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Path: Liver 3 - Acute + Chronic Hepatitis (i) (intro (some causes of…
Path: Liver 3 - Acute + Chronic Hepatitis (i)
intro
acute: clinical/biochem abnormality resolved in > 6 months
if severe rarely causes ALF
chronic: persisting abnormality > 6 months
ongoing effects resembling acute hep - hepatocellular damage as demonstrated by chemical/histological/clinical evidence
syndrome with many causes, but similar histology
some diseases only cause acute (HAV)
some only cause chronic (AIH, Wilson's)
some causes of acute may become chronic (HBV depending on age, most HCV, v rarely HEV)
typical inflamm cell of hepatitis (regardless of duration) = lymphocyte
flares/exacerbations of chronic may mimic acute
some causes of chronic liver disease/damage have distinctive features + aren't considered as 'chronic hepatitis'
alcohol-related liver disease
NAFLD
chronic inflamm biliary tract diseases (PBC, PSC)
hereditary haemochromatosis (causes chronic damage without inflamm)
but still have same risks: fibrosis, cirrhosis, HCC
Acute hep
causes
acute diffuse liver damage with inflamm, short of ALF
viruses
hepatotropic viruses (HAV, HBV, HCV, HEV)
EBV
CMV (when patient immunosuppressed)
rubella
drugs
mimics
chronic hep flares
alcohol-related liver disease
acute biliary obstruction
symptoms
often silent (esp in children)
vague: nausea, anorexia, malaise
v rarely ALF
signs
enlarged tender liver
clinical jaundice may occur (but often anicteric, esp in children)
blood
albumin normal (no chronic damage)
high AST/ALT (can be v high, but normal 6 months later)
elevated bilirubin
prolonged PT (usually mild, except if risk of ALF)
Chronic hep
presentations
@ routine testing/screening
blood donation
health check
general pop
pregnant women
high risk groups
symptom investigation (usually vague - anorexia, malaise)
acute hep followup
cirrhosis +/- decompensation
during a flare
causes
viruses (HBV +/- HDV, HCV, or unknown)
drugs (rare)
AIH
Wilson's
A1AT deficiency
assessment
blood tests (AST/ALT)
viral load or genotype
biopsy
grade necro-inflamm activity
stage fibrosis
scoring systems guide prognosis + tx
non-invasive: fibroscan
effectiveness + tolerability of tx changing
aim: eliminate, reduce, or delay progression to cirrhosis/HCC
piecemeal necrosis
aka interface inflamm
portal tracts inflamed
inflamm blurs sharp boundary with liver parenchyma
a/w damage to involved liver cells
prototypical pattern in chronic hep (esp HBV, autoimmune)
viral hep
infective hep
HAV+HEV
faecal-oral/enteral transmission
no chronic state for HAV, v rare for HEV
serum hep
HCV + HBV
parenteral transmission (blood/body fluids)
risk of chronic state
yellow fever virus
monkey-mosquito-man transmission
esp in equatorial regions
EBV
CMV
rubella
coinfection/superinfection possible
HCV + HBV/HIV
HBV + HDV