Podcast
Questions and Answers
What disease is defined by acute viral liver inflammation, transmitted via the faeco-oral route, and typically resolves with supportive treatment?
What disease is defined by acute viral liver inflammation, transmitted via the faeco-oral route, and typically resolves with supportive treatment?
- Hepatitis D
- Hepatitis A (correct)
- Hepatitis B
- Hepatitis C
What disease involves a DNA virus that integrates into the host genome, potentially leading to chronic hepatitis, cirrhosis, and hepatocellular carcinoma?
What disease involves a DNA virus that integrates into the host genome, potentially leading to chronic hepatitis, cirrhosis, and hepatocellular carcinoma?
- Hepatitis E
- Hepatitis A
- Hepatitis B (correct)
- Hepatitis C
Which disease is characterized by an RNA virus causing liver inflammation with a high risk of progressing to chronic liver disease and cirrhosis?
Which disease is characterized by an RNA virus causing liver inflammation with a high risk of progressing to chronic liver disease and cirrhosis?
- Hepatitis A
- Hepatitis E
- Hepatitis D
- Hepatitis C (correct)
What liver disease is caused by a defective virus that requires Hepatitis B for replication and exacerbates liver damage when both infections are present?
What liver disease is caused by a defective virus that requires Hepatitis B for replication and exacerbates liver damage when both infections are present?
What acute viral hepatitis, transmitted faeco-orally, is typically self-limiting but poses a greater risk of severe outcomes during pregnancy?
What acute viral hepatitis, transmitted faeco-orally, is typically self-limiting but poses a greater risk of severe outcomes during pregnancy?
What condition results from irreversible scarring of the liver caused by long-term damage from factors such as alcohol abuse or viral hepatitis?
What condition results from irreversible scarring of the liver caused by long-term damage from factors such as alcohol abuse or viral hepatitis?
What liver condition involves excessive fat accumulation in the liver unrelated to alcohol consumption, often associated with obesity or high cholesterol?
What liver condition involves excessive fat accumulation in the liver unrelated to alcohol consumption, often associated with obesity or high cholesterol?
What inherited disorder disrupts copper metabolism, leading to the accumulation of copper in the liver, brain, and eyes?
What inherited disorder disrupts copper metabolism, leading to the accumulation of copper in the liver, brain, and eyes?
What disease of the liver is caused by an excessive intake of paracetamol?
What disease of the liver is caused by an excessive intake of paracetamol?
What condition results in the yellowing of the skin and sclera due to elevated bilirubin levels, often linked to liver dysfunction or hemolysis?
What condition results in the yellowing of the skin and sclera due to elevated bilirubin levels, often linked to liver dysfunction or hemolysis?
What disease is characterized by irreversible scarring of the liver due to long-term damage from factors such as chronic hepatitis or alcohol abuse?
What disease is characterized by irreversible scarring of the liver due to long-term damage from factors such as chronic hepatitis or alcohol abuse?
Which liver disease is caused by a DNA virus and can lead to chronic infection, cirrhosis, or hepatocellular carcinoma?
Which liver disease is caused by a DNA virus and can lead to chronic infection, cirrhosis, or hepatocellular carcinoma?
What liver condition is specifically associated with excessive and prolonged alcohol consumption?
What liver condition is specifically associated with excessive and prolonged alcohol consumption?
Which form of viral hepatitis requires co-infection with Hepatitis B to cause liver damage?
Which form of viral hepatitis requires co-infection with Hepatitis B to cause liver damage?
What is the primary route of transmission for Hepatitis E?
What is the primary route of transmission for Hepatitis E?
What condition involves ongoing liver injury for more than six months, characterized by progressive fibrosis and an increased risk of cirrhosis?
What condition involves ongoing liver injury for more than six months, characterized by progressive fibrosis and an increased risk of cirrhosis?
What disease is caused by an RNA virus that is mainly transmitted through blood and can cause chronic hepatitis, cirrhosis and liver cancer?
What disease is caused by an RNA virus that is mainly transmitted through blood and can cause chronic hepatitis, cirrhosis and liver cancer?
A patient presents with jaundice, ascites, and hepatic encephalopathy due to long-standing alcohol abuse. Liver biopsy shows extensive fibrosis and nodule formation. What is the most likely diagnosis?
A patient presents with jaundice, ascites, and hepatic encephalopathy due to long-standing alcohol abuse. Liver biopsy shows extensive fibrosis and nodule formation. What is the most likely diagnosis?
A 30-year-old pregnant woman from a developing country presents in her third trimester with acute jaundice, nausea, vomiting, and right upper quadrant pain. Serological tests are negative for Hepatitis A, B, and C. What is the most likely form of hepatitis?
A 30-year-old pregnant woman from a developing country presents in her third trimester with acute jaundice, nausea, vomiting, and right upper quadrant pain. Serological tests are negative for Hepatitis A, B, and C. What is the most likely form of hepatitis?
A 55-year-old male with a history of intravenous drug use is diagnosed with chronic hepatitis. Serological tests reveal the presence of anti-HCV antibodies and a high viral load. Liver biopsy shows significant fibrosis and inflammation. What is the most critical next step in managing this patient's condition?
A 55-year-old male with a history of intravenous drug use is diagnosed with chronic hepatitis. Serological tests reveal the presence of anti-HCV antibodies and a high viral load. Liver biopsy shows significant fibrosis and inflammation. What is the most critical next step in managing this patient's condition?
What liver condition is defined by irreversible scarring resulting from prolonged damage, irrespective of the initial cause?
What liver condition is defined by irreversible scarring resulting from prolonged damage, irrespective of the initial cause?
Which viral hepatitis is caused by a DNA virus and has a vaccine available for prevention?
Which viral hepatitis is caused by a DNA virus and has a vaccine available for prevention?
What liver disease is uniquely associated with requiring Hepatitis B virus for its replication and to cause infection?
What liver disease is uniquely associated with requiring Hepatitis B virus for its replication and to cause infection?
Which type of viral hepatitis is primarily transmitted through the faeco-oral route and is particularly dangerous for pregnant women?
Which type of viral hepatitis is primarily transmitted through the faeco-oral route and is particularly dangerous for pregnant women?
What condition is characterized by ongoing liver damage lasting more than six months, increasing the risk of developing cirrhosis?
What condition is characterized by ongoing liver damage lasting more than six months, increasing the risk of developing cirrhosis?
Which medication, commonly used as an analgesic and antipyretic, is a well-known cause of acute liver failure in cases of overdose?
Which medication, commonly used as an analgesic and antipyretic, is a well-known cause of acute liver failure in cases of overdose?
In the context of liver serology, what does the detection of HBsAg in a patient's blood indicate?
In the context of liver serology, what does the detection of HBsAg in a patient's blood indicate?
What class of medication is often used in patients with cirrhosis and ascites to manage fluid accumulation by promoting increased fluid excretion?
What class of medication is often used in patients with cirrhosis and ascites to manage fluid accumulation by promoting increased fluid excretion?
Which of the following statements best describes the mechanism of action of Vitamin K in managing liver disease-related coagulopathy?
Which of the following statements best describes the mechanism of action of Vitamin K in managing liver disease-related coagulopathy?
Considering drug metabolism in severe liver disease, which of the following antibiotic classes is generally advised to be avoided due to increased risk of adverse effects?
Considering drug metabolism in severe liver disease, which of the following antibiotic classes is generally advised to be avoided due to increased risk of adverse effects?
What liver disease is defined by irreversible scarring resulting from prolonged damage, often due to alcohol or viral hepatitis?
What liver disease is defined by irreversible scarring resulting from prolonged damage, often due to alcohol or viral hepatitis?
Which condition involves liver damage that results from long-term alcohol misuse, potentially leading to fatty liver, hepatitis, and cirrhosis?
Which condition involves liver damage that results from long-term alcohol misuse, potentially leading to fatty liver, hepatitis, and cirrhosis?
What liver condition is characterized by excessive fat accumulation unrelated to alcohol intake, frequently associated with obesity and high cholesterol?
What liver condition is characterized by excessive fat accumulation unrelated to alcohol intake, frequently associated with obesity and high cholesterol?
Which inherited disorder leads to the accumulation of copper in the liver, brain, and eyes due to a defect in copper metabolism?
Which inherited disorder leads to the accumulation of copper in the liver, brain, and eyes due to a defect in copper metabolism?
What autoimmune disease progressively destroys the small bile ducts in the liver?
What autoimmune disease progressively destroys the small bile ducts in the liver?
Which condition is a genetic disorder that causes the body to store too much iron, potentially damaging the liver and other organs?
Which condition is a genetic disorder that causes the body to store too much iron, potentially damaging the liver and other organs?
What condition results in the yellowing of the skin and eyes due to elevated bilirubin levels?
What condition results in the yellowing of the skin and eyes due to elevated bilirubin levels?
What is the term for liver disease that persists for more than six months, potentially progressing to cirrhosis and other complications?
What is the term for liver disease that persists for more than six months, potentially progressing to cirrhosis and other complications?
A defective virus requires coinfection with Hepatitis B for its replication and causes increased liver damage. What is this virus?
A defective virus requires coinfection with Hepatitis B for its replication and causes increased liver damage. What is this virus?
What is the most common route of transmission for Hepatitis A?
What is the most common route of transmission for Hepatitis A?
What disease is characterized by irreversible scarring of the liver resulting from prolonged damage, such as from alcohol abuse or viral hepatitis?
What disease is characterized by irreversible scarring of the liver resulting from prolonged damage, such as from alcohol abuse or viral hepatitis?
What disease involves a DNA virus that can integrate into the host genome, potentially leading to chronic hepatitis, cirrhosis, and even hepatocellular carcinoma?
What disease involves a DNA virus that can integrate into the host genome, potentially leading to chronic hepatitis, cirrhosis, and even hepatocellular carcinoma?
What disease is specifically associated with excessive fat accumulation in the liver in individuals who do not consume excessive amounts of alcohol?
What disease is specifically associated with excessive fat accumulation in the liver in individuals who do not consume excessive amounts of alcohol?
What disease involves abnormal copper metabolism, leading to copper accumulation in the liver, brain, and eyes?
What disease involves abnormal copper metabolism, leading to copper accumulation in the liver, brain, and eyes?
What disease is characterized by yellowing of the skin and sclera due to elevated bilirubin levels in the blood?
What disease is characterized by yellowing of the skin and sclera due to elevated bilirubin levels in the blood?
What disease is defined as liver damage resulting from long-term alcohol misuse, which can manifest as fatty liver, alcoholic hepatitis, and cirrhosis?
What disease is defined as liver damage resulting from long-term alcohol misuse, which can manifest as fatty liver, alcoholic hepatitis, and cirrhosis?
What disease is characterized by an RNA virus and has a high risk of progressing to chronic liver disease and cirrhosis?
What disease is characterized by an RNA virus and has a high risk of progressing to chronic liver disease and cirrhosis?
What disease is caused by a defective virus that requires Hepatitis B for replication and exacerbates liver damage when both infections are present?
What disease is caused by a defective virus that requires Hepatitis B for replication and exacerbates liver damage when both infections are present?
What disease is defined as an autoimmune condition leading to the progressive destruction of small bile ducts within the liver?
What disease is defined as an autoimmune condition leading to the progressive destruction of small bile ducts within the liver?
What disease is characterized by acute viral liver inflammation, is typically transmitted via the faeco-oral route, and usually resolves without leading to chronic liver damage?
What disease is characterized by acute viral liver inflammation, is typically transmitted via the faeco-oral route, and usually resolves without leading to chronic liver damage?
What disease is characterized by irreversible scarring of the liver due to long-term damage from various causes, such as viral hepatitis or alcohol abuse?
What disease is characterized by irreversible scarring of the liver due to long-term damage from various causes, such as viral hepatitis or alcohol abuse?
What condition results from chronic, excessive consumption of alcohol, leading to a spectrum of liver damage from fatty liver to cirrhosis?
What condition results from chronic, excessive consumption of alcohol, leading to a spectrum of liver damage from fatty liver to cirrhosis?
What disease involves a defective virus that can only replicate in the presence of Hepatitis B, exacerbating liver damage?
What disease involves a defective virus that can only replicate in the presence of Hepatitis B, exacerbating liver damage?
What acute liver disease is typically transmitted via the fecal-oral route and poses a higher risk of severe illness in pregnant women?
What acute liver disease is typically transmitted via the fecal-oral route and poses a higher risk of severe illness in pregnant women?
What condition is classified by ongoing liver damage lasting more than six months, potentially leading to cirrhosis?
What condition is classified by ongoing liver damage lasting more than six months, potentially leading to cirrhosis?
What acute condition can develop as a result of acetaminophen overdose, potentially leading to rapid liver failure?
What acute condition can develop as a result of acetaminophen overdose, potentially leading to rapid liver failure?
What infection is caused by an RNA virus, primarily transmitted through blood, which often leads to chronic hepatitis and increases the risk of liver cancer?
What infection is caused by an RNA virus, primarily transmitted through blood, which often leads to chronic hepatitis and increases the risk of liver cancer?
What prophylactic medication is administered to alcohol misusers to prevent variceal bleeding by reducing portal hypertension?
What prophylactic medication is administered to alcohol misusers to prevent variceal bleeding by reducing portal hypertension?
What condition in patients with liver disease is treated with medications like spironolactone, which increase fluid excretion to counteract fluid accumulation caused by portal hypertension?
What condition in patients with liver disease is treated with medications like spironolactone, which increase fluid excretion to counteract fluid accumulation caused by portal hypertension?
A patient presents with jaundice, dark urine, and a history of recent travel to an area with poor sanitation. Serological tests reveal the presence of anti-HAV IgM antibodies. What is the most likely diagnosis?
A patient presents with jaundice, dark urine, and a history of recent travel to an area with poor sanitation. Serological tests reveal the presence of anti-HAV IgM antibodies. What is the most likely diagnosis?
Flashcards
Hepatitis B
Hepatitis B
DNA virus infecting the liver; can be acute or chronic, leading to cirrhosis or liver cancer.
Hepatitis C
Hepatitis C
RNA virus often progressing to chronic hepatitis, cirrhosis, or liver cancer, mainly blood-borne.
Hepatitis D
Hepatitis D
Defective virus needing Hepatitis B co-infection; worsens liver damage.
Hepatitis E
Hepatitis E
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Cirrhosis
Cirrhosis
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Chronic Liver Disease
Chronic Liver Disease
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Alcohol-Related Liver Disease (ARLD)
Alcohol-Related Liver Disease (ARLD)
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Interferon
Interferon
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Ribavirin
Ribavirin
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Hepatitis Serology
Hepatitis Serology
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NAFLD
NAFLD
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Haemochromatosis
Haemochromatosis
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Primary Biliary Cirrhosis
Primary Biliary Cirrhosis
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Jaundice (Icterus)
Jaundice (Icterus)
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ARLD Stages
ARLD Stages
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Acute Liver Failure
Acute Liver Failure
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Prophylactic Beta-Blockers
Prophylactic Beta-Blockers
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Fresh Frozen Plasma (FFP)
Fresh Frozen Plasma (FFP)
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Miconazole Mechanism
Miconazole Mechanism
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Beta-Blockers (in ARLD)
Beta-Blockers (in ARLD)
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Diuretics (liver disease)
Diuretics (liver disease)
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Interferon Mechanism
Interferon Mechanism
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Chronic Liver Disease Tx
Chronic Liver Disease Tx
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CMV / EBV / Herpes Simplex
CMV / EBV / Herpes Simplex
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Paracetamol Overdose
Paracetamol Overdose
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Hepatitis A Cause
Hepatitis A Cause
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Hepatitis A Treatment
Hepatitis A Treatment
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Hepatitis A Prevention
Hepatitis A Prevention
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Wilson Disease
Wilson Disease
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Non-Alcoholic Fatty Liver Disease (NAFLD)
Non-Alcoholic Fatty Liver Disease (NAFLD)
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ARLD Cause
ARLD Cause
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Paracetamol Use and Risk
Paracetamol Use and Risk
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NSAIDs Mechanism
NSAIDs Mechanism
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Fluconazole
Fluconazole
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Vitamin K role
Vitamin K role
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Avoid Antibiotics (Liver Disease)
Avoid Antibiotics (Liver Disease)
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Interferon Use/Mechanism
Interferon Use/Mechanism
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Study Notes
Hepatitis A
- Acute viral inflammation of the liver, transmitted via the faeco-oral route.
- Caused by Hepatitis A virus (HAV), often from contaminated water/food or poor hygiene.
- Acute, self-limiting inflammation of the liver transmitted faeco-orally, with no chronic carrier state.
- Treatment is usually supportive (rest, fluids).
- Hospitalization is rarely needed
- Prevented by vaccination; improve hygiene, avoid contaminated food/water.
Hepatitis B
- DNA virus that can be acute or chronic (>6 months) and lead to cirrhosis or hepatocellular carcinoma
- Parenteral exposure (blood/bodily fluids), sexual transmission, IV drug use, vertical (mother to baby) can cause it.
- A viral infection (DNA virus) that integrates into the genome; can be acute or progress to chronic hepatitis and increase the risk of cirrhosis and hepatocellular cancer.
- Chronic cases might need Interferon or antiviral therapy; in end-stage disease, transplant considered
- Vaccination is key; safe sex, avoid shared needles, screen blood products help prevent it.
Hepatitis C
- RNA virus that commonly progresses to chronic hepatitis, cirrhosis, or liver cancer
- Mainly blood-borne, e.g., IV drug use, transfusions (rare nowadays), needlestick accidents can cause it.
- An RNA virus causing acute or chronic liver inflammation; high risk of chronic disease and cirrhosis.
- Interferon ± Ribavirin, though modern direct-acting antivirals can achieve high clearance rates can assist treatment
- No vaccine; avoid contaminated needles, reduce transmission risks assists prevention
Hepatitis D
- Same parenteral routes as HBV but only in the presence of active Hepatitis B can cause it
- A defective virus that needs Hepatitis B for replication; worsens liver damage when co-infected.
- Treatment & prevention includes controlling/preventing Hepatitis B (HBV vaccination), also limit needle/blood exposure
- A defective virus that requires Hepatitis B co-infection; can worsen the liver damage.
Hepatitis E
- Caused by contaminated food/water.
- Supportive care; only rarely needs transplant can assist treatment
- Good hygiene, properly cooked/clean water and no widely used vaccine assists prevention
- An acute viral hepatitis spread via faeco-oral route (often water-borne)
- Can be severe in pregnant women
CMV / EBV / Herpes Simplex
- Viral infections (Cytomegalovirus, Epstein-Barr Virus, Herpes Simplex) that can cause hepatic inflammation.
Cirrhosis
- Chronic hepatitis (B or C), alcoholic liver disease, NAFLD, or autoimmune conditions can cause it
- Address underlying cause (e.g., suppress alcohol, treat hepatitis), manage complications (varices, ascites).
- Advanced cases might need transplant can assist treatment
- Limit or treat triggers (alcohol, viruses), early intervention if the disease is found assists prevention
- Irreversible scarring of the liver from long-term damage (e.g., alcohol, viral hepatitis), leading to liver failure.
- Irreversible scarring (fibrosis) of the liver after long-term damage (viral, alcohol etc.)
Chronic Liver Disease
- Chronic viral hepatitis (C/B), alcohol, autoimmune, toxins, or NAFLD can cause it
- Focus of treatment includes treating the cause (antiviral therapy, stop alcohol, etc.) and managing complications.
- Prevention involves avoiding harmful factors and screening high-risk individuals.
- Ongoing liver injury over >6 months with progressive fibrosis and risk of cirrhosis.
Alcohol-Related Liver Disease (ARLD)
- Liver damage from chronic excessive alcohol use, typically presenting as fatty liver, alcoholic hepatitis, or cirrhosis.
- Abstinence from alcohol, nutritional support, management of complications (ascites, varices, encephalopathy).
- Liver damage comes from chronic alcohol misuse, encompassing fatty liver and cirrhosis also
- Keep alcohol low (4 g/day, with >10–15 g potentially causing acute liver failure).
Paracetamol Overdose (Drug-induced Hepatitis)
- Follow dosage guidelines strictly and patient education for prevention
- Acute liver damage comes from excessive paracetamol (acetaminophen) intake.
- Use activated charcoal if early; N‐acetylcysteine can be used as antidote, and supportive measures.
Non-Alcoholic Fatty Liver Disease (NAFLD)
- Excess fat accumulation in the liver unrelated to alcohol, often linked to obesity or high cholesterol.
Haemochromatosis
- A genetic condition causing excessive iron storage, which can damage the liver and other organs.
Primary Biliary Cirrhosis
- An autoimmune disease causing progressive destruction of the small bile ducts in the liver.
Wilson Disease
- An inherited disorder of copper metabolism, leading to copper accumulation in liver, brain, and eyes.
Jaundice (Icterus)
- A condition of yellow discoloration of skin/sclera from high bilirubin levels, often due to liver dysfunction or hemolysis.
Medication List
- Use of Interferon: Antiviral/immunomodulatory for chronic Hepatitis B or C.
- Mechanism of Interferon: Enhances immune response to viruses, reducing viral replication.
- Use of Ribavirin: Combined with Interferon for Hepatitis C.
- Mechanism of Ribavirin: Antiviral nucleoside analogue interfering with viral RNA synthesis.
- Use of Paracetamol: Analgesic, antipyretic.
- Mechanism of Paracetamol: Reduces prostaglandin synthesis (centrally). Toxic in overdose → liver failure.
- Use of Prophylactic Beta‐Blockers (e.g., Propranolol): In alcohol‐abusing patients to reduce portal hypertension and variceal bleeding risk.
- Mechanism of Prophylactic Beta‐Blockers (e.g., Propranolol): Non‐selective β‐adrenergic blockade lowers portal venous pressure.
- Use of Miconazole: Antifungal for candidiasis.
- Mechanism of Miconazole: Inhibits ergosterol synthesis in fungal cell membranes.
- Use of Fluconazole: Systemic antifungal for candidiasis, etc.
- Mechanism of Fluconazole: Also inhibits fungal cytochrome P450 needed for ergosterol production.
- Erythromycin: Macrolide antibiotic inhibiting bacterial protein synthesis (50S).
- Metronidazole: Disrupts anaerobic bacterial DNA.
- Tetracycline: Inhibits protein synthesis by binding the 30S ribosomal subunit.
- Mechanism of NSAIDs: Inhibit COX enzymes → reduce prostaglandin synthesis. Often avoided if GI bleed risk is high.
- Vitamin K use: Replenish or boost coagulation factors (II, VII, IX, X) in liver disease.
- Vitamin K Mechanism: Cofactor for gamma‐carboxylation of clotting factors. IV Vit K may help correct coagulopathy if cause is deficiency.
- Diuretics use: In cirrhosis patients for ascites (e.g., spironolactone or loop diuretic).
- Diuretics Mechanism: Increase fluid excretion, lowering portal hypertension–related fluid accumulation.
- Use of Antibiotics (general): If infection is suspected (e.g., spontaneous bacterial peritonitis).
- Mechanism of Antibiotics (general): Depends on chosen antibiotic, but aim is to kill or inhibit bacterial growth.
- Sedation (Benzodiazepines) use: Anxiolytic/sedative.
- Sedation (Benzodiazepines) Mechanism: Enhance GABA activity. In cirrhosis, can precipitate coma due to poor metabolism → must avoid or use with great caution.
Medication List Additional Information
- Miconazole is contraindicated in severe liver impairment.
- Fluconazole's dose needs adjusting in liver disease.
- Erythromycin, Metronidazole, and Tetracycline should be avoided in severe liver disease.
Procedures List
- Hepatitis Serology use: Identifies specific hepatitis viruses (A, B, C, E) and markers (e.g., HBsAg, anti-HBc, anti-HBs) for infection status.
- Hepatitis Serology mechanism: Blood tests detect viral antigens/antibodies indicating active or past infection, carrier states, or immunity.
- Fresh Frozen Plasma (FFP) use: Correcting coagulopathy in severe liver disease or acute bleeds (contains clotting factor).
- Fresh Frozen Plasma (FFP) mechanism: Replaces missing/deficient clotting factors to reduce bleeding risk.
- Ultrasound, MRI, CT for the Liver use: Imaging to evaluate liver architecture, detect cirrhosis, masses, or vascular abnormalities.
- Ultrasound, MRI, CT for the Liver mechanism: The non-invasive scanning techniques provide structural information (ultrasound is first-line, MRI more detailed for soft tissue, CT more general).
- Endoscopy (re: Varices) use: Detecting or treating esophageal varices in portal hypertension.
- Endoscopy (re: Varices) mechanism: Flexible endoscope visualizes the esophagus, allowing, potential for banding varices to prevent bleeding.
- Vaccination (Hepatitis A/B) use: Preventing infection by hepatitis A or B virus.
- Vaccination (Hepatitis A/B) mechanism: Induces protective antibodies that neutralize or prevent the viral infection.
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Description
Study notes defining Hepatitis A, B, and C. Hepatitis A is a self-limiting liver inflammation, while Hepatitis B can be acute or chronic. Hepatitis C is an RNA virus with a high risk of chronic disease.