diseases of the liver

Question 1

cholestasis if isolated elevation of alk phos then consider

Answer 1

bone involvment

Question 2

chronic hepatitis is what time from

Answer 2

over 3-6 months

Question 3

what is anasarca and what is it from

Answer 3

full body swelling due to nephrotic syndrome or heart failure

Question 4

ascites most common cause from

Answer 4

portal HTN from chronic liver disese

Question 5

risk factors for chronic liver disedase

Answer 5

alcohol
transfusions
tattoos
IVDU
viral hepatitis

Question 6

non portal HTN causes

Answer 6

infections
malignancy
inflammatory disorders
ductal disruption

Question 7

risk factors for NAFLD

Answer 7

hispanics
people with psoriasis
cholecystecomy and heavy soft drink consumption

Question 8

non alcoholic fatty liver cna lead to

Answer 8

CVD
cirrhosis
colorectal cancer
CKD

Question 9

other causes of fatty liver

Answer 9

vinyl chloride
CCl4
yellow phosphorus

Question 10

non alcoholic fatty liver disease 
symptoms
labs
etiology
histology 
diagnose
tx

Answer 10

usually asymptomatic
-mild RUQ discomfort, hepatomegaly

normal or increased transaminase and alk phos

obesity, DM, hypertriglyceridemia, metabolic syndrome

histo: NAFLD macrovesicular steatosis
- NAFLD–>NASH: macrovesicular steatosis and focal infiltration by PMNs and mallory hyalin

US to demonstrate macrovascular steatosis

liver bx diagnositc

tx: lifestyple modification

Question 11

what is first step with pt with ascites

Answer 11

abdominal ultrasound

noninvasive

Question 12

someone who comes in with abdominal pain with known ascites and a fever and altered mental status must rule out

Answer 12

spontaneous bacterial peritonitis

-this is the #1 differential in any cirrotic that comes in with ascites and showing decompensation

Question 13

in person with liver cirrhosis that is severely malnourished maybe from alcohol is super at risk for ____ for cause of acites
what test preformed

Answer 13

TB

adenosine deaminase

Question 14

with a chylous ascites what level test do you do

Answer 14

triglyceride level

Question 15

how do you calculate SAAG

Answer 15

serum albumin - ascitic fluid albumin

Question 16

what test looks for esophageal varices

Answer 16

esophagoduodenoscopy
EGD
pt with HCV and liver scarring

Question 17

spontaneous bacterial peritonitis most common pathogens

Answer 17

E coli, or klebsiella pneumonia

or strep pneumo or viridans or engerococus

Question 18

SBP in what pts

Answer 18

10-20% of known cirrhoti pts

presenting with decompensation–> worsening encephalopathy, fever, ab pain, worse renal function

Question 19

PMN highly suggestive of bacterial peritonitis

Answer 19

PMN >250/mcL with >75% of all white cells

Question 20

symptoms of hepatitis A
labs
treatment

Answer 20

anorexia
malaise
aversion to smoking
mild RUQ
acute
increased aminotransferases--> eleevated alk phos and bilirubin
self limited

Question 21

HBV labs

Answer 21

increased aminotransferases–>elevated alk phos and bilirubin

Question 22

where is chronic HBV endemic

Answer 22

asia and sub saharan africa

maternal transission

Question 23

risk of what with chronic HBV

Answer 23

HCC

cirrhosis

Question 24

endemic areas of HDV

Answer 24

africa
central asia
eastern europe
amazon region of brazil

Question 25

in pt with anti hcv positivity what should you do with them

Answer 25

recommend ordering HCV RNA

Question 26

what does anti-HCV in serum but negative HCV RNA mean

Answer 26

recovery from past infection

Question 27

complications of CV

Answer 27

``` mixed cryoglobulinemia membranoproiferative GN increased risk for non-hodkin lymphoma cirrhosis and HCC decrease in serum cholesterol and LDL ```

Question 28

HCV genotype 3 increases risk for

Answer 28

hepatic steatosis

Question 29

hcv screening recommendations

Answer 29

people born between 1945 and 1965

Question 30

HEV risk factors

Answer 30

those treated with tacrolimus for immunosuppression tend to get Hep E africa liver transplant pts (a1-antitrypsin deficiency is #1 reason for child to get liver transplant)

Question 31

HEV is spread how

Answer 31

waterborne spread by swine pets in home consuming undercooked organ meats

Question 32

treatment of HEV | what kind of virus

Answer 32

self limited | RNA hepevirus

Question 33

fulminant acute liver failure | subfulminant

Answer 33

hepatic encephaolpathy w/in 8 wks after onset of acute liver disease. INR over 1.5 8w-6m after onset

Question 34

leading causes of death in acute liver failure

Answer 34

cerebral edema and sepsis

Question 35

treatment of acute liver failure | tylenol OD

Answer 35

supportive corticosteroids of uncertain value stress gastropathy prophylaxis N-acetylcysteine in tyleono OD

Question 36

tylenol OD treat with important to get a ___ hr acetaminophen level criticial ingestion treatment interval for max protection against severe hepatic injury is btwn ___ and __ hrs

Answer 36

N-acetylcysteine 4 hour acetaminophen level 0 and 8 hours

Question 37

autoimmune hepatitis

Answer 37

``` most common in young mid age women +ANA and or SM AB anti-LKM1 AST/ALT can be >1000 units/L billi increased ```

Question 38

treatment autoimmune hepatitis

Answer 38

steroids and azathioprine

Question 39

increased risk with autoimmune hepatitis

Answer 39

cirrhosis and HCC

Question 40

drugs that cause hepatitis that histologicaly mimic autoimmune hepatitis are

Answer 40

``` nitrofurantoin minocyline ASA NSAIDs terbinafine TNF inhibitor isoniazid ```

Question 41

what cant you give in a thymine deficient alcoholic before administering thymine (B1)

Answer 41

dextrose | will cause wernecke korsakoff

Question 42

what gives you a megaloblastic anemia

Answer 42

folic acid and B12 deficiency

Question 43

when do you get severe alcoholic hep with 50% mortality

Answer 43

when total bili over 10 mg/dL and PTT over 6 sec | susceptible to infections too

Question 44

risk of alcoholic cirrhosis with

Answer 44

over 50g daily for over 10 years

Question 45

what is the maddrey discriminant function

Answer 45

disease severity and mortality risk in pts with alcoholic hepatitis estimated by this (DF) need PTT, and bilirubin if value over or = to 32 then have high short term ortality and may benefit from treatment with gluocorticois lower score doesn't benefit

Question 46

glasgow alcoholic hepatitis score

Answer 46

``` age bilirrub bun ptt peripheral wbc ``` score over 9 or =9 then survival benefit with glucocorticoids

Question 47

hepatic encephalopathy grading: somnolence to semistupor, responive to verbal stimuli confusion gross disorientation, bizarre behavior

Answer 47

grade 3

Question 48

``` hepatic enceph alopathy grading: trivial lack of awareness shortened attention span impaired performance of addition euprhoia or anxiety ```

Answer 48

grade 1

Question 49

hepatic encephalopathy grading: ``` lethargy or apathy min disorientation for time or place subtle personalitiy change inapprop behavior impaired performance of subtraction ```

Answer 49

grade 2

Question 50

hepatic encephalopathy grading: coma

Answer 50

grade 4

Question 51

cirrhosis labs

Answer 51

``` macrocytic andemia decreased wbc infection SP thrombocytopenia prolonged PTT modes elevation in AST (ALT) and alk phos and total bili decrease albumin increased risk DM vitamin D deficiency--> osteoporosis ```

Question 52

cirrhosis imaging

Answer 52

``` lUS contrasted CT or MRI, biopsy fibrosure liver iopsy egd ```

Question 53

criteria in child pugh score

Answer 53

APE AB ascites bilirubin encephalopathy albumin ptt