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GEN MED GI > Gen Med Liver Disorders > Flashcards

Gen Med Liver Disorders Flashcards

(60 cards)

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1
Q

Inflammation of the liver, less than 6 mo

A

Acute Hepatitis

Chronic is over 6 months

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2
Q

Persistently elevated AST and ALT

A

Chronic Hepatits

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3
Q

Most Common Viral Hepatic Dz Worldwide

A

Hep B

Vaccine not yet available

Often transmitted @ birth or by blood or mucus membranes (sexually even kissing)

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4
Q

Most Common Viral Hepatic Dz in US

A

Hep C

Kids vaccinated for B since 1980s

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5
Q

Flu-ey: malaise, muscle & joint aches

Headache/fever, N/V/D

A

If not flu - think Acute Hepatitis A,B or C

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6
Q

Incubation of Hepatitis A&B

A

7-10 days

Surface Antigen will present during this pd

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7
Q

Jaundice, Smokers w/smoke aversion
Profound loss of appetite
Clay colored stools, Abdominal Discomfort
Choluria

A

Chronic Hepatitis B or C (A is just acute)

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8
Q

What’s on a Hepatitis Panel?

A 
Hep A Antibody: IgM    2d - 6 mo
Hep B Surface Antigen earliest to rise 
Hep B Core Antibody: IgM
Hep C Antibodies - nonspec as to M/G
-You must order Billir, ALT/AST 
  CBC, total protein/albumin & PT-INR
  separately
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9
Q

Why test PTT/PT-INR in suspected Hepatitis?

A

Liver makes clotting factors, High PTT or low PT-INR suggests they’re not being made right

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10
Q

CBC results in Hepatitis

A

Right shift, should be Lymphos

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11
Q

Add which test if alcoholism is the suspected cause of Hepatitis symptoms:

A

GGT
-Usefule to confirm liver source of elevated Alk Phos

-Persistent elevation in alcoholism but goes up even for a brief binge so you can monitor alcohol intake with GGT

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12
Q

AST

A

Aspartate Transaminase

  • up when liver, muscle & RBCs are damaged
  • If only AST is up, probably not the liver. If it’s elevated with ALT and ALK PHOS and of course GGT, then its a hepatic source
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13
Q

ALT

A

Alanine Transaminase

  • Up when Muscle Liver & Kidneys are damaged. This one is very livery, second to GGT If its up, think liver
  • On statins? Remove and retest in few weeks
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14
Q

LDH

A

Lactate DeHydrogenase
-Up when Cardiac Cells, Liver Cells & RBCs are elevated

-Only useful in liver testing if all the others are up too

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15
Q

Alk Phos

A

Alkaline Phosphatatse

  • In liver, Alk Phos is secreted around bile ducts so it rises in obstructive liver dz like stones in the hepatic/common bile duct, cholangitis etc.
  • Elevated during bone growth: i.e. growth spurts OR bone cancer, obviously age is a factor in this. If its up after the growth plates close, that’s not good unless in pregnancy.
  • Also a marker for Kidney & Intestinal issues so it’s not a good marker for liver in isolation
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16
Q

Hepatocellular Dz

A

Hepatocytes are damaged

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17
Q

Cholestatic Dz

A

Biliary ducts are damaged

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18
Q

Infiltrative Hepatic Dz

A

Liver is invited by neoplasm or amyloid plaque

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19
Q

Significance of Bilirubin

A

Spleen breaks down Heme to “unconjugated “ Bilirubin then attaches it to Albumin and sends it to the liver to be in corporated into Bile

In the liver, unconjugated bilirubin is separated from albumin and attached to Glucuronic Acid (now it’s CONJUGATED) and can be excreted

If Conjugated Bilirubin is high, then the liver is conjugating fine but is unable to secrete it - think biliary obstruction

If unconjugated bilirubin is high and conjugated is normal, the problem is upstream of the liver, think Hemolysis/Bleeding/Spleen trouble

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20
Q

Neonatal Jaundice

A

Neonates often lack enough liver enzyme to conjugate their indirect bilirubin, so that level rises and they also have an incomplete BBB so it can get into their brains and cause brain damage.

We degrade indirect bilirubin with UV light, so that’s why babies get bililighted. In a few days, the liver gets itself together and can conjugate on its own unless there is a congenital anomaly.

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21
Q

Budd Chiari Syndrome

A

Hepatic Vein Blockage by thrombosis (primary) or by compression (tumor pressing on it, secondary)

  • Abd Pain + Ascities + Hepatomegaly, usually jaundice. This is obstructive liver dz but on the way OUT not in. Portal system will back up below the obstruction - no esophageal varix
  • Polycythemia Vera, Oral Contraceptives, Hepatic cancer, Pregnancy/Post Partum
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22
Q

Hepatitis A (HAV)

A

Self limiting, usually less than 6 mo
-Vaccine Available 2 dose series
babies over 1 yr adults under 40
- Give IgG and Vaccine ASAP for Exposure to
prevent development of Dz
- Adults over 40 or babies under 1 year get
IgG instead of Vaccine

Fecal Oral - can’t work in food prep during acute phase

IgM peaks in 1st week, stays up for months
Marks Acute phase, contagious
IgG rises in 1 month, stays up for years
Marks “Convalescent” Stage, non infectious
No antigen test

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23
Q

Hep B (HBV) Incubation/transmission

A 
1-10 weeks
Blood-Blood
   IV Drug Users
   Health Workers
   Transfusion/Transplant (outside US)
   Dialysis contamination
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24
Q

Screen for Hep B

A

Pts w/acute hepatitis sxs
Pts w/chronically elevated LFTs
Foreigners
Pregnant Women (need to stop transmission at birth) All pregnant women are screened in US

Prison inmates
IV drug users
Partners of B+
Dialysis Pts, regularly

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25
Rx HBV for neonate with + mother
IgG and HBV vaccine at birth Effective All babies are supposed to get their first HBV vaccination before leaving the Hosp after birth.
26
HBsAg
Hep B Surface Antigen Acute/contagious marker Rises 1-10 weeks post exposure before Sxs & ALT Gone after 4-6 months
27
AntiHbs
Antibody to Hep B Surface Antigen rises only after surface antigen disappears - it is made to fight surface antigen and so we can't detect it while it's fighting, it's too busy. We detect it after it "won" Can stay up for a lifetime and is an immunity marker. If someone has + AntiHBs and + AntiHBc they had the dz and have immunity. This one can rise again during a second bout or reinfection or a relapse.
28
Anti HBc
Antibody to the Hep B core antigen The core antigen rises when sxs begin whereas Hbs antigen is pre-sxs. It's presence without HBc antibodies indicates acute infection. Once the antibodies appear, we can tell that they've fought the antigen and are now circulation on patrol and the acute phase is over.
29
Hep B IgM
indicates acute infectious Hep B, rises between disappearance of the surface antigen and before core antibodies. Hep B IgM rises and then the long term IgG is the marker of actual immunity.
30
HBe Antigen
Rises during high viral replication after HB surface antigen rises. Marker of high infectiousness Antibodies to HBe (anti - HBe) is a good marker of immunity post natural infection, not all virus types produce HBe though and this is not produced by the vaccination.
31
Ground Glass Hepatocytes on Biopsy
Very high viral load - infectious
32
First Line Rx for Hep B
``` Antivirals: NucleoSIDE/TIDE alalogs: -Entecavir (Baraclude) NucleoSIDE analog Infrequent resistance Suppresses HBV DNA -Tenofovir disoproxil (Viread) NucleoTIDE analog Used if resistant to Entecavir Infrequent resistance ```
33
Entecavir & Tenofovir
First line Hep B nucleoside analog antivirals
34
Adafovir
Can't use this alone in Hep B | Must use with Lamivudine
35
Anti HVC
Hep C antibodies Not detected until 2-8 weeks AFTER LIVER DAMAGE (after LFTs rise!) May still be negative 6 months after, if body is not fighting off infection well. There has to be a lull in the battle for these to become detectable but not finding them in serum doesn't mean they're not in there working.
36
EIA test
Elisa test for Hep C (HCV) + EIA gets retested w/ HCV RNA assay
37
RT-PCR
Rapid Test for HCV reverse transcriptase Can detect viral activity within days of exposure Use for needle stick/ post exposure
38
Determines extent of liver damage in HCV
Biopsy
39
Must co-exist with Hep B
Hep D (HDV) IV Drug Users/Kidney Dialysis Test all who are + for HBV Antigen rises FAST 1-3 days IgM rises FAST 10 days No Rx for HDV
40
``` ALT 3X Normal Limt and/or ALP 2X Normal Limit with /without Billirubin 2X normal limit ```
Think Toxic Hepatitis, drug induced - Think Statins, Aspirin, INH (in TB) - Phenytoin (Dilantin Seizures) - MethylDopa (A2 Agonist for HTN, Hydralazine and Clonadine...)
41
Itching & Jaundice
Signs of Cholestasis/ Bile Obstruction Think Stones or clotting in the hepatic veins. Clotting is usually medication related. Get Sonogram for stones then move to clotting if Negative OCP’s, anabolic steroids, androgens, allopurinol, carbamazepine, chlorpromazine, flucloxacillin
42
Steatosis Hepatitis Fatty Liver Disease
High Triglycerides in Liver Damage Reye's Syndrome in kids (no aspirin !) Normal TGs is 150, damaged liver overproduces
43
Liver Mets are from:
Colon, Lung & Breast Cancer
44
Hepatocellular Carcinoma (HCC)
Most common Malignant Carcinoma of the liver Pale masses in the liver caused by repeated inflammation & recovery 80% are associated with cirrhosis, mainly from alcoholism and Hep C Likes to move into the portal vein and the hepatic veins, where it causes Ascites and Splenomegaly -these aren't really mets, as they're still in the liver they're called 'vascularizations' Mets to Lung, Bones, Lymph Nodes then Adrenal Glands
45
HCC signs
Chronic Hepatitis sxs + weight loss & muscle wasting
46
Alpha Fetaprotien elevated
Tumor marker for Hepatocellular carcinoma and various congenital disorders of the fetal liver Elevated in 50%- 70% of HCC cases
47
Tumor Capsule (and septum)
EXCEPT in HEPATOCELLULAR CARCINOMA, Capsules are typically the division between benign and malignant tumors. "Benign tumors are encapsulated" but this doesn't always hold true and NOT IN HCC. Well established HCC and benign tumors have capsules but metastasis occurs when the capsule ruptures Still, the presence/absence of a capsule is pursued as part of staging: The capsule is best imaged with MRI
48
Wilson Disease
Hepatic Copper malprocessing, Congenital High Copper leads to organ damage Mainly Japan
49
Painless Jaundice
Obstruction, think cancer
50
Most common imaging to dx Hepatocellular Carcinoma
CT scan Though for staging, MRI picks up tumor capsule best
51
Rx for Hepatocellular Carcinoma
Resection Transplant - only if no mets Cryosurgury/Ultrasound if not a surgical candidate Selective Internal Radiation: Radioactive pellets injected into the artery that feeds the tumor, sclerosing it to cut off supply and irradiating it from within.
52
HCC dx testing
Suspicious? Have chronic hepatitis/cirrhosis sxs WITH weight loss and muscle wasting... GET A SONOGRAM We don't like to poke the liver that shows nodules on CT w/contrast, we can "seed" new tumors that way and cause bleeding that the body can't handle due to low clotting factor production. If SONO is + for masses, CT w/contrast is diagnostic and we spread out to look for mets to lung, bonescan adrenals and lymph nodes once HCC is noted in the liver.
53
Reye Syndrome
Aspirin in Kids & Teens w/viral illness Just don't use aspirin for anyone but adults Causes mitochondrial damage in the liver. Usually in youths with a congenital abnormality but we don't test for this regularly. Causes encephalopathy, brain damage and death
54
Dx testing for Cirrhosis
Sonogram first, then biopsy We don't biopsy if we suspect cancer but we do with cirrhosis as things aren't that bad yet.
55
Hepato-Pulmonary Syndrome
Hepatic disease w/dyspnea Dyspnea worse sitting than lying (opposite of CHF) Thought to be caused by decreased liver clearance of endogenous vasodilators like NO2 resulting in ventilation-perfusion mismatch (too much blood to the lungs) Pulse Ox should be low, get arterial blood gases. Bubbles in Left Atrium may show on echocardiogram No RX other than liver transplant, constricting vasculature to lungs with somatostatin is experimental
56
Test LFTs q 6 mo if on these meds
Januvia - sitagliptin DPP-4 Statins NSAIDS
57
Liver 911
``` Varices - cough/vomit blood get endoscopy Ascities - get endoscopy Encephalopathy Peritonitis Platelets under 50,000 ```
58
TIPS
Trans Jugular IntraHepatic Stent Bypasses liver, relieves ascites, varices, portal hypertension
59
K+ in Encephalopathy
As NH3+ rises, K+ dives Sxs are Weakness, Tingle/Numbness Cramping Palpitations Constipation
60
Ca 19-9
``` Tumor Marker for Pancreatitis Also Colon Cancer Hepatocellular Carcinoma Esophageal Carcinoma ```

GEN MED GI (4 decks)

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