hepatitis

Question 1

Which organ should you think of if a patient complains of arthralgia or myalgias?

Answer 1

Think about the liver

Question 2

What symptoms can a patient present with if they have acute viral hepatitis?

Answer 2

General: fatigue, fever, arthralgia, myalgia
Skin: rash, pruritis
HEENT: jaundice
GI: abdominal pain, anorexia, nausea/vomiting

Question 3

What areas should you focus on with physical exam of someone with acute viral hepatitis?

Answer 3

Vital signs
Skin
HEENT
Cardiac, respiratory systems
Abdomen
Neuro

Question 4

Which lab is most sensitive and specific marker for viral liver infections

Answer 4

ALT

Question 5

ALT or AST differentials?
Fatty liver
Alcoholic liver
Drug/chemical toxicity
Hemachromatosis

Answer 5

ALT

Question 6

ALT or AST differentials?
MI
Acute pancreatitis
Musculoskeletal trauma
Acute hemolytic anemia
Severe burns

Answer 6

AST

Question 7

AST two times ALT

Answer 7

Alcoholic hepatitis
alcoholic cirrhosis
liver congestion
liver metastases

Question 8

Enzyme in cells lining liver, biliary tract, bone
Differentials
Vitamin D deficiency
Metastatic/neoplastic disease
Cholestasis
Infiltrative liver disease (tumors, abscesses)
Granuloma

Answer 8

Alkaline Phosphatase

Question 9

What do you look at to determine the source for the elevated alkaline phosphatase?

Answer 9

Look at isoenzymes to differentiate between bone or liver

Question 10

Which do you look at (direct or indirect) bilirubin when assessing for viral hepatitis?

Answer 10

Direct (conjugated)
***Also present with Hepatic dysfunction
Obstruction of bile flow
possibly stones
tumor

Question 11

Found in liver, heart, kidney, muscle
Source differentiated through isoenzymes
Differentials: MI, hemolytic anemias, tumors

Answer 11

Lactic Dehydrogenase (LDH)

Question 12

LFTs 
AST: prejaundice increase up to several thousand units; not prognostic
ALT: later increase up to several thousand units; not prognostic
ALP, LDH: elevated; specifics require isoenzymes
Bilirubin: increased D/T
CBC: Low total WBC, leukopenia 
Differentials 
Low polys, bands: bandemia
High lymphs: lymphocytosis
H/H: mild anemia
Albumin: +/-
Prothrombin time: +/-

Answer 12

Acute Viral Hepatitis Lab Results

Question 13

What could a prolonged prothrombin time (PT) indicate in a patient with acute viral hepatitis?

Answer 13

Prolonged duration indicates impending liver failure; need to test for specific viral markers

Question 14

acts as primary, long-term antibody against viruses/bacteria, fixes complement

Answer 14

IgG

think G for GONE as in the acute infection is gone.