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GI Week 4 > Lecture 36: Acute and Chronic Hepatitis > Flashcards

Lecture 36: Acute and Chronic Hepatitis Flashcards

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1
Q

What are the characteristics of hepatitis A?

A

Most common cause of viral hepatitis world wide
Acute infection ONLY
Absorbed in the intestine and replicates n hepatocyte
Transmitted fecal-oral

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2
Q

How many people in world have hepatitis B?

A

5% in the world, over 300 million

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3
Q

If you get infected by hepatitis B as an ADULT, how many go to chronic cases?

A

Only 5%

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4
Q

If you get infected by hepatitis B as a CHILD, how many go on to chronic cases?

A

Over 90%!!

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5
Q

What percentage of infants/children who are NEWLY infected with HBV go on to chronic cases?

A

90%!!

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6
Q

What percentage of adults who are NEWLY infected with HBV go on to chronic cases?

A

5%!!

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7
Q

If someone has chronic HBV, they most likely contracted HBV when they were?

A 
A child (90% chance)
Rather than an adult (5%)
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8
Q

What is the serology for Acute HBV?

A

HbsAg +
HbsAb -
HbcoreAb + (IgM)

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9
Q

What is the serology for VACCINATED against HBV?

A

Everything negative EXCEPT for HepBsurfaceAb or HbsAb +

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10
Q

What does the presence of Hep B surface antibody mean?

A

It means that you are VACCINATED or CLEARED the infection

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11
Q

What is the serology for chronic HBV?

A

HBV DNA elevated

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12
Q

What is the treatment for hepatitis B?

A
  1. Tenofovir
  2. Entecavir
  3. Interferon
  4. Adefovir
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13
Q

What are the characteristics of Hepatitis D?

A

Aka the DELTA agent
It will NOT replicate UNLESS there is hepatitis B present
Coinfection with hepatitis B = 34% vs. 5% of fulminant liver failure

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14
Q

What is the relationship between hepatitis B and D?

A

You cant have hepatitis D without hepatitis B

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15
Q

How is HepD spread?

A

Percutaneous exposure

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16
Q

How many people have hepatitis C?

A

3-5 million Americans
1:33 americans between 1945-1965
Gotten through injecting drug use

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17
Q

How many people can CLEAR the hepatitis C infection acutely

A

Only 20%

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18
Q

What is decompensated liver disease?

A

When you have SIGNS AND SYMPTOMS of liver failure
The worse sequelae to cirrhosis
Liver disease in which the liver is damaged and not functioning normally
Compensated liver = you see no signs and symptoms of end stage liver disease

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19
Q

What is the treatment for HCV?

A

Interferon
Ribavirin
Telaprevir and Boceprevir

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20
Q

What is important to remember about hepatitis E?

A

Think about hepatitis E in pregnant women
21% chance of fulminant hepatits the further you are into pregnancy
Most patients clear HEV

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21
Q

What are the characteristics of Hepatitis E?

A

RNA virus
Most common cause of epidemic enterically transmitted hepatitis
Fecal-oral transmission

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22
Q

What is the treatment of HEV?

A

Ribavirin

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23
Q

What are the three types of autoimmune liver disease?

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A
  1. Autoimmune hepatitis
  2. Primary Biliary Cirrhosis
  3. Primary Sclerosing Cholangitis
24
Q

What is autoimmune hepatitis?

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A

Syndrome of progressive hepatitis characterized by loss of tolerance to hepatic autoantigens that results in

- hepatocellular necroinflammation
- Autoantibodies
- hypergammaglobulinemia and/or increased IgG
- non-pathognomic hstopathology
- responsiveness to immunosuppressive medications
25
What is the epidemiology of autoimmune hepatitis?
Uncommon cause F:M ratio = 4:1 Bimodal distribution = 10 years and 45 years of age 40% mortality in symptomatic patients
26
What is the clinical spectrum of autoimmune hepatitis?
1. acute hepatitis - 25-30%, younger, ICTERIC actue viral hepatitis 2. Asymptomatic - extraheaptic manifestaitons can present 3. Fulminant hepatic FAILURE - around 5%
27
What are the two types of autoimmune hepatitis (AIH)?
Type 1 Type 2 Type 3 (no autoantibodies associated with it, may be a null category)
28
What are types of antibodies associated with type1/2 AIH? Significance?
Type 1 = ANA and SLA Type 2 = LKM1 and SLA/LP Type 2 antibodies (LKMI and LA/LP) are MUCH MORE LIKELY to present with other autoimmune diseases
29
What is the treatment for autoimmune hepatitis?
1. Prednisone | 2. Azathioprine (immunomodulator, decreases DNA synthesis)
30
What are the characteristics of primary biliary cirrhosis?
1. Ongoing inflammatory destruction of the interlobular and septal bile ducts which leads to chronic cholestasis and biliary cirrhosis 2. triggered by autoantigens and can produce antibodies such as AMA 3. Misnomer because most patients don’t actually have cirrhosis 4. Antimitochondrial antibody (AMA), 90-95% of patients have a positive AMA 5. usually the CT or MRI is normal!
31
Why is Primary Biliary Cirrhosis a misnomer?
Because PATIENTS DON’T ACTUALLY HAVE CIRRHOSIS MOTHERFUCKER!!!
32
What is the antibody that is associated with PBC?
AntiMitochondrial Antibody AMA is present in 90-95% of all patients If you have AMA, it is A HIGH FUCKING RISK FACTOR for PBC So if you have AMA then you will eventually get PBC
33
What is the epidemiology of PBC?
F:M = 9:1 50 years agoe of onset Has elevated ALKALINE PHOSPHATASE
34
What are the signs and symptoms of PBC?
1. Fatigue 2. Pruritus 3. jaundice 4. HYPERpigmentation 5. hepato/splenomegaly 6. Xanthelasma 7. Sicca syndrome 8. Arthritis 9. Scleroderma AUTOIMMUNE SHIT 10. Lichen planus, discoid lupus, pemphigoid
35
What is Xanthelasma?
Sharply demarcated yellowish deposit of fat underneath the skin of the EYELIDS
36
What is the treatment of PBC?
1. Ursodiol | Assess for fat soluble vitamins and osteoporosis
37
What are the fat soluble vitamins? Significance?
A, D, E and K | Need to check for these deficiencies in folks with PBC
38
What are the characteristics primary sclerosing cholangitis?
1. Chronic Cholestatic liver disease of unknown etiology characterized by inflammation and fibrosis of the biliary tree 2. Mean age of onset = 40 3. M:F = 2:1 4. Associated with IBD, specifically UC 5. SCARY as fuck because it could lead to cholangiocarcinoma
39
How many people with primary sclerosing cholangitis have IBD?
``` 80%!!!! But people with IBD don’t have primary sclerosing cholangitis 5-7% of patients with UC have PSC 3% of patients with CD have PSC So not otherway around ```
40
What is the radiologic findngs for PSC?
Beads on a string | the lumen looks like it is squeezed at certain points
41
What is the risk of cholangiocarcionoma in PSC?
8-30% risk of cholangiocarcionma | CA19-9 is genetic marker
42
What is CA19-9?
A genetic marker for tumor | Specifically in cholangiocarcionoma from PSC
43
What are the histological features of PSC?
Onion skinning
44
What is the difference between AMA and p-ANCA? Difference between ANA?
Former is a genetic marker for PBC Latter is a genetic marker for PSC (don’t need to check to make definitive diagnosis) ANA = marker for LUPUS or SLE
45
What is DILI?
Drug-induced liver injury
46
What causes DILI?
1. acetaminophen | 2. Methotrexate (used for CD, if you remember…so if you are treating Crohns watch out for DILI)
47
What are the two types of agents that lead to DILI?
1. intrinsic -acetaminophen -methotrexate DOSE DEPENDENT 2. idiosyncratic -we didn’t expect it DOSE INDPENDENT
48
When you have pruritis, what kind of injury?
Cholestatic VS hepatocellular | More likely cholestatic
49
What is pruritus?
ITCHINESS MOTHERFUCKER
50
What is the most common cause of acute liver failure in the US?
Acetaminophen Causes hepatotoxicity in 10 grams (10,000 mg) And usually you are given 500 mg of acetaminophen in a pill Lower doses result in hepatotoxicity in patients who consume alcohol regularly
51
How does acetaminophen get metabolized?
1. Gets broken down by CYP2E1 to i. NAPQI ii. glucuronide iii. Sulfate 2. Once NAPQI is formed, it igets broken down by glutathione to Cyteine and Mercapturic Acid
52
How does alcohol combined with acetaminophen lead to toxicity?
Alcohol uses up glutathione, which is needed to breakdown NAPQI Lack of glutathione = increased NAPQI = increased acidity
53
What is NAPQI?
A breakdown product of acetaminophen that causes acetaminopjhen toxicity Stands for N-acetyl-p-benzoQuinone imine
54
What is the treatment for acetaminophen?
N-acetylcysteine | This is the precursor to glutathione (so you can produce glutathione to get rid of NAPQI)
55
What drugs are implicated in a drug induced liver injury?
1. augmentin 2. macrobid 3. anti-TB 4. Bactrim 5. anti-retroviral 6. Levaquin

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