Generaal Flashcards
(25 cards)
Acute hepatitis can be caused by:
o Viruses
• Drug-or alcohol-induced
o Ischemia
o Autoimmune or fat deposition
Which 4 feature always present in Acute Hepatitis?
Severe upper quadrant pain
Jaundice
Dark urine ( from bilirubin)
Elevated transaminases
Concerning transaminases, which one is elevated when?
- AST and GGT are elevated in drug-and alcohol-induced hepatitis
- AST is generally elevated in a 2:1 ratio with ALT in alcohol-induced hepatitis
. -ALT is greater than AST with viral hepatitis. AST is greater than ALT with drug-and alcohol-induced hepatitis
. -AST and ALT are classically elevated greater than 1,000 in ischemic, acute viral, and medication-overdose (classically acetaminophen) hepatitis.
In viral hepatitis, what are the most important features of
Hep-A ?
Trans imitated via
Contaminated food, water or via Sexual transmission
Dx by: anti-Hep~A IgM
Rx: Self resolving
What are the most important features of Viral hepatitis of Hep~B?
Associated with polyarteritis nodosa
Dx: Hep~sAg, and anti-HBc IgM
Rx: Treat chronic disease (HBeAg+) with:
Lamivudine, Entecavir, Adefovir or interferon
What pecluritis give Hepatitis C viral infection it’s identity?
Associated with mixed Cryoglobulinemia
Genotype 2&3 have better response to therapy than 1
Dx: anti-HCV IgM & HCV RNA are best initial tests
Rx.: Ribavirin and Interferon
What’s peculiar with Hep D virus
Super imposed onto HepB infection
What’s special with Hep E viral infection
Mostly occurs in pregnant women
The two most important and accurate feature of Diagnosis of viral hepatitis are…:
AST/ALT ratio is 1:2
Most accurate tests are Viral PCR
In Alcohol induced hepatitis, What’s special in regards to Dx and Treatment
AST/ALT ratio is 2:1
Severe illness is treated with steroids
What’s most important about
Alpha 1-antitrypsin deficiency (A1AT).
Hepatitis?
Look for COPD/emphysema.
Best initial test: Low A1AT Level
The most accurate test is Liver Biopsy
Lung disease is treated with enzyme replacement. Severe cases require liver transplant.
Can lead to cirrhosis.
What’s the most the important information about
(NASH)
Non-Alcoholic Steatohepatitis ?
Common in Obese people,
Liver biopsy is the most accurate test
Looks like alcohol induced hepatitis on histology
Rx: Manage underlying Diabetes
What’s peculiar with Autoimmune hepatitis?
Usually co-occurs with autoimmune conditions like ITP
DX: +ve ANA, and LKM-1
Or soluble antigens against soluble liver antigen
Rx: Glucocorticoids or Azathiprine
Can lead to cirrhosis
What’s liver cirrhosis?
Basically fibrosis of the liver
Mention the nine things patients with liver cirrhosis present with
Gynecomastia and hypogonadism: increased circulating estrogen
•
• Ascites:———due to hypoalbuminemia
Rx—treat with sodium restriction and diuretics; if refractory, large-volume paracentesis is used.
• Thrombocytopenia:—-secondary to hypersplenism
• Caput medusa:—-abdominal venous congestion
• Fetor hepaticus:—bad breath from dimethyl sulfide
• Jaundice
• Asterixis:————wrist flapping on extension due to encephalopathy
• Spider angiomata and palmar erythema
Mention the 5 major complications of Liver Cirrhosis
• Esophageal varices: Prevent bleeding with a non-selective beta blocker such as propanolol; if bleeding occurs, treat with endoscopic banding.
Encephalopathy presents with altered mental status to coma; treat with
lactulose.
- Hepatic encephalopathy (HE) presents with altered mental status to coma; The best initial treatment is with lactulose. The best treatment to reduce recurrent episodes of HE is with rifaximin.
- Hepatorenal syndrome leading to renal failure: Transplant is the only true cure.
- Hepatopulmonary syndrome presents with “orthodeoxia” or desaturation on sitting up.
- Hepatocellular carcinoma: Screen with ultrasound and alpha-fetoprotein levels in patients with advanced liver disease; transplant is indicated for patients with limited disease. Treatments when transplant is not possible are: chemoembolization, ethanol ablation, radiofrequency ablation, and chemotherapy.
When does patient with Ascites undergo paracentecsis
•Patients with cirrhosis and new-onset ascites
or ascites in the presence of pain, fever, or abdominal tenderness must undergo a diagnostic paracentesis.
The fluid must be sent for albumin level, Gram stain, and cytology. If the serum ascites to albumin gradient (SAAG) is less than 1.1, then portal hypertension is not present. A SAAG greater than 1 . 1 is indicative of portal hypertension as the cause of the ascites.
What’s looked out for when analyzing Ascitic fluid in the lab?
The fluid must be sent for
- albumin level,
- Gram stain,
- and cytology.
If the serum ascites to albumin gradient (SAAG) is less than 1.1, then portal hypertension is not present.
A SAAG greater than 1 . 1 is indicative of portal hypertension as the cause of the ascites.
What’s Spontaneous Bacterial Peritonitis (SBP)
Defined as an ascitic neutrophil
count greater than 250 per mm ,
it is treated with cefotaxime or ceftriaxone for 5 to 7 days.
After recovery, prophylactic antibiotics such as ciprofloxacin or norfloxacin must be continued.
Name the five commonest causes of Liver cirrhosis
Alcoholic Cirrhosis
Primary biliary cirrhosis (PBC)
Primary sclerosing Cholangitis
Wilson disease( Autosomal recessive)
Hemochromatosis
Summarize Alcoholic cirrhosis
It’s a dx of exclusion, in many years of drinking
AST/ALT ratio is 2:1
Dx. Best is Biopsy ( With Macrosteatosis and Mallory bodies)
Rx. Is supportive and Transplant
Summarize Primary Biliary Cirrhosis (PBS)
Presentation ( Middle aged woman, with Pruritus, Fatigue and Xanthemas
Has hx of autoimmune disorders
Dx. Best initial test is ALP level and Antimitochondrial antibodies
- Most accurate tat is Liver biopsy
Rx: Ursodeoxycholic acid n liver transplant if advanced
Summarize Primary Sclerosing Cholangitis
Presentation ( with Ulcerative colitis 80%, elevated bilirubin, and ALP)
Risk for cholangiocarcinoma.
Dx.: Most accurate is ERCP
RX: Ursodeoxycholic acid & Cholestyramine used for symptom relief
Transplant is the only cure
Summarize Wilson disease in one slide
Presentation.( Psychiatric abnormalities like tremor, Choreiform movements
Remember is due to pathological accumulation of copper in various organs
Dx: best Initial test is Keyser Fleischer rings on the slit lump eye examination
Elevated serum copper, and low Ceruloplasmin level in 80-95% of cases
Most accurate test is liver biopsy
