GI lecture 5 highlights

Question 1

List 2 key parts of management of MAFLD

Answer 1

1) Abstinence from alcohol
2) Weight loss

Question 2

List the management for MAFLD and AFLD (alcoholic fatty liver disease)

Answer 2

1) MAFLD: No pharmacologic agents. Improve risk factors.
2) AFLD: Steroids only with severe disease

Question 3

What is the only time a steroid helps with hepatitis? Which steroid?

Answer 3

Methylprednisolone for alcoholic hepatitis

Question 4

What are 2 ways Hep A is transmitted?

Answer 4

1) Fecal-oral route
2) Shellfish

Question 5

RUQ tenderness & ________ hepatomegaly are found on PE in 85% of patients with Hep A

Answer 5

mild

Question 6

Does Hep A lead to cirrhosis?

Answer 6

No (!!!)

Question 7

How long does a Hep A infection last?

Answer 7

Subsides over 2-3 weeks with recovery by 9 weeks; NOT chronic

Question 8

You can’t have Hep D without also having Hep _________

Answer 8

D

Question 9

How is Hep B transmitted?

Answer 9

Transmitted by inoculation of infected blood, blood products or sexually, (MSM), vertical

Question 10

Hep B: Vertical transmission from HBsAg+ mother; risk of chronic infection in child is ~_______%-
need vaccine w/in 24 hrs of birth to prevent*

Answer 10

~90%

Question 11

Hep B is prevalent in _________, and in __________ drug users

Answer 11

MSM & IV

Question 12

Hep B: ________ at infection is the principal determinant of clinical outcome

Answer 12

Age

(neonates have worse outcomes)

Question 13

Hep B: ______% of chronic HBV infections progress to HCC

Answer 13

25%

Question 14

Hep B: Estimated _________ worldwide with past or present infection; estimated _____________ chronic carriers worldwide

Answer 14

2 billion; 296 million

Question 15

Approximately 70 percent of patients with acute hepatitis B virus (HBV) infection have _______________ or ____________ hepatitis

Answer 15

subclinical or anicteric

Question 16

Hep B: ~____% adult acquired infections become chronically infected (90% perinatally infected and 20-50% 1-5 YO.)

Answer 16

~5%

Question 17

Hep B: Acute liver failure in <1% with up to _____% mortality

Answer 17

60%

Question 18

Hep B: Can it become chronic? What may it lead to?

Answer 18

May become chronic; can lead to cirrhosis

Question 19

Hep B is chronic if ___________ is persisting > 6 months.

Answer 19

HBsAg

Question 20

What appears after clearance of HBsAg & with vaccination?

Answer 20

anti-HBs (antibody to HBsAg):

Question 21

IgM anti-HBc indicates __________ HBV infection

Answer 21

acute

Question 22

Hep B: anti-HBc indicates prior infection _______ from vaccine

Answer 22

not

Question 23

Hep B: What indicates viral replication and infectivity?

Answer 23

HBeAg

Question 24

Hep B: When should you get qualitative test to determine observation vs treatment?

Answer 24

HBV DNA

Question 25

Describe the structure of Hep B

Answer 25

Question 26

Once you confirm an active Hep B infection, you should vax for _________

Answer 26

HAV

Question 27

Acute Hep B: 1) What is the main gist of Tx? 2) There are measures to prevent infection in ____________________

Answer 27

1) Mainly supportive 2) exposed contacts

Question 28

What are the odds of an adult pt with acute hep B getting a chronic hep B infection?

Answer 28

<5%

Question 29

What is the main way to transmit hep C?

Answer 29

blood to blood

Question 30

Hep C: 1) Up to ______% develop cirrhosis over 20-30 years. 2) Chronic disease occurs in ~______% 3) What is the main Sx?

Answer 30

1) 30% 2) 85% 3) Usually asymptomatic

Question 31

List one of the main extrahepatic manifestations of Hep C

Answer 31

Renal disease (membranoproliferative glomerulonephritis)

Question 32

Hep C: 1) Is it curable? 2) Detectable HCV Ab with ______________ HCV RNA suggests recovery from past infection

Answer 32

1) Yes, now curable 2) undetectable

Question 33

Hep C: 1) HCV Ab is __________ protective (does ______ confer immunity,) 2) However, it will remain ____________ after a patient has been treated 3) Therefore in a treated/cured patient, a positive _______ is needed to know if the virus has relapsed, NOT a positive HCV A

Answer 33

1) not; not 2) positive 3) RNA

Question 34

Hep C: 1) Positive HCV Ab indicates what? 2) How do you differentiate active vs past infection? 3) When is a Hep C infection considered chronic?

Answer 34

1) Active OR past infection NOT life-long immunity 2) Quantitative HCV RNA 3) If >6 months

Question 35

What confirms an active Hep C infection?

Answer 35

Detectable HCV level over 6-month period

Question 36

Main determinants for agent & duration of Hep C are what?

Answer 36

Treatment status (naïve vs experienced) & absence/presence of cirrhosis, genotype

Question 37

Hep C: 1) There's a positive _________ even after cure from active infection. 2) Is antibody protective? 3) All ___________ screening for hepatitis C in patients who have been previously treated should be performed using ***HCV RNA (qualitative or quantitative).

Answer 37

1) HCV Ab 2) No 3) future

Question 38

Cirrhosis of the liver: Represents late stage of progressive _______________ characterized by distortion of hepatic ____________ and formation of regenerative ____________

Answer 38

progressive fibrosis; architecture; nodules

Question 39

Cirrhosis of the liver: 1) Name the other reason for this to occur besides cholestasis 2) Name one common cause in the US

Answer 39

1) Chronic hepatic inflammation 2) Metabolic associated steatohepatitis (MASH)

Question 40

Metabolic associated steatohepatitis (MASH) is a common cause of what in developing countries?

Answer 40

Cirrhosis of the liver

Question 41

Cirrhosis: 1) What are the 2 clinical classifications? 2) Which is asymptomatic? 3) Splenomegaly is a PE sign of what? 4) Name 1 lab abnormality

Answer 41

1) compensated vs decompensated 2) Compensated 3) Hepatic decompensation 4) Thrombocytopenia

Question 42

Cirrhosis: What is a major part of preventing superimposed insults to liver in these pts?

Answer 42

Vaccination

Question 43

Cirrhosis complications: 1) What are 2 a major ways to deal with ascites? 2) What do you have a high index of suspicion/low threshold early antibiotics for?

Answer 43

1) TIPS; < 2G sodium/day 2) SBP (Spontaneous Bacterial Peritonitis)

Question 44

Non-portal hypertensive cirrhosis complications: 1) Build-up of ammonia (NH3) can occur with what? 2) What 2 things should pts with this condition NOT do?

Answer 44

1) Hepatic encephalopathy (HE) 2) Drive or fast

Question 45

1) What is HCC? 2) Most forms of chronic hepatitis not at increased risk until cirrhosis develops (exception is _______________) 3) Elevated ________ is not specific for HCC since it can also be seen in patients with gonadal tumors, and pregnancy.

Answer 45

1) Primary liver tumor 2) chronic hepatitis B 3) AFP

Question 46

Acute (secondary) peritonitis: 1) What are 4 Sxs of the initial injury? 2) What should you always do for these pts?

Answer 46

1) Guarding, rigidity, distention, rebound 2) Always consult a surgeon

Question 47

Ascites complications: How is Spontaneous Bacterial Peritonitis (SBP) diagnosed?

Answer 47

Paracentesis

Question 48

Definitive treatment for decompensated cirrhosis is what?

Answer 48

Liver transplant

Question 49

List the 2 scores relevant to liver transplant

Answer 49

1) Model for End-stage Liver Disease (MELD) score 2) Childs-Pugh score

Question 50

Fulminant (sudden onset) Hepatic Failure: Defined as severe acute liver injury with encephalopathy and impaired synthetic function (INR of ≥1.5) in a patient ***without ______________________ disease ***

Answer 50

pre-existing liver

Question 51

What does NOT lead to chronic liver disease?

Answer 51

Fulminant (sudden onset) Hepatic Failure:

Question 52

___________________ is most common toxin assoc w/FHF in U.S

Answer 52

Acetaminophen

Question 53

What is often study of choice for FHF (b/c there's a risk of renal failure with IV contrasted CT)?

Answer 53

U/S with doppler

Question 54

What are the 3 FHF diagnostic criteria?

Answer 54

1) Elevated aminotransferases (ALT & AST) (often with abnormal bilirubin & alkaline phosphatase) 2) Hepatic encephalopathy 3) Prolonged PT (INR > 1.5)

Question 55

Factors involved in coagulopathies in cirrhosis include?

Answer 55

altered blood flow diminished numbers and function of platelets increased platelet sequestration in the spleen  inflammatory alterations in endothelial cells  Vit K deficiency

Question 56

Why do some pts respond to exogenous vitamin K and others don't?

Answer 56

Patients with advanced parenchymal liver disease will not respond b/c liver isn't making factors to reverse it

Question 57

Increased bilirubin production Decreased hepatic uptake Impaired conjugation These all may cause what?

Answer 57

Unconjugated hyperbilirubinemia (indirect)