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Acute Liver Disease

Acute Liver Disease. Prior State. Normal Other System Disease Chronic Liver Disease. Presentation. Symptoms Not jaundiced Jaundiced Liver Failure Not jaundiced Jaundiced. Hepatocellular. Anorexia nausea vomiting Malaise Fatigue Abdominal Discomfort Transaminases * 8.

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Acute Liver Disease

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  1. Acute Liver Disease

  2. Prior State • Normal • Other System Disease • Chronic Liver Disease

  3. Presentation • Symptoms • Not jaundiced • Jaundiced • Liver Failure • Not jaundiced • Jaundiced

  4. Hepatocellular • Anorexia nausea vomiting • Malaise • Fatigue • Abdominal Discomfort • Transaminases * 8

  5. Cholestatic • Itch • Pain • Alkaline Phosphatase * 3 • Bile ducts dilated

  6. Jaundice • Haemolytic • Cholestatic • Pain • Hepatocellular

  7. Aetiology • Hepatotrophic Viruses • Toxins • Alcohol • Medications

  8. Aetiology • Autoimmune • Metabolic • Hepatoma

  9. Aetiology • Hypoxic Hypoperfusion • Fatty Liver

  10. Pathogen Markers • Pathogen • See • Culture • Genome • Gene product

  11. Host Response • IgM antibodies • IgG antibodies • Cellular Response

  12. HAV Serological Course anti-HAV Symptoms ALT Titre Faecal HAV IgM anti-HAV 4 5 6 12 24 0 1 2 3 Months after Exposure

  13. Hepatitis A Virus

  14. - Hepatitis A Vaccine • Increased infection risk • travellers to endemic countries • homosexual and bisexual men • drug users • persons with chronic liver disease

  15. - Hepatitis A Vaccine • Endemic areas • routine childhood vaccination

  16. Acute Hepatitis B Infection Symptoms anti-HBe HBeAg HBV DNA Total anti-HBc Titre anti-HBs IgM anti-HBc HBsAg 0 4 8 12 16 24 28 32 52 100 20 36 Weeks

  17. Hepatitis B Becomes Chronic Acute (6 months) Chronic (Years) HBeAg anti-HBe HBV DNA HBsAg Total anti-HBc Titre IgM anti-HBc Years 0 4 8 16 20 24 28 36 12 32 52 Weeks after Exposure

  18. Hepatitis B Virus

  19. Hepatitis B Vaccine • Household contacts • Sexual partners of HBV carriers • Long term travel to endemic areas

  20. Hepatitis B Vaccine • Healthcare workers • Patients on dialysis • Recipients of blood products • Mentally Handicapped • Patients in institutions • Staff in institutions

  21. Hepatitis B Vaccine • Male Homosexuals • Prostitutes • Heterosexual multiple partners • Persons diagnosed with an STD

  22. Hepatitis B Vaccine • IV drug abusers • Male prison inmates • Prison Staff • Police

  23. Hepatitis B Vaccine • Immigrants* • Adoptees, orphans, unaccompanied minors* *From endemic areas

  24. Perinatal HBV • Hepatitis B vaccine • Within 12 hours of birth • HBIG at a different site • Within 12 hours of birth • Complete vaccination at 6 months • Check response at 9-15 months

  25. Acute HCV Infection anti-HCV Symptoms +/- HCV RNA Titer ALT Normal 6 1 2 3 4 0 1 2 3 4 5 Years Months Time after Exposure

  26. HCV Persists anti-HCV Symptoms +/- HCV RNA Titer ALT Normal 6 1 2 3 4 0 1 2 3 4 5 Years Months Time after Exposure

  27. HEV Infection Symptoms ALT IgG anti-HEV IgM anti-HEV Titre Virus in stool 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Weeks after Exposure

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