Chronic Hepatitis And Cirrhosis Flashcards Preview

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Flashcards in Chronic Hepatitis And Cirrhosis Deck (22)
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0
Q

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

A

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

1
Q

Spontaneous bacterial peritonitis? How common?

A

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

2
Q

The most common causes of chronic hepatitis?

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

Less common causes of chronic hepatitis?

A
  1. Hemachromatosis
  2. Wilson disease
  3. Alpha-1 antitrypsin deficiency
4
Q

Test for autoimmune hepatitis?

A

AMA, anti-LKM (liver kidney microsome)

5
Q

Test for hemachromatosis?

A

High transferrin saturation, High ferritin

6
Q

Test for Wilson’s disease?

A

Low serum ceruloplasmin

7
Q

Ways to test for hepatitis C?

A
  1. ELISA test to detect anti-HCV antibody

2. PCR to detect HCV RNA

8
Q

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

A

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

9
Q

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

A

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

10
Q

Symptoms of cirrhosis?

A
  1. Portal Hypertension
  2. Decreased liver function (jaundice, impaired synthesis of albumen, clotting factors, steroid hormone binding proteins)
  3. Hepatic encephalopathy
11
Q

Portal hypertension: clinical presentation? Diagnosis? Treatment?

A

Ascites, splenomegaly, hypersplenism, encephalopathy, bleeding varices

Evaluation of portal bloodflow using Doppler ultrasound

Nonselective beta blockers (propranolol), Octreotide causes splanchnic vasoconstriction

12
Q

Ascites: clinical presentation? Diagnosis? Treatment?

A

Abdominal distention with peripheral edema

Finding free peritoneal fluid on physical exam

Sodium restriction, spironolactone, loop diuretics, Paracentesis

13
Q

Spontaneous bacterial peritonitis: clinical presentation? Diagnosis? Treatment?

A

Abdominal pain, fever, extension, decreased towel sounds

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

IV antibiotics (cefotoxime or ampicillin/sulbactam)

14
Q

Most common organisms that cause spontaneous bacterial peritonitis?

A

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

15
Q

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

A

Increased amounts of free estrogen which lead to formation of

  1. Spider angiomaya
  2. Palmer erythema
  3. gynecomastia
16
Q

Most common cause of ascites?

A

Portal hypertension as a consequence of cirrhosis

17
Q

Pathogenesis of ascites?

A
  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
18
Q

Serum ascites albumin gradient?

A

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)

19
Q

End stage developments of hemochromatosis?

A

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

20
Q

Patient with ulcerative colitis presents with liver problems. Cause?

A

Sclerosing cholangitis

21
Q

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

A

Primary biliary cirrhosis

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