Hepatitis causes, presentation, and labs

Question 1

What are the causes of hepatitis

Answer 1

1. Viruses
2. Alcohol
3. Drugs
4. poisons
5. idiopathic
   6 autoimmune related

Question 2

Viruses that cause hepatitis

Answer 2

1. hepatitis A, B, D, C, E, G
2. Epstein-barr
3. cytomegalovirus
4. rubella
5. Herpes simplex

Question 3

Drugs that are potential causes of hepatitis

Answer 3

1. some OTCs
2. prescription medications
3. steroids
4. anesthetics

Question 4

Autoimmune issues that are potential causes of hepatitis

Answer 4

1. common in lupus patients

2. more common in women than men

Question 5

Natural history of acute viral hepatitis that leads to recovery

Answer 5

1. acute illness leading to recovery
2. can be clinical or subclinical
3. recovery and immunity

Question 6

Natural history of acute viral hepatitis that leads to chronic infection

Answer 6

1. no recovery
2. clinical or subclinical illness
3. continued viral activity and related complications

Question 7

HPI for acute viral hepatitis: general symptoms

Answer 7

1. Fatigue
2. fever
3. arthralgia
4. myalgia

Question 8

HPI for acute viral hepatitis: skin symptoms

Answer 8

1. rash

2. pruritis

Question 9

HPI for acute viral hepatitis: HEENT

Answer 9

jaundice

Question 10

HPI for acute viral hepatitis: GI

Answer 10

1. abdominal pain
2. anorexia
3. Nausea/vomiting

Question 11

Past medical history for acute viral hepatitis

Answer 11

1. medications
2. alcohol/tobacco use
3. occupational risks
4. high-risk sexual activity
5. sick contacts
6. travel
7. Poisoning

Question 12

Focused PE for acute viral hepatitis

Answer 12

1. Vital signs
2. skin
3. HEENT
4. Cardiac/respiratory
5. abdomen
6. Neuro

Question 13

HPI for chronic hepatitis infection

Answer 13

asymptomatic until advanced disease or other events such as coinfections trigger consideration of viral hepatitis;
highly variable course

Question 14

Past medical history for chronic hepatitis infection

Answer 14

1. same as acute with high risk sexual activity, sick household contacts, etc.
2. injection-drug use;
3. tattooing
4. immigration
5. incarceration/group home placement
6. day care
7. piercing

Question 15

focused PE for chronic hepatitis infection

Answer 15

1. Vital signs
2. skin
3. HEENT
4. cardiac/respiratory
5. abdomen
6. neuro

Question 16

ALT {SGPT} transaminases

Answer 16

1. leaked into serum via damage to ALT-rich tissues or changes in cell membrane permeability

Question 17

ALT {SGPT} transaminase is most sensitive and specific marker for

Answer 17

viral liver infections;

it “tells all”

Question 18

AST {SGOT}

Answer 18

1. found in highly metabolic tissue such as heart, liver;

2. elevated in hepatitis

Question 19

Elevated ALT {SGPT} differentials

Answer 19

1. fatty liver
2. alcoholic liver
3. drug/chemical toxicity
4. hemachromatosis

Question 20

Elevated AST {SGOT} differentials

Answer 20

1. MI
2. acute pancreatitis
3. musculoskeletal trauma
4. acute hemolytic anemia
5. severe burns

Question 21

What is the characteristic transaminase pattern in viral hepatitis

Answer 21

ALT and AST 5-8 times the upper lift of normal

Question 22

AST 2 times ALT can indicate what

Answer 22

1. alcoholic hepatitis
2. alcoholic cirrhosis
3. liver congestion
4. liver mets

Question 23

what is alkaline phosphatase

Answer 23

enzyme in cells lining liver, biliary tract, and bone

Question 24

differential diagnosis for elevated alkaline phosphatas

Answer 24

1. vitamin D deficiency
2. mets/neoplastic disease
3. cholestasis
4. infiltrative liver disease {tumors. abscesses}
5. granuloma

Question 25

How do you determine if elevated alkaline phosphatase is because bone or liver

Answer 25

isoenzymes

Question 26

Bilirubin

Answer 26

by-product of RBC recycling

Question 27

Bilirubin is produced by

Answer 27

1. liver 2. spleen 3. bone marrow

Question 28

indirect bilirubin

Answer 28

unconjugated in the spleen

Question 29

direct bilirubin

Answer 29

conjugated in the liver, travels to bowel through the bile ducts

Question 30

elevated indirect {unconjugated} bilirubin

Answer 30

hemolysis

Question 31

elevated direct {conjugated} bilirubin

Answer 31

1. hepatic dysfunction 2. viral hepatitis 3. obstruction of bile flow by stones, tumors, etc.

Question 32

lactic dehydrogenase {LDH} is found in

Answer 32

1. liver 2. heart 3. kidney 4. muscle

Question 33

lactic dehydrogenase {LDH} source is differentiated by

Answer 33

isoenzymes

Question 34

lactic dehydrogenase {LDH} elevation differentials

Answer 34

1. MI 2. hemolytic anemias 3. tumors

Question 35

LFTs with acute viral hepatitis

Answer 35

1. AST: prejaundice increase up to several thousand units not prognostic 2. ALT: later increase up to several thousand units; not prognostic; 3. ALP, LDH elevated but specifics require isoenzymes

Question 36

Bilirubin with acute viral hepatitis

Answer 36

increased

Question 37

CBC with acute viral hepatitis

Answer 37

1. low total WBC, leukopenia; 2. low polys, bands: bandemia 3. high lymps: lymphocytosis

Question 38

H/H with acute viral hepatitis

Answer 38

mild anemia

Question 39

Albumin with acute viral hepatitis

Answer 39

high or low

Question 40

Prothrombin time with acute viral hepatitis

Answer 40

high or low; prolonged duration indicates impending liver failure; need to test for specific viral markers

Question 41

IgD results from and relates to

Answer 41

B lymphocyte differentiation and relates to antigen receptors

Question 42

IgM aids

Answer 42

early immune response and activates complement

Question 43

IgG acts as

Answer 43

primary, long-term antibody against viruses/bacteria, fixes complement