Hepatitis and Cirrhosis CIS - Unrein Flashcards Preview

Year2 GI Exam II > Hepatitis and Cirrhosis CIS - Unrein > Flashcards

Flashcards in Hepatitis and Cirrhosis CIS - Unrein Deck (62):
1

Case 21yo F jaundice, icterus, resting tremor

dark circles irises of eyes

AST and ALT elevated
bilirubin elevated

wilsons disease

2

primary biliary cirrhosis

middle aged females

anti-mitochondrial antibody**

alk phos and cholesterol elevated

3

anti-mito Ab

primary biliary cirrhosis

4

primary sclerosing cholangitis

males age 20-50yo
with ulcerative colitis

5

wilsons disease

auto recessive
kayser fleischer rings
parkinson like tremor
alk phos low

6

Hep A

fecal oral

7

Hep B

blood, body fluid, tissue

8

test for wilsons disease

best test - 24 hour urine copper**

ceruloplasmin - acute phase reactant - so not specific

9

55yo M abdominal ascites, edema, jaundice
-US - small nodular liver
-EKG cardiomyopathy
-IV drug use
-heavy alcohol
-AST ALT elevated slightly
-INR elevated

-HBsAg - positive
-Anti-HBs - negative
-Anti-HBc - positive
-ANti-HBe - positive
-Anti-HCV - negative

ascites total protein high
SAAG low

Metastatic hepatocellular cancer**

serum albumin gradient

10

serum ascitic albumin gradient

SAAG
serum albumin - ascites albumin

correlates with sinusoidal pressure and is function of oncotic-hydrostatic balance

cirrhosis - high SAAG high ascites total protein low

malignant ascites - SAAG low ascites total protein high

cardiac ascites - SAAG high and ascites total protein high

11

SAAG low
ascites total protein high

malignant ascites

12

SAAG high
ascites total protein low

cirrhosis

13

SAAG high
ascites total protein high

cardiac ascites

14

52yo F 6 pack beer per day, injection narcotics, no jaundice, no abdomen pain

nodular liver edge and palpable spleen tip

AST and ALT elevated
alk phos elevated
anti smooth m Ab - 1:640

autoimmune hepatitis

15

autoimmune hepatitis

diagnosis of exclusion
-rule out viral hepatitis

fulminant liver enzyme elevation

perimenopausal women

16

anti smooth m Ab

autoimmune hepatitis

17

case 18yo F jaundice and icterus, no vaccines, IV injection

diarrhea after eating - cafeteria lady Hep A

ALT AST very elevated
total bilirubin elevated

Anti HepA - positive
HBsAg - positive (active disease)
Anti-HBsAg - negative
IgM Anti-HBc - positive (acute) - chronic is IgG
HCV RNA - negative
Anti-HDV - positive

18

HBsAg

peak of Hep B disease

19

Anti-HBsAg

doesn't rise until illness is over

20

Anti-HBc IgM

just before onset of symptoms

21

HCV RNA

detectable 1-3 weeks after infection

unless this persists as chronic infection

22

Hep D

super infection in chronic carrier state or co-infection with Hep B

surface Ag of Hep B required for Hep D to replicate

23

25yo F itching bad, 27 weeks pregnant, prenatal vits, icteric eyes

Alk phos elevated
bilirubin elevated

intrahepatic cholestasis of pregnancy

24

intraheptic cholestasis of pregnancy

2nd or 3rd trimester

mild elevation of bilirubin and alk phos

25

hyperemesis gravidarum

unrelenting nausea and vomiting that is 1st trimester disorder

resolved by week 16

elevated transaminases

no itching or cholestasis

26

HELLP

hemolysis, elevated liver enzymes, low platelets

left threatening complication of pregnancy in 3rd trimester and requires urgent delivery

27

acute fatty liver of pregnancy

leads to liver failure with elevated transaminaseas and abnormal INR

28

Case 35yo M pruritis, RUQ pain, ulcerative colitis, prednisone tx

AST Alt elevated
Alk phos very elevated

perinuclear antineutrophlic cytoplasmic Ab - 1:1280

primary sclerosing cholangitis

29

hemochromatosis

iron overload state with elevated transferrin

hyperpigmentation**

30

acute cholecystitis

acute symptoms with eating fatty meal and females of late repro age who are overweight

5 Fs

31

diagnostic test of choice for PSC

ERCP
-endoscopic retrograde cholangiopancreatography

dye lights up the biliary tree

arborization of the biliary tree**

32

32yo M jaundice and icterus, Hep B and Hep A vaccines

needle stick from jaundice patient
6 beers / weekends
acetaminophen 2x daily

AST and ALT elevated
bilirubin elevated

Anti-HAV titer 1:640
HBsAg negative
Anti-HBs - titer 1:640
Anti-HBc - negative
Anti-HCV - Titer 1:640

Hep C

33

1:640 titer

is a pretty strong response

based on dilution

34

Hep A vaccine

offers lifelong immunity

fecal oral transmission

35

Hep B

pt will have anti-HBs antigen

chronic Hep B - HBsAg positive

HBeAg - indicates ongoing replication

36

49yo F increased skin pigmentation, RUQ pain, increased urination
-12 beers weekends
-irregular pulse

ALT and AST elevated
alk phos elevated
ceruloplasmain normal

hemochromatosis

**pigmentation

irregular pulse - conduction abnormality in heart

37

increased fluid intake and urinating more

diabetic

38

polyphagia, polydypsia, polyuria

diabetic

39

diabetic and hemochromatosis

iron deposit in pancreas - destruction

40

diagnosis of hemochromatosis

transferrin saturation

ferritin - acute phase reactant - not specific

41

tx of hemochromatosis

blood donation

42

Case 39yo M malaise, jaundice, hepatomegaly
-obese
-alcohol use
-polyuria and polydipsia
-hypercholesterol
-fatty liver

acetaminophen 650mg/day

AST and ALT elevated

gamma-glutamyl transferase elevated

bilirubin elevated

Anti-HBs positive

tx - weight loss and blood glucose control

GGT - specific for liver**

non-alcoholic alcoholic steatohepatitis

43

ledipasvir/sofosbuvir

new tx for Hep C

very expensive**

44

entecavir

tx for Hep B

45

Case 30yo M jaundice, icterus, RUQ pain, crohns, Hep B vaccine
-INH prophylaxis - PPD skin test positive

ALT and AST elevated
bilirubin elevated

Anti-HBs - positive

INH toxicity

46

co-infection

hep D on top of chronic hep B carrier

47

superinfection

get both hep B and D same time

-more rare than co-infection

48

Case 48yo F HTN control, elevated AST and ALT

IgM Anti-HBc - positive

if Anti-HBs positive in 3 months - indicates acute infection

in window period

49

most sensitive marker for acute Hep B

anti-HBc IgM

50

chronic Hep B

HBsAg

51

Hep D

requires presence of HBsAg

52

Case 64yo M confusion, icterus, jaundice, hepatomegaly, flapping tremor, handle of whiskey a day

US - fatty liver
ALT AST elevated
GGT elevated
bilirubin elevated
ammonia elevated

etiology of confusion and hepatic abnormalities
-ethanol

neuro sx - ammonia

tx - laculose

53

AST > ALT by 2x

alcohol

also - GGT elevation disproportionately

54

flapping tremor

asterixis

with alcoholics

55

lactulose

tx of delirium due to high ammonia

transform the freely diffusible ammonia into ammonium (NH4+) which can no longer diffuse back into the blood

56

Case 52yo F alcoholic liver disease and Hep B
-sudden increase abdominal girth and pain

-mild BUN and Cr elevated
-AST ALT elevated
-alk phos elevated
-bilirubin elevated
-Anti-HBs - positive

spontaneous bacterial peritonitis

tx - drain - and antibiotics

57

spontaneous bacterial peritonitis

no specific criteria

high index of suspicion ket to early diagnosis

58

hepatorenal syndrome

decomposition of kidneys

activation of RAAS and renal vasoconstriction as result of systemic vasodilation

59

reactivation Hep B

HBsAg positive
anti-HBc IgM negative
HBeAg may be positive

60

Case 40yo F sudden jaundice, icterus, RUQ, palpable liver edge
-IV drug use

-AST ALT elevated
-bilirubin elevated
-Anti-HBs - positive
-Anti-HCV - positive
-HCV-RNA - positive

chronic hep C infection with acute activation

61

Case 56yo M chronic hep B, new abdomen pain, fever, ascites, no jaundice

US - hepatomegaly and portal vein thrombosis

hepatocellular carcinoma

all malignancies - hypercoagulable - portal vein thrombosis

62

all cancer patients

hypercoagulable