Hepatitis and Cirrhosis

Question 1

Autoimmune hepatitis

Answer 1

Type 1 and 2
Occur in women
Often have other autoimmune dz

Question 2

Autoimmune hepatitis tx

Answer 2

Corticosteroids

Azathioprine 2nd line

Question 3

Hemochromatosis

Answer 3

Mostly in caucasians
Iron overload form increased absorption
Leads to cirrhosis, cardiomyopathy, diabetes, hypogonadism.

Question 4

How much iron does it take for hemochromatosis to manifest symptomatically?

Answer 4

around age 40 OR when iron stores reach 15-40 grams.

Females have delayed sx

Question 5

Classic hemochromatosis S/S

Answer 5

Cutaneous hyperpigmentation (bronzing)
Diabetes
Cirrhosis

Question 6

Gold standard for hemochromatosis dx

Answer 6

Liver biopsy

Question 7

Hemochromatosis tx

Answer 7

Phlebotomy every 2-4 months

Avoid alcohol, red meat, iron

Question 8

Wilson’s dz

Answer 8

Hepatolenticular degeneration
Autosomal recessive
Affects copper metabolism
Copper build up in liver and brain.
Easily treated if diagnosed early

Question 9

Wilsons Dz presentation

Answer 9

Presents btw 1st and 3rd decade.
Liver dz of young child
Neuropsych sx

Question 10

Kayser-Fleischer rings

Answer 10

Copper ring Iin eyes

For dx of wilsons dz

Question 11

Wilsons dz tx

Answer 11

If not treated, fatal

Chelate for tx

Question 12

3 stages of alcoholic liver dz

Answer 12

Fatty liver
Alcoholic hepatitis
Fibrosis and cirrhosis

Question 13

Fatty liver

Answer 13

Mostly asymptomatic
Can occur within hrs of binge
Tender hepatomegaly
May occur in obesity and preg

Question 14

Alcoholic hepatitis

Answer 14

Asymptomatic to very ill
Anorexia, weight loss, abd pain
Jaundice
Fever

Question 15

ALcoholic hepatitis physical findings

Answer 15

Spider angiomas
Palmar erythema
gyenecomastia
Parotid enlargement
testicular atrophy
ascites
encephalopathy

Question 16

Alcoholic hepatitis lab findings

Answer 16

AST:ALT ratio greater than 2
Anemia
Hyperbilirubinemia

Question 17

Is alcoholic hepatitis reversible?

Answer 17

Usually, but may progress

Question 18

Most common cause of liver failure in the US?

Answer 18

Drug-induced Liver Injury

Question 19

DILI

Answer 19

Drug-induced liver injury

APAP, Abx

Question 20

How to tx APAP OD?

Answer 20

N-acetylcysteine

Question 21

S/S of Viral Hepatitis

Answer 21

Can be asymptomatic
Malaise and fatigue
Anorexia, N/V
Myalgias
Pale stools, dark urine
Jaundice
RUQ pain

Question 22

Viral hepatitis tx?

Answer 22

Supportive

Manage sx

Question 23

Does HAV cause a chronic infection?

Answer 23

No

Question 24

HAV route of transmission

Answer 24

Fecal oral mostly

Close contact, sex, food, blood

Question 25

HBV route of infection?

Answer 25

``` Sexual contact Perinatal Breaks in skin, injectables Organ transplant Transfusions (RARE) ```

Question 26

HBV post-exposure tx

Answer 26

Vaccine and | HBIG in different body site

Question 27

Extrahepatic HBV manifestations

Answer 27

``` Fever Rash Arthralgias Polyarteritis nodosa Glomerular dz ```

Question 28

HbsAg

Answer 28

Hepatitis B surface antigen Appears prior to onset of sx Persistence past 6 mo indicated chronic infection dissapears within 4-6 months in infection

Question 29

HbcAg

Answer 29

HBV CORE antigen | Indicates acute infection

Question 30

Anti-HBsAg

Answer 30

Follows disappearance of HBsAg. Persists for life *Just presence of this means immunity by vaccination. *Presence of this AND HBsAg indicated HBV carrier.

Question 31

Chronic HBV Tx

Answer 31

Interferon | But not in pts w/ decompensated cirrhosis

Question 32

Majority of liver transplants in the US are from?

Answer 32

HCV

Question 33

Risk for HCV transmission

Answer 33

IVDU Sex Jail, blood transfusion

Question 34

which cancer does HCV lead to?

Answer 34

HCC

Question 35

HCV serology

Answer 35

80-100% of pts remain HCV RNA positive | 60-80% have persistent liver enzyme elevation.

Question 36

HCV Tx

Answer 36

Peginterferon | Ribavirin

Question 37

HDV

Answer 37

Required HBV for replication Parenteral, close contact transmission Low risk of chronic infxn High risk of superinfection

Question 38

HEV

Answer 38

Waterbourne RNA virus No chronic form Spread by fecally contaminated water

Question 39

HGV

Answer 39

Does not cause hepatitis in humans. | Protective in HIV patients

Question 40

Cirrhosis

Answer 40

Development of fibrosis of liver Nodules Impairment of function

Question 41

Tx of hepatic encephelopathy

Answer 41

Lower ammonia levels by: Lactulose Enemas