Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

GI > Disorders of the Liver II - Exam 4 > Flashcards

Disorders of the Liver II - Exam 4 Flashcards

(103 cards)

Start Studying
1
Q

What are the different ways viral hepatitis A-D are transmitted?

A

A: fecal-oral route

B: Bloodborne, sexually transmitted

C: Bloodborne, sexually transmitted

D: Only associated with Hepatitis B co-infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What type of virus is Hep A? Where is it commonly found?

A

RNA virus

fecal-oral route and commonly seen in crowded living areas with poor sanitation and RESTURANTS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the incubation period for Hep A? How long can it be fecally excreted? Is there a chronic carrier state?

A

Incubation period averages 30 days

Can be fecally excreted for up to 2 weeks before clinical illness and up to a week after clinical illness

no chronic carrier state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Is Hep A more severe in adults or children? What is a weirdly sorta unique finding with Hep A and B?

A

more severe in adults

distaste for smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Hep A jaundice usually occurs after _____ days. What will their stools look like?

A

jaundice occurs after 5-10 days

stools may be acholic (very pale stools)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

________ levels will be elevated in a pt with Hep A. **How is the dx of hep A established?

A

Elevated serum aminotransferase levels

The diagnosis is established by detection of: serum IgM anti-HAV antibodies:
Antibody to Hepatitis A (anti-HAV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

_____ is the best lab indicator for active hep A infection. **_____ is the best indicator of previous exposure, non-infectivity and immunity

A

IgM: active infection

IgG: previous exposure, non-infectivity, and immunity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What will the liver labs be doing in an acute hep A infection? What additional labs will be elevate?

A

**Striking ALT/AST elevations

elevated levels of bilirubin, WBC normal to mildly elevated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the tx for Hep A? What is the prevention? What is the prognosis?

A

tx: symptomatic: rest and fluids

prevention: wash hands and vaccination!!

Clinical recovery typically complete within 3 months (relapses may occur)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

the diagnosis of acute hep A infection depends on the detection of _____

A

IgM anti-HAV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

the development of an __________, which occurs subsequent to the IgM response, is protective and provides lifelong immunity

A

immunoglobin G anti-HAV (IgG anti-HAV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hep B structure is ______. What are the 2 parts that make it up?

A

partially double stranded DNA

inner core protein and outer surface coat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

**What are the 2 components of the Hep B inner core protein? _____ makes up the outer surface coat

A

Hepatitis B core antigen (HBcAg)

Secretes Hepatitis B e antigen (HBeAg)

HBcAg secretes HBeAg
______________

Hepatitis B surface antigen (HBsAg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Who are the at risk populations for hep B? What is the prevention?

A

IV drug users
Prison inmates
Healthcare workers

vaccination!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

_____ occurs in less than 1% of Hep B infections, but if occurs, has a mortality rate of up to 60%

A

Acute liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the incubation period of Hep B? What is the average incubation period?

A

6 weeks to 6 months

12-14 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

**What does HBsAG stand for? What does it indicate?

A

Hepatitis B surface antigen

Active infection (acute or chronic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

**What does Anti-HBs (HBsAb) stand for? What does it indicate?

A

Hepatitis B surface antibody

Immunity (from recovery or vaccination)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

**What does HBeAg stand for? What does it indicate?

A

Hepatitis B e antigen

High infectivity and active viral replication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

**What does Anti-HBe (HBeAb) stand for? What does it indicate?

A

Hepatitis B e antibody

Lower infectivity, less active viral replication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

**What does Anti-HBc (HBcAb) - Total stand for? What does it indicate?

A

Current or past infection (not from vaccination)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

**What does anti-HBc IgM stand for? What does it indicate?

A

Hepatitis B core antibody (IgM)

Acute or recent infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

**What is the first HBV serologic markers to elevate/first sign of infection? If it persists beyond 6 months, what does it indicate?

A

Hepatitis B surface antigen (HBsAG)

first sign of infection

indicates chronic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Appearance of ____ and decline in ____ indicates recovery of acute infection and non-infectivity.

A

anti-HBs

HBsAG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What markers need to be present that would indicate previous vaccination with immunity?
Persistence of anti-HBs without elevated HBsAG
26
____ appears one month after HBsAg is detected. What does it indicate?
IgM anti-HBc indicates a diagnosis of declining acute Hepatitis B
27
_____ also appears during acute hepatitis B, but persists ____. What will show in recovery? Chronic dz?
IgG anti-HBc indefinitely With recovery → IgG occurs with Anti-HBs With chronic ds → IgG occurs with HBsAG
28
**______ Indicates viral replication and infectivity (when patient is most infectious). When does it appear? What follows it?
Hepatitis B envelope antigen (HBeAG) Appears: shortly after HBsAG in the serum in the incubation period followed by appearance of anti-HBe
29
presence of _____ indicates the hep B acute phase is over and the chance of infectivity is low
Hepatitis B e-antibody (HBeAb)
30
______ parallels the presence of HBeAg. ** What is important to note about it?
HBV DNA precise marker of viral replication and infectivity
31
_______ and _____ makes the diagnosis of acute Hep B infection
IgM anti-HBc with combo of HBsAG
32
What is the tx for ACUTE hep B?
33
What is the prophylaxis Hep B tx after exposure? **What is the associated timeframe?
Hepatitis B immune globulin (HBIG) then initiation of the vaccine series Must give within 7 days of exposure
34
What is the tx for an infant born to a Hep B positive mother?
Hepatitis B immune globulin (HBIG) Indicated in newborns with HBV + mothers: HBIG and initiation of vaccine series within 12 hours of birth to infant
35
What is the prevention for Hep B?
universal precautions safe sex education do NOT share needles VACCINATION
36
What lab values would make you think chronic Hep B? 40% of chronic hep B will develop _____
Elevated ALT/AST for > than 6 months and presence of HBsAg cirrhosis
37
**What is the tx for CHRONIC hep B?
1st line: Nucleoside and nucleotide analog (first line) Entecavir (Baraclude) or Tenofovir (Vemlidy) 2nd line: Interferon
38
________ MOA incorporates into viral DNA and inhibits reverse transcriptase = mutations of virus rendering ineffective
Nucleoside and nucleotide analog (first line) Entecavir (Baraclude) or Tenofovir (Vemlidy)
39
____ MOA inhibits viral replication. What is the BBW?
interferon BBW: for infections
40
What is the interpretation?
prior infection (inactive)
41
What is the interpretation?
immune due to Hep B vaccination
42
What is the interpretation?
acutely infected
43
What is the interpretation?
chronically infected
44
The diagnosis of Hep B relies on the presence of _____ in the serum
HBsAg
45
Which antibody shows immunity?
anti-HBs
46
What is the structure of Hep C? **50% of cases are transmitted via _____
single stranded RNA IV drug use
47
What is the risk of Hep C maternal-neonate transmission?
Risk of maternal-neonatal and sexual transmission low in Hep C higher transmission rate for Hep B
48
______ is the most common bloodborne infection in the United States, with an estimated 2.4 million people harboring an active infection. Approximately 21% of ____ pts also have Hep C
Hep C HIV
49
What is the incubation period of Hep C? High incidence develop _____ (up to 85%)
Average 6-7 week incubation period with waxing and waning jaundice chronic hepatitis
50
**diagnosis of Hep C is based on ______. What does the presence of HCV RNA tell you?
HCV antibodies = presence of Anti-HCV HCV RNA: Presence indicates current infection
51
**What does the presence of Anti-HCV without HCV RNA indicate?
prior Hep C exposure with recovery.
52
What hep has the highest incidence of becoming chronic? What does Hep C increase your risks for?
Hep C Non-Hodgkin's lymphoma Glomerulonephritis idiopathic pulmonary fibrosis thyroiditis
53
What is the prevention for Hep C?
NO VACCINE!!! NOT spread sexually or during childbirth really just spread from dirty needles associated with IV drug use
54
What is the older tx method for Hep C?
Interferon x 6-24 weeks and can add Ribavirin if no improvement
55
**What is the newer tx options for Hep C?
A 6 week course of ledipasvir/sofosbuvir (Harvoni)
56
What are 3 risk factors that would add to the progression of chronic hep C to cirrhosis?
Increased risk in men Those who drink more than 50g alcohol daily Those who acquire HCV infection after age 40 years
57
_____, _____ and _______ promotes progression of Hep C to fibrosis. What can slow progression?
Tobacco cannabis smoking hepatic steatosis coffee can slow progression
58
antiviral cure about _____ of hep C infections
95%
59
**What is Hep D associated with? What pt population? How is it dx? What is the tx?
Only associated with Hepatitis B - coinfection mainly among IV drug users detection of serum antibodies: anti-HDV tx: self care, supportive and avoiding alcohol
60
Where is Hep E commonly found? What is the structure?
Central and Southeast Asia, the Middle East, and North Africa, where it is responsible for WATERBORNE hepatitis outbreaks RNA virus not common in the US, need to ask travel history
61
**What is the MC pt population associated with Hep E? In developed countries, how is it commonly spread?
pregnant women swine, and consuming undercooked organ meats
62
What is the incubation period for Hep E? How is the dx made?
2-10 weeks The diagnosis is made most readily by testing for IgM anti-HEV in serum
63
“flu-like symptoms” followed by “icteric phase” of frank jaundice What am I? What are some extrahepatic manifestations? What labs will be elevated?
Hep E arthritis; pancreatitis; thrombocytopenia; and a variety of neurologic complications, including Guillain-Barré syndrome and peripheral neuropathy elevated aminotransaminase and bilirubin levels
64
What is the tx for Hep E? **What is the important take away regarding Hep E?
A 3-month course of treatment with oral ribavirin can be very severe in preg women!! mortality rate can reach 15-25% no vaccine approved in the US, but there is a promising one in China
65
What is hemochomatosis? How is it inherited? What is the associated gene?
Increased iron absorption from duodenum and stored in liver autosomal recessive HFE gene mutation
66
How is iron stored?
stored in the liver as hemosiderin
67
When does hemochromatosis typically present? What are some late findings?
usually around 50 symmetric arthropathy hepatomegaly hepatic dysfunction bronze skin pigmentation (melanin deposition), cardiac enlargement (can progress to heart failure) DM
68
What will the iron lab values show of a pt with hemochromatosis?
Elevated serum iron levels and serum ferritin LOW TIBC: total iron binding capacity
69
____ can be used to confirm hemochromatosis dx and ____ to determine the extent of liver damage
genetic testing liver bx
70
What is the tx for hemochromatosis? What are the chelating agents?
low iron diet decrease alcohol weekly phlebotomy until iron stores are depleted then PRN Deferoxamine IV or Deferasirox po
71
What is Wilson Dz? How is it inherited?
genetic defect on chromosome 13 that affects the copper transporting enzyme and leads to excessive absorption of copper form intestines, and decreased excretion by the liver rare autosomal recessive disorder
72
What does Wilson disease lead to ? When does it commonly present?
deposition of copper in liver and brain childhood or young adult
73
What are the 2 organs systems affected the most by Wilson disease?
liver and brain: can present with parkinsonian like symptoms, ataxia, dysphagia, incoordination elevated LFTs and cirrhosis can also have psych features
74
**What is the pathognomic sign for Wilson disease?
Kayser-Fleischer ring copper deposits in cornea
75
What are some common lab findings on a pt with Wilson disease?
Increased urinary copper excretion Low serum ceruloplasmin levels Liver biopsy to assess chronic hepatitis and cirrhosis
76
What is the tx for Wilson Disease?
restriction of dietary copper: shellfish, nuts, mushrooms, chocolate **oral penicillamine: chelating agents with vit B6 oral zince to promote fecal excretion of copper
77
What is Gilbert syndrome? What enzyme?
Characterized by MILD unconjugated bilirubinemia Reduced activity of glucuronyl transferase
78
What is the role of glucuronyl transferase?
Liver enzyme that gives glucuronic acid and changes bilirubin into a form that can be removed from body in bil
79
**Recurrent episodes of jaundice that are triggered dehydration, fasting, infection, menstruation, over-exertion, alcohol What am I? What lab finding? What is the tx?
Gilbert Syndrome Unconjugated hyperbilirubinemia ( < 3mg/dL) and NORMAL everything else! benign, no tx is necessary
80
What is Crigler Najjar Syndrome? What is it caused by?
Congenital nonhemolytic jaundice Rapidly severe, High levels of unconjugated hyperbilirubinemia Rare autosomal recessive disorder that is either a complete or partial Glucuronyl transferase deficiency
81
When does Crigler Najjar Syndrome present? What can it lead to?
Occur in infancy High levels of bilirubin can lead to neurological damage. “Kernicterus”
82
**What are the different levels of Crigler Najjar Syndrome?
Type I levels 20-50 mg/dL Type II levels < 20mg/dL High levels definitive for diagnosis
83
What is the tx for Crigler Najjar Syndrome? What is the tx for Type II?
Phototherapy!! phenobarbital which will also induce the enzyme
84
Why does phototherapy work well for Crigler Najjar Syndrome? ______ is curative
Lowers bilirubin levels through photo-oxidation Adds oxygen to the bilirubin so it easily dissolves Body can excrete through urine/feces liver transplant is curative
85
What is Dubin Johnson Syndrome? What is the key word here? What does it result in?
Genetic mutation affecting *transport* proteins of bilirubin Elevations in Conjugated serum bilirubin
86
Intermittent Jaundice, fatigue May see *darkly pigmented liver* on gross inspection Conjugated hyperbilirubinemia in the absence of other abnormalities What am I? What is the tx? What can exacerbate the condition?
Dubin Johnson Syndrome benign condition: no tx needed illness, OCP and pregnancy
87
What is the Rotor Syndrome? What are the 2 key words?
Rare genetic disorder Hepatic defect in *storage* of *conjugated* bilirubin Leaks back into bloodstream
88
How can you tell Rotor Syndrome apart from Dubin Johnson?
Can inject dye and do “transport study” to determine if Rotor or Dubin Johnson liver bx: Rotor will have a norma looking liver and Dubin Johnson will have dark liver
89
What is the tx for Rotor Syndrome?
benign condition: no tx needed
90
What is Budd-Chiari Syndrome? What is the usually underlying cause?
Hepatic venous outflow obstruction Hereditary and acquired hypercoagulable states can be defined in 75% of patients
91
tender, painful hepatic enlargement (RUQ pain) Jaundice Splenomegaly Ascites chronic: bleeding varices and hepatic encephalopathy may be evident What am I? **What is the imaging of choice? What will it show?
Budd-Chiari Syndrome Doppler ultrasonography: occlusion/absence blood flow in hepatic veins/IVC May see “spider web” pattern of occluded hepatic veins
92
In Budd-Chiari Syndrome, the doppler ultrasonography may show prominate _______ since its venous drainage may be occluded
caudate lobe: venous drainage may be occluded since it is supplied by L/R hepatic veins
93
_______ allows visualization of the obstructed veins and collateral vessels in _______
MRI with contrast Budd-Chiari Syndrome
94
What is the tx for Budd-Chiari Syndrome?
95
Hepatocellular Carcinoma arise from liver _______ cells and 80% are due to ________
parenchymal cells d/t Cirrhosis
96
What are the hepatocellular carcinoma risk factors for patients with cirrhosis?
Obesity Male gender Age > 55 Family History DM HCV or HBV infection Alcohol
97
**What are the 2 lab findings associated with hepatocellular carcinoma?
Spike in ALP Alpha fetoprotein in 70% of patients
98
**What are the first line imaging for hepatocellular carcinoma? What confirms?
CT and MRI are first line imaging to identify masses liver bx confirms
99
**When can a liver bx be deferred in Hepatocellular Carcinoma?
Can be deferred if mass on CT and + alpha fetoprotein
100
What are the staging classifications for Hepatocellular Carcinoma?
101
What is the screening for hepatocellular carcinoma?
102
What is the tx for Hepatocellular Carcinoma? What MELD score?
103

GI (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions