Hepatitis/Liver disease Flashcards
(63 cards)
What AST: ALT ratio is suggestive of alcholic liver disease
AST:ALT ratio > 2
ALT > AST is usually suggestive of what conditions
- NASH
- Acute or chronic viral hepatitis
cholestatic diseases is evident by what elevated labs
- Alk phos
- GGT
What pathology is characteristic of non-alcoholic steatohepatitis (NASH). how is it diagnosed?
- fatty liver with inflammation of liver + hepatocyte injury
- biopsy
in order for patient to be diagnosed with non-alcoholic fatty liver disease, what threshold of alcohol consumption must they be drinking under
- < 20 g ETOH/ day (less than 2 drinks per day)
non-alcoholic fatty liver (NAFL) is characterized by what pathology
- fatty liver without injury of hepatocyctes on liver bx
which has a higher risk of progression to cirrhosis: non-alcoholic fatty liver (NAFL) or non-alcholic steatohepatitis (NASH)
- NASH
- risk of progression of fibrosis, cirrhosis, liver failure and liver cancer is higher
List the risk factors for nonalcoholic fatty liver disease
- metabolic syndrome : strongest predictor
- abd obesity
- hyperlipidemia
- DM (insulin resistence)
how is NASH diagnosed
- liver biopsy is gold standard
- shows steatosis (fat accumulation) and inflammation
PCP managment for NASH
- exercise, weight loss
- control DM and hyperlipidemia
- discontinue ALL ETOH
- vaccine for hep A and B if not immune
What is hereditary hemochromatosis? where are the areas of accumulation?
- hereditary disorder of iron metabolism
- increased GI absorption of iron
- iron accumulates
- liver
- pancreas
- heart
- adrenals
- testes
- pituitary
- kidney
What is bronze diabetes and what is it associated with
- hereditary hemochromatosis
- triad of DM, bronze pigmentation of skin, cirrhosis
If you suspect hereditary hemochromatosis, you would screen with a serum Fe, TIBC, and Ferritin. What results would you expect?
- Fe/TIBC = transferrin saturation (TS)
- TS > or = 45 and/or
- ferritin > 250 in men, > 200 in women
If transferrin saturation and ferritin levels are consistent with hereditary hemochromatosis, what is the next lab you should order? how is diagnosis confirmed
-
HFE mutation analysis
- HFE = hereditary hemochromatosis
- Dx: genetitic testing +/- liver biopsy
what is the goal of tx for hereditary hemochromatosis
- prevent cirrhosis from iron overload
- avoid vit C and iron supplements
- avoid ETOH
- regulary phlebotomy
What is Wilson’s disease
- hereditary disorder of copper metabolism
- autosomal recessive
- results in accumulation of copper in liver
- once liver’s capacity for copper is exceeded, copper is released into bloodstream -> accumulates in brain, cornea, joints, kidney, heart, pancreas
clinical manifestations of wilson’s disease usually affect what 3 areas
- hepatic
- neurologic
- psychiatric
Kayser-Fleischer ring (brown ring around iris) is pathognomonic for
wilson’s disease
if you suspect wilson’s disease, initially screen should include what
-
serum ceruloplasmin
- the plasma copper-carrying protein is low
- < 5 ug/dl is strong evidence for WD
What disease should you expect in a patient with COPD/emphysema at a young age (30s-40s) or unexplained chronic liver disease
alpha-1 antitrypsin deficiency
what specialized testing is available for alpha-1 antitrypsin deficiency
- serum a-1 antitrypsin (decreased)
- a-1 antitrypsin phenotype
List the lab tests you should order if you suspect autoimmune hepatitis
- antinuclear antibodies (ANA)
- anti-smooth muscle antibodies (ASMA)
- liver kidney microsomial antibody (LKMA)
- antibody to liver cytosol (LKC-1)
- IgG
What do you expect AST and ALT to be in autoimmune hepatitis
7-10 x the ULN
management of autoimmune hepatitis is initiated by gastroenterologist/hepatologist, but what is the medication that patient will likely be put on
- prednisone + azothioprine
