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GI Week 4 > DSA 6: Approach to Hepatobiliary Patient (Chronic Liver Disease / Cirrhosis) > Flashcards

DSA 6: Approach to Hepatobiliary Patient (Chronic Liver Disease / Cirrhosis) Flashcards

1
Q

Chronic hepatitis is described as a group of disorders characterized by a chronic inflammatory reaction in the liver for at least?

A

6 months

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2
Q

Chronic HBV has an association with?

Chronic HCV has an association with?

A

1) Polyarteritis nodosa

2) Mixed cryoglobulinemia

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3
Q

What is used to identify if there is presence or absence of fibrosis (cirrhosis) in chronic hepatitis?

A

1) Serum FibroSure

2) US elastography

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4
Q

Chronic HBV is endemic in?

90% of infants are infected via?

What causes a higher probability of chronicity?

A

1) Asia and sub-Saharan Africa
2) Maternal transmission
3) The younger the age at the time of HBV infection

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5
Q

Cirrhosis associated with chronic HCV progression increases in?

A

1) Males that heavily drink
2) Get infection after 40 yo
3) Immunocomp
4) Smoke

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6
Q

What common food and/or drink slows the progression of chronic HCV?

A

Coffee

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7
Q

Presence of what serology points towards chronic HCV?

A

HCV Ab and HCV RNA

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8
Q

Which type of autoimmune hepatitis is most common?

A

Type 1

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9
Q

What antibodies are associated with type 1 autoimmune hepatitis?

Which are associated with type 2?

A

1) Anti-smooth muscle Abs (SMA)

2) Anti-liver/kidney microsomal Abs (anti-LKM)

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10
Q

Classic autoimmune hepatitis (type 1) is most prevalent in what population?

A

Females ranging from 30-50 yo

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11
Q

What clinical features are associated with classic autoimmune hepatitis (type 1)?

A

1) Progressive jaundice
2) Epistaxis
3) Amenorrhea

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12
Q

What is the treatment for autoimmune hepatitis?

A

Glucocorticoids

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13
Q

What complications are associated with Autoimmune hepatitis?

A

Leads to cirrhosis and if left untreated can cause hepatocellular carcinoma

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14
Q

How much alcohol intake in a day can cause alcoholic liver disease over a 10 year span in men?

In women?

A

1) Exceeds 80 g/day

2) 30–40 g/day

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15
Q

What is the fatty liver (steatosis) caused by alcohol characterized by?

A

1) Asymptomatic hepatomegaly

2) Elevation in bilirubin and Alkaline phosphatase

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16
Q

What values are seen on CMP in regards to AST/ALT when a patient presents with alcoholic liver disease?

A

AST 2x greater than ALT

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17
Q

What is found on CBC with alcohol liver disease?

A

1) Leukocytosis with left shift

2) Anemia

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18
Q

What is a direct toxic effect of alcohol on megakaryocyte production or to hypersplenism?

A

Thrombocytopenia

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19
Q

What is seen on PT/PTT/INR with alcohol liver disease?

A

Marked prolongation of the prothrombin time

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20
Q

What is present on liver biopsy with alcohol liver disease?

A

Mallory-Denk bodies (alcoholic hyaline)

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21
Q

What supplements should be given to patients with alcohol liver disease?

A

1) Multivitamin
2) Thiamine
3) Folic acid
4) Zinc

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22
Q

Why is thiamine co-administered with glucose when treating alcohol liver disease?

A

Prevents Wernicke-Korsakoff syndrome

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23
Q

What should be given to patients with severe alcoholic hepatitis?

A

1) Steroids

2) Pentoxifylline

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24
Q

How long must patients abstain from alcohol to be considered for liver transplantation?

A

6 months

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25
Alcohol liver disease is the most common precursor to what condition in the United States?
Cirrhosis
26
What is used to calculate Maddrey’s discriminant function (DF)? What cutoff is associated with poor prognosis for alcohol liver disease?
1) PT and serum bilirubin | 2) ≥32
27
Fatty liver is also known as?
Hepatic steatosis
28
What is the most common cause of chronic liver disease in the US?
Non-alcoholic fatty liver disease (NAFLD)
29
The principal causes and increased risk for NAFLD are?
Metabolic Syndrome: 1) Obesity 2) Diabetes mellitus (insulin resistance) 3) Hypertriglyceridemia
30
NAFLD causes an increased risk for?
1) CV disease 2) Chronic kidney disease 3) Colorectal cancer
31
What protects against the development of NAFLD?
Physical activity and coffee consumption
32
What is used to assess liver stiffness that can be used to estimate hepatic fibrosis in NAFLD?
Ultrasound elastography
33
What is seen on liver biopsy for NAFLD similar to alcohol liver disease?
Mallory-Denk bodies
34
What autosomal recessive condition is the most commonly diagnosed inherited hepatic disorder in infants and children? What complication does it cause?
1) Alpha-1 Antitrypsin deficiency | 2) Pulmonary emphysema
35
Which phenotype is associated with alpha-1 Antitrypsin deficiency and causes severe reductions in enzyme levels?
PiZZ
36
What should be recommended to alpha-1 Antitrypsin deficiency patients to help manage the condition?
Smoking abstinence
37
What chronic disease of the liver is characterized by autoimmune destruction of small intrahepatic bile ducts and cholestasis?
Primary Biliary Cholangitis
38
What population is most affected by primary biliary cholangitis?
Women around 50 yo
39
What are some risk factors for primary biliary cholangitis?
1) UTI 2) Smoking 3) Hormone replacement therapy 4) Hair dye
40
What unique clinical manifestation is seen in primary biliary cholangitis?
Xanthelasma
41
What will we find on lab for primary biliary cholangitis?
1) Antimitochondrial antibodies (AMA) 2) Increased alkaline phosphatase 3) Increased IgM levels
42
How is primary biliary cholangitis treated?
Ursodeoxycholic acid
43
Hemochromatosis is an autosomal recessive mutation of what gene on chromosome 6?
HFE gene
44
What does hemochromatosis cause?
Increases accumulation of iron as hemosiderin in various organs including the liver
45
While most symptoms are rarely recognized clinically before the patient’s 50’s, what are seen on H/P for hemochromatosis?
1) Cirrhosis with hepatomegaly 2) Abnormal skin pigmentation 3) DM 4) Heart failure 5) ED in males
46
Prognosis of hemochromatosis is favorable with? What is used in addition to this?
1) Phlebotomy therapy | 2) PPI
47
If the patients can't tolerate phlebotomy due to hemochromatosis, anemia, or thalassemia what should we use to treat hemochromatosis?
Deferoxamine
48
Risk factors for advanced fibrosis include?
1) Male sex 2) Excess alcohol consumption 3) DM
49
Affected patients of hemochromatosis are at increased risk of infection with?
1) Vibrio vulnificus 2) Listeria monocytogenes 3) Yersinia enterocolitica
50
Wilson disease is a rare autosomal recessive mutation of what gene on chromosome 13?
ATP7B
51
What age group is mostly affected by Wilson disease?
Under 40
52
What does Wilson disease cause?
1) Impaired copper excretion into bile | 2) Failure to incorporate copper into ceruloplasmin
53
What diagnostic findings point towards Wilson disease?
1) Low serum ceruloplasmin 2) Elevated hepatic copper concentration 3) MRI of the brain shows increased copper deposition
54
How would a Wilson disease patient present?
Child or young adult with hepatitis, hemolytic anemia, and neuro abnormalities
55
What is the pathognomonic sign of Wilson disease?
Brownish or gray-green Kayser-Fleischer ring (In the eye)
56
What is the treatment for Wilson disease?
Oral penicillamine
57
What association does right heart failure have with the liver?
Nutmeg liver due to congestion of liver
58
Hepatojugular reflux is present with?
Heart failure
59
What levels are markedly elevated in heart failure?
BNP
60
What levels are elevated during shock liver (ischemia involved)?
1) Aminotransferase | 2) LDH
61
What is the pathophysiology seen in cirrhosis?
Fibrosis replaces normal liver and regenerative nodules are formed
62
What are the most common causes of cirrhosis?
1) Hepatitis C 2) Alcoholic liver disease 3) NAFLD
63
What is diagnostic and therapeutic for ascites and cirrhosis?
Abdominal Paracentesis
64
How is the SAAG (Serum ascites albumin gradient) score calculated? If it is >1.1 it is most likely related to? If it is >250 PMNs/mL think?
1) Serum albumin -- Ascites albumin 2) Portal hypertension 3) SBP
65
Ascites is the pathologic accumulation of fluid in?
Peritoneal cavity
66
What is the most common cause of ascites?
Portal hypertension secondary to chronic liver disease
67
What diagnostic tool reliably establishes the presence of fluid?
Abdominal ultrasound
68
What is the most important test for ascites?
A white blood cell count with differential
69
Cirrhosis, Budd-Chiari syndrome, and liver metastases is seen with a SAAG score of? Biliary leak, pancreatitis, and peritoneal carcinomatosis is seen with a SAAG score of?
1) Greater than 1.1 g/dL | 2) Less than 1.1 g/dL
70
What is characterized by alteration in mental status in the presence of liver failure?
Hepatic encephalopathy
71
What levels are typically elevated in hepatic encephalopathy?
Ammonia
72
How does hepatic encephalophy present on H/P?
Confusion, drowsiness, and asterixis (flapping tremor)
73
What is used to treat hepatic encephalopathy?
Lactulose
74
Exposure to what may contribute to etiology of hepatocellular carcinoma and causes a mutation in p53?
Aflatoxin
75
How is hepatocellular carcinoma screened for?
Check AFP levels and perform US every 6 months
76
What is considered in patients with worsening functional status based on the MELD/MELD-Na score?
Liver transplant
77
What MELD score is required for liver transplant listing?
Greater than 14

GI Week 4 (12 decks)

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