just supporting, buy some pt might need antiviral therapy
33
# Hepatitis Which antiviral therapies are used in HBV? (acutely) | 3
- entecavir - tenofovir disoproxil - tenofovir alafenamide
34
# Hepatitis Which antiviral therapies are used in HBV? (chronically)
* entecavir * tenofovir disoproxil * tenofovir alafenamide * peginterferon alfa 2a
35
# Hepatitis Most HBV pts will need a liver transplant. True or false?
**FALSE** 95% of immunocompetent patients with an acute infection can be managed with supportive care because are mable to achieve **seroconversion** with appearance of antibodies to hepatitis B surface antigens however, if disease progresses, then they might need a liver trasplant and it can result in liver failure
36
# Hepatitis Hepatitis C virus (HCV) is a ____-stranded ____ virus of the Flaviviridae family.
single, RNA
37
# Hepatitis Acute HCV is usually self-limiting. Chronic HCV infection often follows a progressive course over many years and can ultimately result in ____, ____, and the need for a ____.
cirrhosis hepatocellular carcinoma the need for liver transplantation.
38
# Hepatitis What are the main modes of transmission for HCV?
mostly blood (sometimes bodily fluids)
39
# Hepatitis HCV can be symptomatic and asymptomatic. Symptomatic pts tend to develop chronic liver disease.
FALSE a higher percentage of symptomatic pts 'clear' the virus
40
# Hepatitis What are some extra-hepatic manifestations of HCV?
* arthritis * cryoglobulinaemia with or without glomerulonephritis * porphyria cutanea tarda ## Footnote Porphyria cutanea tarda (PCT) is a rare disorder characterized by painful, blistering skin lesions that develop on sun-exposed skin (photosensitivity). Affected skin is fragile and may peel or blister after minor trauma.
41
# Hepatitis There is a higher incidence of ____, and associations with ____, ____ and ____ lymphoma
- diabetes and associations with: - lichen planus - Sjogren syndrome - non-Hodgkin's lymphoma
42
# Hepatitis HBV and HCV cytokines in the ____ phenotypes are profibrotic and cause the development of chronic infection
Th2
43
# Hepatitis HBV and HCV A dominant ____ response, with a weak ____ response, may lead to rapid fibrosis.
A dominant **CD4 Th2** response, with a weak **CD8 interferon-gamma** response, may lead to rapid fibrosis.
44
# Hepatitis HBV and HCV ____ cytokines are antifibrotic and thus a dominant ____ and ____ response may cause less fibrosis.
**Th1** cytokines are antifibrotic and thus a dominant **CD4 Th1** and **CD8 cytolytic** response may cause less fibrosis.
45
# Hepatitis Which cytokines are profibrotic and which cytokines are anti-fibrotic? Th1 / Th2
Th1 : anti Th2 : pro
46
# Hepatitis How would a pt with asymptomatic acute HCV be diagnosed?
- 10% of patients having a mild influenza-like illness with jaundice and a rise in serum aminotransferases Most patients will not be diagnosed until they present, years later, with evidence of abnormal transferase values at health checks or with chronic liver disease.
47
# Hepatitis How might the LFTs of a pt with chronic HCV come back?
mild elevations in the aminotransferases (usually ALT)
48
# Hepatitis Testing for hepatitis C virus (HCV) using an HCV antibody test should be considered in the following groups: ## Footnote Hep C testing [https://cks.nice.org.uk/topics/hepatitis-c/#!diagnosisSub:3](http://)
1. People who are asymptomatic who are at high risk of hepatitis C infection 2. People with clinical features that could be indicative of hepatitis 3. People with abnormal liver function tests *(ALT raised more than 10x the upper limit of normal may indicate acute viral hepatitis, but this is not specific for HCV infection)*
49
# Hepatitis Which is more likely ot develop into chronic disease? HBV or HCV?
HCV
50
# Hepatitis How do we investigate for HCV?
evaluation of HCV, RNA and HCV antibodies
51
# Hepatitis HCV RNA can be detected from ____ to ____ weeks after infection. Anti-HCV tests are usually positive ____ weeks from infection.
HCV RNA can be detected from **1 to 8 weeks** after infection. Anti-HCV tests are usually positive **8 weeks** from infection.
52
# Hepatitis What baseline investigations should be done while awaiting HCV antibody investigations?
* Hepatitis C RNA test for active hepatitis C and genotyping (if this has not been requested already). * FBC * U&Es * LFTs * Clotting screen. * HbA1c level. * TFTs * Ferritin level * Hepatitis B surface antigen (HBsAg) or antibody to hepatitis B core antigen (anti-HBc) to **check hepatitis B status**. * HIV test, *even if the person has recently been tested.*
53
# Hepatitis Why do check TFTs in pt with HCV?
for baseline as antiviral therapy can cause thyroid dysfunction
54
# Hepatitis Why check ferritins levels in pt with suspected HCV?
to assess iron stores (can be elevated in chronic hepatitis C)
55
# Hepatitis What are we looking for in a FBC for a pt with suspected HCV?
anaemia, neutropenia, and thrombocytopenia
56
# Hepatitis How do we manage HCV? (prescribing)
Antiviral combination therapy *Combination dual drug therapy injections of **pegylated interferon alpha** and daily oral doses of oral **ribavirin**. * ## Footnote People with HCV genotype 1 typically have a longer treatment course than other genotypes and have a worse prognosis. They may be considered for treatment with triple therapy involving the addition of a protease inhibitor which has improved treatment success rates compared with dual therapy.
57
# Hepatitis How are Hep A/B/C transmitted?
Hep A: faecal oral Hep B: blood / bodily fluids Hep C: bloods (bodily fluids sometimes)
58
# Hepatitis Are there vaccines for Hep A/B/C?
only for A and B
59
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