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clin med III, exam 2 > Hepatitis/Liver disease > Flashcards

Hepatitis/Liver disease Flashcards

1
Q

What AST: ALT ratio is suggestive of alcholic liver disease

A

AST:ALT ratio > 2

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2
Q

ALT > AST is usually suggestive of what conditions

A
  • NASH
  • Acute or chronic viral hepatitis
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3
Q

cholestatic diseases is evident by what elevated labs

A
  • Alk phos
  • GGT
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4
Q

What pathology is characteristic of non-alcoholic steatohepatitis (NASH). how is it diagnosed?

A
  • fatty liver with inflammation of liver + hepatocyte injury
  • biopsy
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5
Q

in order for patient to be diagnosed with non-alcoholic fatty liver disease, what threshold of alcohol consumption must they be drinking under

A
  • < 20 g ETOH/ day (less than 2 drinks per day)
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6
Q

non-alcoholic fatty liver (NAFL) is characterized by what pathology

A
  • fatty liver without injury of hepatocyctes on liver bx
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7
Q

which has a higher risk of progression to cirrhosis: non-alcoholic fatty liver (NAFL) or non-alcholic steatohepatitis (NASH)

A
  • NASH
    • risk of progression of fibrosis, cirrhosis, liver failure and liver cancer is higher
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8
Q

List the risk factors for nonalcoholic fatty liver disease

A
  • metabolic syndrome : strongest predictor
  • abd obesity
  • hyperlipidemia
  • DM (insulin resistence)
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9
Q

how is NASH diagnosed

A
  • liver biopsy is gold standard
    • shows steatosis (fat accumulation) and inflammation
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10
Q

PCP managment for NASH

A
  • exercise, weight loss
  • control DM and hyperlipidemia
  • discontinue ALL ETOH
  • vaccine for hep A and B if not immune
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11
Q

What is hereditary hemochromatosis? where are the areas of accumulation?

A
  • hereditary disorder of iron metabolism
    • increased GI absorption of iron
    • iron accumulates
      • liver
      • pancreas
      • heart
      • adrenals
      • testes
      • pituitary
      • kidney
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12
Q

What is bronze diabetes and what is it associated with

A
  • hereditary hemochromatosis
  • triad of DM, bronze pigmentation of skin, cirrhosis
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13
Q

If you suspect hereditary hemochromatosis, you would screen with a serum Fe, TIBC, and Ferritin. What results would you expect?

A
  • Fe/TIBC = transferrin saturation (TS)
    • TS > or = 45 and/or
    • ferritin > 250 in men, > 200 in women
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14
Q

If transferrin saturation and ferritin levels are consistent with hereditary hemochromatosis, what is the next lab you should order? how is diagnosis confirmed

A
  • HFE mutation analysis
    • ​HFE = hereditary hemochromatosis
  • Dx: genetitic testing +/- liver biopsy
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15
Q

what is the goal of tx for hereditary hemochromatosis

A
  • prevent cirrhosis from iron overload
    • avoid vit C and iron supplements
    • avoid ETOH
    • regulary phlebotomy
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16
Q

What is Wilson’s disease

A
  • 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
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17
Q

clinical manifestations of wilson’s disease usually affect what 3 areas

A
  • hepatic
  • neurologic
  • psychiatric
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18
Q

Kayser-Fleischer ring (brown ring around iris) is pathognomonic for

A

wilson’s disease

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19
Q

if you suspect wilson’s disease, initially screen should include what

A
  • serum ceruloplasmin
    • ​the plasma copper-carrying protein is low
    • < 5 ug/dl is strong evidence for WD
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20
Q

What disease should you expect in a patient with COPD/emphysema at a young age (30s-40s) or unexplained chronic liver disease

A

alpha-1 antitrypsin deficiency

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21
Q

what specialized testing is available for alpha-1 antitrypsin deficiency

A
  • serum a-1 antitrypsin (decreased)
  • a-1 antitrypsin phenotype
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22
Q

List the lab tests you should order if you suspect autoimmune hepatitis

A
  • antinuclear antibodies (ANA)
  • anti-smooth muscle antibodies (ASMA)
  • liver kidney microsomial antibody (LKMA)
  • antibody to liver cytosol (LKC-1)
  • IgG
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23
Q

What do you expect AST and ALT to be in autoimmune hepatitis

A

7-10 x the ULN

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24
Q

management of autoimmune hepatitis is initiated by gastroenterologist/hepatologist, but what is the medication that patient will likely be put on

A
  • prednisone + azothioprine
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25
Q

Which types of viral hepatitis can only present acutely

A
  • A, E
  • only AcuteE
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26
Q

Which types of viral hepatitis are transmitted fecal-oral

A
  • A,E
  • fEcal-orAl
27
Q

Which types of viral hepatitis are you able to get a vaccine for

A
  • A,B
  • ABle to get vacine
28
Q

Which types of viral hepatitis is dependent on hep B

A

hepatitis D is dependent on hep B

29
Q

Which types of viral hepatitis is fatal in pregnancy

A
  • hepatitis E can be fatal in PrEgnancEE
30
Q

high endemic areas of acute hepatitis A

A
  • Asia
  • Africa
31
Q

incubation period for hepatitis A

A

2-7 weeks

32
Q

What is the prodrome and icteric phase of hepatitis A

A
  • prodrome: flu-like illness
  • icteric phase:
    • jaundice, dark urine, pruritus, light colored stool
33
Q

What lab tests should you order in assesment of hepatitis A

A
  • elevated
    • AST, ALT
    • biliruben
    • ALP
  • IgM anti-HAV and IgG anti-HAv
34
Q

what lab is consistent with acute infection of hepatitis A? what lab implies immunity?

A
  • IgM anti-HAV -> acute infection
  • IgG anti-HAV -> immunity
35
Q

what post-exposure prophylaxis is available for hepatitis A

A
  • healthy, 12 months - 40 yo
    • vaccinate within 2 weeks of exposure
  • out of this range?
    • give immune globulin (IG)
36
Q

how is Hepatitis B transmitted

A
  • blood/blood derived body fluids
    • blood
    • sexual contact
    • parenteral contact
    • perinatal: during delivery
37
Q

which viral hepatitis is the leading cause of cirrhosis and hepatocellular carcinoma worldwide

A

Hepatitis B

38
Q

A vaccine or infection with Hepatitis B will give what positive antibody test

A
  • antibody to surface antigen
    • anti-HBs
39
Q

An acute infection with Hepatitis B will lead to what positive antibody tests

A
  • antibody to hepatitis B core antigen
    • IgM anti-HBc
  • hepatitis B surface antigen (HBsAg)
40
Q

Most often, when does Hepatitis B become chronic

A
  • Hep B becomes chronic in immune compromised patients or if exposure is as an infant from mother to child
41
Q

What percetage of acute HBV infections become chronic

A

6-10%

42
Q

complications of chronic Hepatitis B

A
  • cirrhosis
  • Hepatocellular carcinoma (HCC)
43
Q

hepatitis B surface antigen (HBsAg) will be positive under what circumstances

A

(+) active disease (acute or chronic)

44
Q

Antibody to surface antigen (anti-HBs) will be positive under what circumstances

A
  • + immunity (vaccine or resolved infection)
45
Q

antibody to hepatitis B core antigen: IgM and IgG and total will be positive under what circumstances

A
  • (+) IgM anti-HBc -> acute exposure
  • (+) IgG anti-HBc and (+) Total anti-HBc-> previous exposure
46
Q

What is the first detectable marker of infection and is detectable in blood 1-9 weeks after exposure

A
  • hepatitis B surface antigen (HBsAg)
    • hallmark of active infection
47
Q

hepatitis B vaccine results in a positive

A

Antibody to surface antigen (anti-HBs/HBsAb)

  • signifies recovery and immunity with infection
48
Q

how long with IgM anti HBc persist in blood

A
  • 3-6 months
  • indicates acute or recent infection
49
Q

how long will IgG anti-HBc persist

A
  • persists indefinitely
  • indicates prior or resolving infections
50
Q

what is total anti-HBc

A

IgM antibody + IgG antibody

51
Q

What is the new Hepatitis B e-antigen (HBeAg) and indicator of

A
  • index of infectivity
    • ​marker of replication
  • associated with higher levels of HBV DNA
52
Q

What is the new antibody to hepatitis B e-antigen (anti-HBe) and indicator of

A
  • indicates lower levels of HBV DNA
  • seroconversion from HBeAg positive to anti-HBe positive is a predictor of long term clearance of HBV
53
Q

How can you use labs to differentiate between a prior infection with resulting immunity with Hep B and a prior vaccination with resulting immunity

A
  • prior infection
    • hep B surface antibody (anti-HBs) (+)
    • Hep B core antibody IgG (anti-HBc igG) positive
  • prior vaccination
    • hep B surface antibody (anti-HBs) (+)
    • Hep B core antibody IgG (anti-HBc igG) negative
54
Q

what is important for you to remember as PCP in managment of Hepatitis B

A
  • vaccinate for Hep A
  • HCC surveillance
    • even in pts without cirrhosis
  • monitor for signs of cirrhosis
55
Q

CDC screening recommendations for hep B

A
  • everyone < or = 18 yo
  • adults over 18 who are at risk
56
Q

Hepatitis B and Hep C are what type of viruses

A
  • Hep B: DNA virus
  • Hep C: RNA virus
57
Q

how is Hepatitis C transmitted

A
  • blood/blood derived body fluids
    • IVDU
58
Q

what percentage of patients with Hepatitis C will develop a chronic infection

A

75-85%

59
Q

acute infection symptoms occur how long after exposure with hepatitis C? what percentage of patients experience symptoms?

A
  • 2-12 weeks
  • 70-85% cases are asymptomatic
60
Q

What testing is done in evaluation of hepatitis C

A
  1. antibody to hepatitis C (anti-HCV) = initial screening test
    • (+) indicates current infection or past exposure
    • if (+) then order HCV RNA
  2. (+) HCV RNA confirms presence of active HCV
61
Q

What must be present in order for a patient to be infected with Hepatitis D

A
  • seen only in conjunction with hepatitis B
62
Q

how is Hepatitis D diagnosed

A
  • delta virus RNA with + HBsAg
63
Q

how is hepatitis E diagnosed

A

Hepatitis E RNA

clin med III, exam 2 (6 decks)

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