Studydroid is shutting down on January 1st, 2019

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Cirrhosis - P
Necrosis of hepatic parenchyma with connective tissue proliferation and nodular regeneration
Cirrhosis - A
Alcohol, hep B/C/autoimmune, biliary cirrhosis, haemochromatosis, Wilson\\\'s disease, a1-antitrypsin disease, CF, NAFLD
Cirrhosis - clinical features
Chronic liver dysfunction: jaundice, anaemia, bruising, palmar erythema, Dupuytren\\\'s. Portal hypertension: splenomegaly, ascites, spider naevi, caput medusae, oesophageal/rectal varices
Cirrhosis - Ix
^ or normal ALT/AST, ^alk phos, ^bilirubin, albumin falls, ^PT, _Na, alpha fetoprotein in hepatocellular carcinoma, USS, endoscopy
Cirrhosis - management
Stop drinking, treat complications, transplantation
Cirrhosis - Cx
Ascites/oedema, hepatic encephalopathy, malnutrition, Vit B deficiency, coagulopathy, impaired immune system, varices, hepatorenal syndrome, hepatocellular carcinoma
Alcoholism - P
Steatosis, fibrosis, cirrhosis
Alcoholism - A
Degree of liver damage dependent on genetic susceptibility and coexisting disease. Women progress faster.
Alcoholism - S
+ve CAGE questionnaire. S+S dependent on damage
Alcoholism - Ix
As for cirrhosis. LFT (^GGT), _albumin, coagulation, FBC (_MCV/^MCV, _PLT, U&E, ^IgA, ^chol), USS, liver Bx (not needed for Dx)
Alcoholism - Rx
Abstinence, acamprosate calcium, nutrition, vitamin replacement, laxatives, liver transplantation
Acute alcoholic hepatitis - S
Fever, nausea, RUQ pain, jaundice, ascites, oedema, encephalopathy
Acute alcoholic hepatitis - Px
Mortality rate ~10%
Acute hepatic failure - types
Hyperacute/fulminant (in 1 wk), acute (within 2-4 wks), subacute (within 4-8wks)
Hepatic failure - P
Acute necrotizing hepatitis leading to cell destruction
Hepatic failure - A
Viral hep, infections (viral, bacterial, parasitic), drugs, toxins, alcohol, ischaemia, pregnancy complications, malignancy
Hepatic failure - Sy
Lethargy, weakness, nausea, anorexia, sleep disturbance
Hepatic failure - Si
Jaundice, fever, fetor hepaticus, encephalopathy, cerebral oedema leading to bradycardia, HTN, tachypnoea
Hepatic failure - Ix
Liver screen (poor Px with ^bilirubin, severe hyponatraemia, rising lactate, acidosis, rapid drop in transaminases, renal failure)
Hepatic failure - Cx
Renal failure, coagulopathy, respiratory failure, sepsis, circulatory failure, hypoglycaemia, pancreatitis
Budd-Chiari syndrome - P
Hepatic venous outflow obstruction; this leads to increased hepatic sinusoidal pressure and portal HTN
Budd-Chiari syndrome - A
Thrombosis (75%), tumour, pregnancy. Associated with hypercoagulable states (myeloproliferative).
Budd-Chiari syndrome - S
Depends on speed of onset; abdominal pain, hepatomegaly, ascites, varices and splenomegaly in chronic form, nausea and jaundice in acute form
Budd-Chiari syndrome - Ix
^^ALT/AST, ^ALP/bilirubin, _albumin, USS with doppler of hepatic vein, CT/MRI
Budd-Chiari syndrome - Rx
Anticoagulation. Ascites is controlled with sodium restriction and diuretics +/- paracentesis. Thrombolysis, angioplasty, TIPS, liver transplant.
Define TIPS
Transjugalar intrahepatic portosystemic shunt - connection made between portal vein and hepatic vein with a catheter introduced through the jugular vein. Reduces portal HTN, but can precipitate encephalopathy.
Hepatitis A - P
RNA virus; transmitted by faecal-oral route. Does not cause cirrhosis.
Hepatitis A - A
Poor hygiene increases risk
Hepatitis A - Sy
n&v, anoriexia, diarrhoea, weakness, fever, malaise, arthralgia, dark urine
Hepatitis A - Si
Jaundice, hepatomegaly, splenomegaly, lymphadenopathy
Hepatitis A - Ix
LFT: ^transaminases and bilirubin, HAV IgM
Hepatitis A - Rx
Supportive
Hepatitis B - P
DNA virus
Hepatitis B - A
Parenteral, sexual, vertical transmission, saliva
Hepatitis B - Sy
More severe that Hep A: n&v, anoriexia, diarrhoea, weakness, fever, malaise, arthralgia, dark urine
Hepatitis B - Si
Jaundice, pruritis, tender hepatomegaly, lymphadenopathy, splenomegaly
Hepatitis B - Rx
Alcohol avoidance, antivirals e.g. lamivudine, interferon alfa
Hepatitis B - Cx
>90% will clear the virus. Carrier state: HBsAg persists for >6 months. 10-20% carriers develop cirrhosis. ^risk of hepatocellular carcinoma.
Hepatitis B - Ix
Serology
Hepatitis C - P
RNA virus. 6 genotypes
Hepatitis C - A
Spread by blood (inc. transfusions, tattoos, IV drugs), body fluids
Hepatitis C - Sy
Prodromal symptoms usually mild or absent; fatigue may be pronounced
Hepatitis C - Si
Jaundice, hepatomegaly
Hepatitis C - Ix
HCV antibody, HCV RNA by PCR
Hepatitis C - Rx
Antiviral therapy: usually peginterferon alfa and ribavirin, many new treatments in development
Hepatitis C - Cx
>80% develop chronic HCV infection; ~30% develop cirrhosis; ^risk of hepatocellular carcinoma
Hepatitis D - P
RNA virus, dependent on presence of HBV for infectivity
Hepatitis D - A
Corresponds to HBV infection
Hepatitis D - S
As hepatitis B
Hepatitis D - Ix
HDAg, HDV RNA by PCR
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