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Spring Round II Exams > clin med- hepatitis lectures > Flashcards

clin med- hepatitis lectures Flashcards

(73 cards)

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1
Q

At what point can you still reverse liver damage (alcohol related)

A

Steatosis

reversible after 4-6 weeks of abstinence

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2
Q

Alcoholic Liver Dz 3 main patterns of injury

A

Fatty liver (simple steatosis)
Alcoholic Hepatitis
Chronic Hep w Fibrosis or Cirrhosis

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3
Q

ALD risk factors

A

> 1 drink/day for women, >2 drinks/day for men

Pattern (daily, binge, fasting)

Obese

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4
Q

Fatty liver

A

A-sx, reversible and self limited (after 4-6 wks of abstinence)

Tx: lifestyle (weight loss and exercise) stop drinking

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5
Q

AH

Alcohol Hepatitis

A

Necrosis and fibrotic scarring

Sx can be none —-> severe

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6
Q

AH severe manifestations

A 
Hepatic encephalopathy
jaundice
Hepatosplenomegaly
Edema
Ascites
Variceal bleeding
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7
Q

AST/ALT ratio in Alcoholic Hepatitis

A

> 1.5

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8
Q

Mallory Denk body

A

Alcoholic Hepatitis

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9
Q

Histology of Alcoholic Hepatitis

A

Neutrophilic lobe inflammation
Clumps of Mallory Denk
Degranulation and fibrosis

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10
Q

Definite dx of Alcoholic Hepatitis

A

Liver biopsy

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11
Q

Confounding factors

A

reasons why Alcohol might not be the cause of the liver damage

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12
Q

Lilie Model

A

response to Steroid

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13
Q

Hepatic Encephalopathy

A

Ammonia travels to brain: neurotoxin

Tx: Lactulose
Sx: EKG change, tremor

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14
Q

4 grades of Hepatic Encephalopathy

A

syndrome of impaired brain fx w/ advanced liver dz

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15
Q

Asterixsis (hand tremor)

A

a sign of Hepatic Encephalopathy

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16
Q

Severe Alcoholic Hepatitis

A

Variceal bleeding
Ascites
Jaundice

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17
Q

Tx of Severe Alcoholic Hepatitis

A

Diuretics

Hepatic Enceph: Lactulose, Rifaximin

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18
Q

Severe Alc Hep diagnostics

A

MDF >32

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19
Q

Tx of Severe Alc Hep

A

Steroids, but stop if not effective after 7 days (using Lilie score)

Liver transplant if meds fail

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20
Q

Liver cirrhosis

A

Process of destruction, regeneration, necrosis, fibrosis and progressive deterioration

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21
Q

Compensated cirrhosis

12 yr survival

A

Portal pressure is not an issue (<10)
Splenomegaly
Anemia
AST elevation

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22
Q

Uncompensated Cirrhosis

<2 yr survival

A

Portal HYPERTENSION

Porto-systemic shunting

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23
Q 
Dupuytren's contracture
Spider nevi
Hepatic enceph
Jaundice
Muscle wasting
Portal HTN
Asterixis
A

Decompensated Cirrhosis

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24
Q

3 possible sites of obstruction causing Portal HTN

A

Prehepatic: Portal vein clot
Intrahepatic: Cirrhosis
Posthepatic: CHF, constrictive pericarditis

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25
HCC surveillance Hepatocell CA
US every 6 mo and AFP
26
TIPS
Transjugular Intrahepatic Portosystemic Shunt
27
Tx if you have decompensated cirrhosis and MELD score >15
Liver transplant
28
HepatoRenal syndrome
``` Inc BUN (Azotemia) prog rise in Cr ```
29
HepatoRenal synd | two subtypes
Type 1: rapidly progressing, multi organ failure (survival <4 wks) Type2: assoc w refractory ascites (longer survival about 6mo)
30
Benign Liver lesions that require NO FURTHER TX
Cavernous hemangioma <4 cm Focal nodular hyperplasia Simple cyst (no sx) Focal fatty change
31
Benign Liver lesions REQUIRING further investigation
Adenoma Liver abscess Inflammatory pseudotumor Atypical cyst or Large Refer to GI/Hepatology
32
High suspicion of Hepatocellular CA in
Cirrhosis | Hep B
33
How to screen Cirrhotic pts for HCC
Platelet count | US elastography
34
How to screen Hep B pts for HCC
US every 6 mo + AFP
35
HCC sx
Sudden appearance of Ascites Cachexia Weight loss
36
Dx of HCC
High AFP and ALP Order: CT first, then Tri phasic MRI if CT not helpful
37
DIAGNOSTIC For HCC
Liver biopsy but try Tri phasic CT --> MRI first
38
HCC tx
Resection rarely feasible Liver transplant early stage RFA/Microwave for small tumors Chemo
39
Most at risk for Fatty liver (steatohepatitis)
Asian indians
40
Ratio of >1.5
Alcoholic liver dz
41
Order of ALT values- Highest to lowest
``` Shock Acute hep Alcohol Chronic hep Cirrhosis Normal ```
42
Progression of Fatty liver
NAFL (no evidence of liver cell injury) --> NASH (inflammation w liver cell injury) --> NASH Cirrhosis (cirrhosis + steatosis)
43
NAFL
no injury
44
NASH
hepatocyte injury present
45
Two main risk factors for NAFLD
Obesity | DM2
46
Fibroscan results indicating fatty liver
Fibroscan (VCTE) >5%
47
HH
accum of IRON
48
HH
Caucasians | Bronze skin, joint, cardiomegaly
49
Triad of Bronze skin, DM, and Cirrhosis
HH
50
Transferrin and | Ferritin values indicating HH
Transferrin> 45 | Ferritin > 200 or 150 (men, women respectively)
51
Tx for HH
Phlebotomy every 6 mo with CA screening (US and AFP)
52
How is HH dx confirmed
HFE gene testing +/- liver bx
53
Screen for HH if pt has
``` Elevated AST/ALT Abn iron studies 1st deg relative w HH Evidence Liver dz Sx of HH ```
54
Wilson dz
Copper | Keyser fisher ring + Neuro
55
Dx Wilson dz (copper)
24 hr Urinary copper | Confirm w Liver bx
56
Tx of Wilson dz (copper)
Chelating agent | Liver transplant
57
A1 deficiency
Inc risk:smoking Panniculitis Emphysema and or Neonatal cholestasis/childhood cirrhosis
58
A1 deficiency tx
Liver transplant
59
AIH: Autoimmune Hepatitis
Non spec sx (fatigue, abd pain, pruritis, joint pain) Acute onset if <30 days: hepatomegaly, tender, jaundice, splenomegaly, fever
60
Serological markers for AIH: Autoimmune Hep
ANA SMA IgG LKMA-1 (kids)
61
Tx for AIH: Autoimmune Hep
Prednisone +/- Azothioprine
62
Hep A
Asia, Africa sanitation Does NOT cause chronic Flu like sx in prodrome Icteric: jaundice, dark urine, pruritis, light colored stool, jaundice
63
Hep A titers
IgM anti-HAV: Acute infection M MEANS ACUTE IgG anti-HAV: Immunity G means you're GOOD
64
Tx for Hep A
Supportive High risk: hospitalize
65
Leading cause of Cirrhosis and Liver CA
Hep B
66
Hep B
Usually becomes chronic in kids Adults usually recover with immunity
67
Acute Hep B is more severe in elderly of what age
>60 YO
68
Tx for Hep B
Supportive +/- Antiviral (only in acute liver failure or protracted course) Hospitalize risky pts
69
Hep C
MOST become Chronic
70
Testing for Hep C
RNA viral load of Hep C Antibody
71
Hep C screening
One time testing for ALL 18 YO or older
72
Hep C tx
Stop drinking DAAT Vaccinae for Hep A and B
73
Hep E is most dangerous in what term of pregnancy
2nd and 3rd trimester

Spring Round II Exams (10 decks)

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