Liver disorders

Liver disorders

Hepatitis
1. hep A (RNA virus)
  1. spread
    1. fecal oral
    2. often in travellers/institutions
  2. incub
    1. 2-6w
  3. symps/signs
    1. prodrome: fever, malaise, anorexia, nausea, arthralgia
    2. jaundice +/- hepatosplenomegaly
  4. tests
    1. serum transaminases rises 3w after exposure
    2. IgM rises from day 25; IgG remains dectable for life
  5. management
    1. prevention
      1. passive immunisation
        human IgG (up to 3mo immun for those at risk (travellers, household contacts)
      2. active immunisation
        1 year immunisation; extended to 10y after 6mo booster
    2. treatment
      1. symptomatic relief
  6. prognosis
    1. usually self limiting
    2. fulminant hepatitis occurs rarely; chronic liver disease does not occur
2. Hep C (RNA flavivirus)
  1. spread
    1. blood; IVDU; sex; acupuncture
  2. course
    1. early infect often mild/asymp
    2. 85% devel chronic infect; 25% devel cirrhosis; a few get hepatocellular cancer
  3. tests
    1. LFTs; anti HCV antibodies; HCV-PCR
    2. Liver biopsy if HCV-PCR +ive to assess liver damage
  4. management
    1. interferon alpha + ribavirin in chronic infect
    2. interferon alpha in acute stage may reduce progresison to chronic disease
3. Hep B (DNA virus)
  1. spread
    1. Blood products, IVDU, sexual intercourse, direct contact
  2. risks
    1. at risk: IVDU + sexual partners; health workers; hemophiliacs; hemodialysis, sexually promiscuous; close family members of carriers; staff of long term institutions
    2. endemic in: far east, africa, mediterranean
  3. incubation
    1. 1-6months
  4. symps and signs
    1. resembles hep A
    2. extra hepatic features are more common
  5. tests
    1. antigens
      1. HBsAg
        Surface
        present 1-6 mo after expsoure
        Persistent for 6 months implies carrier status
      2. HBcAg
        Core
      3. HBeAg
        DNA material
        Present after acute illness
        Implies high infectivity
    2. antibodies
      1. Abs
        Abs Implies vaccine or previous infection
      2. Abc
        Implies previous infection
  6. management
    1. vaccination
      1. may be universal or for high risk groups
      2. passive immunisation may be given following high risk exposure
      3. Given HBsAg to allow body to produce Abs
    2. treatment
      1. supportive
      2. avoid alcohol
  7. complics
    1. Fulminant hepatic failure (rare); relapse; prolonged cholestasis; chronic hepatitis (10%); cirrhosis; hepatocellular carcinoma (upto 60 x increased risk)
MORE
1. http://almostadoctor.co.uk/sites/all/MindMaps/NME/liver1.pdf

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	Creado por greenfylde hace casi 11 años