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

Hepatitis and Cirrhosis CIS - Unrein Flashcards

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1
Q

Case 21yo F jaundice, icterus, resting tremor

dark circles irises of eyes

AST and ALT elevated
bilirubin elevated

A

wilsons disease

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2
Q

primary biliary cirrhosis

A

middle aged females

anti-mitochondrial antibody**

alk phos and cholesterol elevated

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3
Q

anti-mito Ab

A

primary biliary cirrhosis

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4
Q

primary sclerosing cholangitis

A

males age 20-50yo

with ulcerative colitis

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5
Q

wilsons disease

A

auto recessive
kayser fleischer rings
parkinson like tremor
alk phos low

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6
Q

Hep A

A

fecal oral

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7
Q

Hep B

A

blood, body fluid, tissue

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8
Q

test for wilsons disease

A

best test - 24 hour urine copper**

ceruloplasmin - acute phase reactant - so not specific

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9
Q

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

A

Metastatic hepatocellular cancer**

serum albumin gradient

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10
Q

serum ascitic albumin gradient

A

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

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11
Q

SAAG low

ascites total protein high

A

malignant ascites

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12
Q

SAAG high

ascites total protein low

A

cirrhosis

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13
Q

SAAG high

ascites total protein high

A

cardiac ascites

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14
Q

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

A

autoimmune hepatitis

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15
Q

autoimmune hepatitis

A

diagnosis of exclusion
-rule out viral hepatitis

fulminant liver enzyme elevation

perimenopausal women

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16
Q

anti smooth m Ab

A

autoimmune hepatitis

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17
Q

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

diarrhea after eating - cafeteria lady Hep A

ALT AST very elevated
total bilirubin elevated

A 
Anti HepA - positive
HBsAg - positive (active disease)
Anti-HBsAg - negative
IgM Anti-HBc - positive (acute) - chronic is IgG
HCV RNA - negative
Anti-HDV - positive
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18
Q

HBsAg

A

peak of Hep B disease

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19
Q

Anti-HBsAg

A

doesn’t rise until illness is over

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20
Q

Anti-HBc IgM

A

just before onset of symptoms

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21
Q

HCV RNA

A

detectable 1-3 weeks after infection

unless this persists as chronic infection

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22
Q

Hep D

A

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

surface Ag of Hep B required for Hep D to replicate

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23
Q

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

Alk phos elevated
bilirubin elevated

A

intrahepatic cholestasis of pregnancy

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24
Q

intraheptic cholestasis of pregnancy

A

2nd or 3rd trimester

mild elevation of bilirubin and alk phos

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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

Year2 GI Exam II (18 decks)

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