Chronic Hepatitis And Cirrhosis Flashcards Preview

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Flashcards in Chronic Hepatitis And Cirrhosis Deck (22):

Spontaneous bacterial peritonitis? How common?

Bacterial infection of ascitic fluid without any intra-abdominal source of infection. Occurs 10% to 20% of cirrhotic patients with ascites.


Patient with ascites caused by portal hypertension as a complication of hepatic cirrhosis. Next step?

Perform a paracentesis to evaluating ascitic fluid and evaluate for spontaneous bacterial peritonitis


The most common causes of chronic hepatitis?

1. Hepatitis B and C
2. Alcohol
3. Autoimmune hepatitis
4 chronic exposure to drugs toxins


Less common causes of chronic hepatitis?

1. Hemachromatosis
2. Wilson disease
3. Alpha-1 antitrypsin deficiency


Test for autoimmune hepatitis?

AMA, anti-LKM (liver kidney microsome)


Test for hemachromatosis?

High transferrin saturation, High ferritin


Test for Wilson's disease?

Low serum ceruloplasmin


Ways to test for hepatitis C?

1. ELISA test to detect anti-HCV antibody
2. PCR to detect HCV RNA


Percentage of patients who will develop chronic hepatitis from HCV infection? Percentage who will develop cirrhosis? Percentage who will develop hepatocellular carcinoma?

70 to 80% within 10 years
20% within 20 years
After getting cirrhosis, 1% to 4% annually develop HCC


Treatment of choice for chronic hepatitis C? The side effects?

Pegylated alpha interferon (Flu like symptoms and depression) and ribavirin (Hemolysis)


Symptoms of cirrhosis?

1. Portal Hypertension
2. Decreased liver function (jaundice, impaired synthesis of albumen, clotting factors, steroid hormone binding proteins)
3. Hepatic encephalopathy


Portal hypertension: clinical presentation? Diagnosis? Treatment?

Ascites, splenomegaly, hypersplenism, encephalopathy, bleeding varices

Evaluation of portal bloodflow using Doppler ultrasound

Nonselective beta blockers (propranolol), Octreotide causes splanchnic vasoconstriction


Ascites: clinical presentation? Diagnosis? Treatment?

Abdominal distention with peripheral edema

Finding free peritoneal fluid on physical exam

Sodium restriction, spironolactone, loop diuretics, Paracentesis


Spontaneous bacterial peritonitis: clinical presentation? Diagnosis? Treatment?

Abdominal pain, fever, extension, decreased towel sounds

Ascitic fluid contains >250 polymorphonuclear neutrophils and confirmed with positive culture

IV antibiotics (cefotoxime or ampicillin/sulbactam)


Most common organisms that cause spontaneous bacterial peritonitis?

E. coli, Klebsiella, enteric flora, enterococci, pneumococci


Liver cirrhosis leads to a decrease steroid hormone binding globulin. Effect?

Increased amounts of free estrogen which lead to formation of
1. Spider angiomaya
2. Palmer erythema
3. gynecomastia


Most common cause of ascites?

Portal hypertension as a consequence of cirrhosis


Pathogenesis of ascites?

1. Decrease effective circulatory blood volume because of portal hypertension (underfill theory)
2. Inappropriate renal sodium retention being to hyperlipoidemia (Overfill theory)
3. Decreased plasma oncotic pressure


Serum ascites albumin gradient?

Serum albumin - ascitic albumin

If >1.1 caused by portal hypertension (Cirrhosis, portal vein thrombosis, Bud-Chiari syndrome, CHF, constrictive pericarditis)

If <1.1 Non-portal hypertension (Peritonitis, pancreatic ascites, bowel obstruction, serositis, nephrotic syndrome)


End stage developments of hemochromatosis?

Diabetes, cirrhosis of the liver, hypogonadisn, arthropathy, cardiomyopathy, bronze skin


Patient with ulcerative colitis presents with liver problems. Cause?

Sclerosing cholangitis


Alkaline phosphatase elevated 2 to 5 times above normal baseline and otherwise asymptomatic patient?

Primary biliary cirrhosis

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