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Gastroenterology > Hepatology & Biliary Tree Disease > Flashcards

Hepatology & Biliary Tree Disease Flashcards

1
Q

Which test confirms an active hepatitis A infection?

A

anti-HAV IgM

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2
Q

What investigation demonstrates a patient has been immunized against HBV?

A

HBV sAb

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3
Q

Which HBV serology indicates that a patient is immune due to previous infection/exposure?

A

HBV sAb +
HBV Core IgG + (IgM -)
HBV eAb +

All other serology negative.

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4
Q

What HBV serological indicates on acute infection?

A

HBV sAg +
HBV IgM +
HBV eAg +
HBV DNA +

Otherwise negative

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5
Q

What HBV serology indicates chronic hepatitis B infection?

A

HBV sAg +
HBV Core IgG +
HBV DNA +

Variable HBV eAg & HBV eAb

Otherwise negative.

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6
Q

What is the treatment for an acute hepatitis B infection?

A
  • Supportive for patient
  • Ensure household and sexual contacts are immune -> provide hepatitis B immune globulin and hepatitis B vaccine if they are not immune
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7
Q

Which patients with chronic hepatitis B infection need to be screened every 6 months for HCC?

A 
Asian M > 40 or Asian F > 50
African > 20
All Cirrhotics
Family Hx HCC (Start at age 40)
All HIV co-infected patients (Start at 40)
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8
Q

Which patients with chronic HBV do you treat?

A 
Cirrhosis
Extra-Hepatic Manifestations
HBeAg + w/increased ALT & DNA > 20000
HBeAg - w/increased ALT & DNA > 2000
Pregnancy - to prevent fetal transmission
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9
Q

What is the 1st line treatment for HBV infection?

A

1st Line: Nucleotide Analogues (tenofovir, enter air, lamivudine)

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10
Q

List 3 extra-hepatic manifestations of HBV infection.

A

Vasculitis - Polyarteritis Nodosa
Renal - Membranous Nephropathy > MPGN
Heme - Aplastic Anemia

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11
Q

Who should you treat for HCV?

A

ALL patients except those with short life expectancy owning to comorbidities.

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12
Q

What are the extra intestinal manifestations of HCV?

A

Autoimmune - thyroid, myasthenia, sjogren’s
Renal - MPGN > MN
Derm - Porphyria cutanea tarda, leukocytoclastic vasculitis, lichen planus
Heme - cryoglobulinemia, lymphoma, autoimmune hemolytic anemia, ITP

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13
Q

How do you use the Maddrey discriminate function score?

A

< 32 - No role for steroids in alcoholic hepatitis

> or = 32 - Prednislone 40 mg PO daily x 28 days

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14
Q

What are the contraindications to prednisolone in alcoholic hepatitis (4)?

A

Infection — SBP, active HBV, TB +/- HCV
Active GI Bleeding (relative)
Multi organ failure/shock
AKI with Cr > 221 mmol/L

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15
Q

When should a liver transplant be considered for hepatic failure?

A

Refer if MELD > or = 21 OR if Child-Pugh C liver cirrhosis.

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16
Q

How is the Lille score utilized in alcoholic hepatitis?

A

Calculate the Lille Score on Day 7 of prednisolone:
> 0.45 —> not responding, stop steroids
< 0.45 —> responding, continue to complete a 28 day course.

17
Q

What is the most common cause of death in NAFLD?

A

Cardiovascular Causes

18
Q

What is the recommended non-pharmacological treatment for NAFLD?

A

Weight loss: > or = 3.5 % loss of MW improves steatosis, > or = 7-10% to improve fibrosis.
Dietary Changes
Moderate Intensity Exercise

19
Q

In which patients with NAFLD would you use pharmacotherapy? What medications can you use?

A

Pioglitazone (thiazolidinedione) and vitamin E can be used to treat BIOPSY PROVEN NASH and fibrosis only.

20
Q

What are the components of the Child Pugh score?

A

Ascites - Absent (0); Slight (1); Mod (2)
Bilirubin - < 34.2 (0); 34.2-51.3 (1); > 51.3 (2)
INR - < 1.7 (0); 1.7-2.2 (1); > 2.2
Albumin - > 35 (0); 28-35 (1); < 28 (2)
Encephalopathy - None (0); Gr 1-2 (1); Gr 3-4 (2)

21
Q

If a patient with cirrhosis has NO esophageal varices, how often do you screen them?

A

Compensated - EGD Q2-3 years

Decompensated - EGD at the time of decompensation & then Q1 year

22
Q

If a patient with cirrhosis has small, low risk varices, how often do you screen the with repeat EGD?

A

EGD q1-2 years

23
Q

When do you water restrict patients with cirrhosis and fluid overload/ascites?

A

When their sodium is < 125

24
Q

What is the most common compound heterozygote that may result in hemochromatosis?

A

C282Y/H63D

25
Q

What infections are patients with hemochromatosis at increased risk for?

A

Yersinia enterocolitica
Vibrio vulnificus (avoid shellfish)
Listeria monocytogenes

26
Q

When should you perform genetic testing for hemochromatosis?

A

Transferrin saturation > 45%
AND/OR
Ferritin > 300 in M
Ferritin > 200 in F

27
Q

What is the first line treatment in hemochromatosis?

A

Phlebotomy to target ferritin 50-100

28
Q

What are the second line agents to treat hemochromatosis?

A

Chelation agents

29
Q

What vitamin do you need to avoid in hemochromatosis and why?

A

Avoid vitamin C supplements (excess) because it increases iron absorption.

30
Q

What is the definition of SBP?

A

Neutrophils in ascitic fluid > 250 OR culture positive ascitic fluid.

31
Q

What is the treatment for confirmed SBP?

A 
Ceftriaxone (or Fluoroquinolone if allergy) x 5 days
WITH
Day 1: Albumin 1.5 g/kg
Day 3: Albumin 1 g/kg
IF Cr > 88, BUN > 10.7 OR bilirubin > 68
32
Q

Which patients require prophylaxis for SBP?

A
  1. Patients who have previously had SBP
  2. Patients with cirrhosis who present with GI bleeding, regardless of whether they have ascites.
  3. Cirrhotic patients with ascitic fluid protein < 15 g/L AND at least one of:
    - impaired renal function (Cr > 106, BUN > 8.9, Na < 130)
    - impaired liver function (CP > or = 9 AND bilirubin > 51)
33
Q

What is the definition for acute pancreatitis?

A

Need at least 2/3 criteria for diagnosis:

  1. Consistent abdominal pain
  2. Lipase and/or analyses > 3x ULN
  3. Characteristic findings on imaging.
34
Q

What antibiotics would you use to treat complicated pancreatitis?

A

Carbapenem OR

Quinolone + metronidazole

35
Q

What is the treatment for hepatorenal syndrome?

A

Albumin 1g/kg/day
Midodrine 7.5-12.5 mg PO TID
Octreotide 100-200 ug SC TID

OR

Terlipressin + albumin

36
Q

When should you suspect hepatopulmonary syndrome?

A

If ABG reveals PaO2 < 80 & and A-a gradient > or = 15

37
Q

What workup should you consider if a patient has a PVT or MVT?

A

Consider thombophilia workup and JAK2 testing if:

(1) No hx of cirrhosis
(2) Prior hx of thrombosis
(3) unusual site of thrombosis (hepatic veins)
(4) family hx of thrombosis

38
Q

When should you anticoagulation a patient with NO cirrhosis and a chronic PVT/MVT?

A

Anticoagulate if:

(1) Thrombophilia
(2) Progression of clot into mesenteric veins
(3) Bowel ischemia

Gastroenterology (4 decks)

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