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Summary Cluster Abdomen - Lectures

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This document is a summary of all useful lectures not included in the written exam and which do not fit with the main topics covered at each outpatient clinic but which may nonetheless be useful during the oral exam. The themes covered include virology (hepatitis), medical microbiology (UTIs), radi...

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  • December 7, 2017
  • 18
  • 2017/2018
  • Summary
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I. Virology

Lecture - Viral Hepatitis

- Infectious causes
- Hepatitis A-E virus
- Epstein Barr virus (mononucleosis)
- Cytomegalovirus
- Yellow fever
- Q fever: Coxiella burnetii (pneumonia) which can cause hepatitis
- HIV
- Lyme disease
- Syphilis
- Non Infectious causes
- Alcohol (ASH), drugs (antibiotics, statins, chemotherapy)
- Steatosis (NASH) associated with obesity
- Autoimmune
- Ischemic
- Wilson’s disease

- Acute Hepatitis
- Clinical presentation
- Asymptomatic
- Flu like symptoms: fatigue, malaise, nausea, myalgia
- Pain RUQ
- Jaundice
- Acute liver failure (days/weeks)
=> NO CIRRHOSIS

- Chronic Hepatitis
- Clinical presentation
- Asymptomatic -> fibrosis -> end stage liver disease (cirrhosis,
hepatocellular carcinoma, liver failure) -> death
- End stage liver disease: liver may shrink (-> not detectable via
palpation)
- Symptoms (cirrhosis):
- portal hypertension
- Ascites
- Splenomegaly: backflow to the spleen
- Esophageal varices: lower third
- Nausea, vomiting, aspiration (-> respiratory failure):
bleeding in the stomach
- Caput medusae

- Liver Failure
- Markers:

, - Coagulation abnormality: INR > 1.5, increased prothrombin time: low
clotting factor production
- Encephalopathy: ammonia
- Decreased albumin, increased bilirubin, hypoglycemia,
- Renal failure: hepatorenal syndrome




- Hepatitis B
- Characteristics: DNA virus envelope, different genotypes have different prevalent
locations
- Transmission: parenterally, sexually, vertically/perinatally (mother to child
transmission = MTCT), blood-blood
- Incubation: 1-6 months

, - Inactive HepB can become active: pregnancy, immunosuppression (via
infections, chemotherapy, etc)

- Patient has cleared the
virus

- HBsAG: produced acutely to
clear the infection
- Anti-HBs: only produced if the
infection is cleared
- Anti HBc: proves the patient
was in contact with the virus
(not just the vaccine)




- Patient will not clear the virus

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