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Risk Factors, Hepatitis, TBL 7.04 MECHANISTIC DIAGRAM, Gerry Guo, Kara…
Risk Factors
Immigrant from Endemic country of HBV
Family history
Unvaccinated
Poor drug compliance
Hepatitis
Kupffer cells in liver activate
immune response against HBV
ACUTE FLARE OF CHRONIC HBV INFECTION
Oral nucleoside/nucleotide analogues (Tenofovir/Entecavir)
Increased risk of hepatocellular carcinoma in absence of cirrhosis
Patient and family screening (ultrasound)
Diagnosed during pregnancy
High risk of vertical transmission
Screen daughter for HBV
Pegylated interferon
HBsAg +ve, Anti-HBsAg +ve, Anti-HBcAg +ve
Low grade fever, malaise and reduced appetite
Adaptive immune system activated
T cell & cytokine mediated damage
Plasma cells activated to produce antibodies
HBcAb positive
Immune-mediated damage to liver from inflammation
Liver has decreased Function
(Decompensated liver Disease)
Decreased albumin production
Hypoalbuminemia
Serum albumin 25 g/L
Failure to conjugate and excrete bilirubin
Jaundice
Yellowed skin
Scleral icterus
Dark urine
Bilirubin = 170 umol/L
Failure to produce coagulation factors
Elevated INR (1.8)
Vitamin K supplement + packed cell replacement
Elevated ALT and AST (ALT 1060 U/L, AST 720 U/L)
ALT > AST
Suggestive of viral hepatitis
Bile acid release into blood stream
Pruritus
Scratch marks
Decreased bile acid release into duodenum
Decreased absorption of fat-soluble vitamin K
UCDA/cholestyramine?
Liver transplant
Impaired inactivation of oestrogens
Increased oestrogen levels in circulation
Increased vascularity to palms
Palmar erythema
Reduced TPO production
Reduced bone marrow development
Monitor Nutrition
Avoidance of
alcohol
Chronic inflammation
DECOMPENSATED LIVER DISEASE
Fibrosis progressing to cirrhosis
Portal hypertension
Splenomegaly
Sequestration of RBCs
Normocytic anaemia
Decreased Hb (100 g/L)
Fatigue
Visible on abdominal CT
Platelet deficiency = 98x10^9g/L
Transudate in interstitial space
Ascites
SPONTANEOUS BACTERIAL PERITONITIS
Ascitic tap - elevated WCC in ascitic fluid (427 x 10^6/L), polymorphs 80%
Empirical broad spectrum antibiotics + culture
1 more item...
Lactulose as prophylaxis for hepatic encephalopathy
Translocation of gut bacteria to blood stream & ascitic fluid - failure of liver to launch immune response
Administer albumin on days 1 and 3
Abdominal distension
Shifting dullness
Spironolactone
Excessive RAAS activation
2 more items...
Salt restriction
+/- Frusemide
+/- Paracentesis
Visible on abdominal CT
Mild peripheral oedema
Endoscopy to screen for varices
Beta blockers?
potential variceal prevention
Splanchnic vasodilation
Lymph build up
Child-Pugh C
Ferritin = 811 ug/L
Irritation of T5-T9 spinal nerves
Generalised upper abdominal pain
TBL 7.04 MECHANISTIC DIAGRAM
Gerry Guo, Kara Harris, Mohammed Hassan, Christy Hou & Daniel Kasunic