Autoimmunity and the liver Flashcards Preview

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Flashcards in Autoimmunity and the liver Deck (23):
1

Who is most likely to be a carrier for Hep B?

Neonates. Immature immune system is less likely to clear the infection.

2

What HLA types is autoimmune hepatitis associated with?

HLA-DR3 and HLA-DR4

3

What autoantibodies associated with AIH?

1. ANA
2. SMA (smooth muscle antibodies)
3. Liver-kidney microsomal

4

What unique labs would you see in AIH?

bilirubin high
--Elevated transaminases (500-1000)
--HYPER GAMMA globulinemia
--positive for autoantibodies
HOWEVER, often asymptomatic. Can co-exist with other autoimmune diseases

5

Presentation of AIH?

Same as general signs of hepatitis
--Fatigue
--Dark urine/light stools
--RUQ discomfort
--Arthralgia
--spider nevi
--Jaundice
--splenomegaly/hepatomegaly

6

Unique findings on biopsy of autoimmune hepatitis:

1. PLASMA cells
2. Lobular inflammation with rosettes

7

What could help in your diagnosis of AIH?

Use the scoring system from autoimmune hepatitis group. Definite AIH if you score over 15.

8

How do you treat autoimmune hepatitis?

Prednisone
-Azathioprine

9

What's on your differential with a transaminase level above 1000?

1. Acute viral hepatitis
2. Autoimmune hepatitis
3. Ischemic hepatitis
4. Acute drug/toxin injury

10

What's on your differential with a transaminase > 10,000

acetaminophen toxicity
ischemic hepatitis

11

What liver lab finding would make you suspect alcoholic hepatitis?

AST: ALT ratio of 2:1

12

Typical pt with primary biliary cirrhosis?

Middle aged women

13

Pathogenesis of primary biliary cirrhosis?

Destruction of interlobular bile ducts (at the microscopic level).
--Ductopenia
--Slowly progressive cholestasis

14

Symptoms of Primary Biliary cirrhosis?

Hyperpigmentation
--Pruritis
--Xanthomas
--Jaundice is a late manifestation
Often, normal PE

15

What lab would you want to order in PBC?

AMA is sensitive and specific for PBC

16

Histology of PBC

FLORID DUCT LESION is textbook.
--Portal triad with inflammatory cells

17

How do you treat PBC?

Ursodeoxycholic acid

18

Typical pt with primary sclerosing cholangitis?

Males much more common

19

Pathogenesis of primary sclerosing cholangitis

Inflammation, fibrosis, and stricturing of medium nad large bile ducts (as opposed to PBC)

20

What other disease do you need to watch out for in a pt with primary sclerosing cholangitis?

Ulcerative colitis. If they have UC, then at risk for colon cancer

21

What are complications of primary sclerosing cholangitis?

1. Cholestasis
2. Biliary strictures
3. Bacterial cholangitis
4. Cholangiocarcinoma

22

Histological findings in primary sclerosing cholangitis?

Onion skinning

23

How can you tell whether elevated GGT/AP is due to biliary obstruction VERSUS hepatic cholestasis?

Need to image the liver/biliary tree with ultrasound
PSC==Biliary obstruction (larger bile ducts)
PBC:==hepatic cholestasis