Liver

Question 1

what are the major drugs that cause liver disease?

Answer 1

acetaminophen, isoniazid, methyldopa, methotrexate

Question 2

tender hepatomegaly is suggestive of what?

Answer 2

congestive hepatomegaly

Question 3

small nodular liver is suggestive of what?

Answer 3

cirrhosis

Question 4

splenomegaly is suggestive of waht?

Answer 4

portal hypertension

Question 5

ascites is suggestive of what

Answer 5

portal hypertension and hypoalbuminemia

Question 6

liver problems with xanthomas is indicative of what liver disease?

Answer 6

primary biliary cirrhosis

Question 7

What liver proteins are measured in the liver panel?

Answer 7

total protein
albumin
prothrombin

Question 8

Where else is AST found?

Answer 8

liver, muscle, RBCs, kidney, brain

Question 9

Is GGT or ALP more specific to the liver

Answer 9

GGT

Question 10

AST or ALT higher in alcoholic hepatitis?

Answer 10

AST

Question 11

Does cholestasis mean obstruction?

Answer 11

No

Question 12

What does AST/ALT>1000 suggest?

Answer 12

toxins, shock liver, viral hepatitis

Question 13

What are ways to diagnose NASH?

Answer 13

US- fatty infiltrate, Biopsy,

+ if the patient has DM, obesity

Question 14

What is PSC associated with

Answer 14

Anca, UC, cholagiocarcinoma

Question 15

what is the main mechanism of NASH?

Answer 15

triglyceride infiltration–> hepatocellular injury may be related to free oxygen radical formation and induction of cytochrome p-450 for metabolism of FFA

Question 16

What are the risk factors for NASH

Answer 16

obesity
diabetes
hypertriglycerides
metabolic syndrome
HTN

Question 17

what is metabolic syndrome

Answer 17

HTN, insulin resistance, increased waist to hip, HLD

Question 18

What are the components of the MELD score?

Answer 18

serum bilirubin
INR
serum creatinine

THE HIGHER THE SCORE THE GREATER THE 3 MONTH MORTALITY

Question 19

how many will die within 2 years of onset of ascites?

Answer 19

50%

Question 20

what can diagnose ascites more sensitively?

Answer 20

US 100 mL, physical exam needs 1500 mL

Question 21

What clinical symptoms suggest SBP?

Answer 21

fever, abdominal pain, encephalopathy, worsening clinical condition

Question 22

What pathogens cause SBP?

Answer 22

E.Coli, Kleb, strep.

Question 23

T-F- if the organisms isolated is >1 then it is SBP?

Answer 23

False- it would be secondary peritonitis

Question 24

What is a major complication of SBP?

Answer 24

hepatorenal syndrome

Question 25

What are the indications of paracentisis?

Answer 25

New onset ascites, signs of SBP, clinical deterioration, symptom relief

Question 26

Is coagulopathy a contraindication of paracentisis?

Answer 26

No

Question 27

What are the causes of SAAG >1.1?

Answer 27

portal hypertension from cirrhosis, SBP, acute hepatits, RHF, venous thrombosis, schisto TRANSUDATE

Question 28

What are the causes of SAAG

Answer 28

peritoneal carcinomatosis, pancreatitis, peritoneal dialysis EXUDATE

Question 29

If ascites prtoein is

Answer 29

SBP prophylaxis

Question 30

if PMNs >250 what do we know?

Answer 30

SBP diagnosis | also can do gram stain + culture

Question 31

What should be the treatment for SBP

Answer 31

Cefotaxime- ceftriaxone | albumin infusion to minimize risk of hepatorenal syndrome

Question 32

What are the indications for SBP prophylaxis?

Answer 32

hospitalized cirrhotics w/GI bleed ascites protein 2.5 prior SBP

Question 33

what is hepatorenal syndrome>

Answer 33

AKI- vasodilation of splanchnic arteries and vasoconstriction of renal circulation

Question 34

How doe we diagnoses hepatorrenal syndrome

Answer 34

AKI no response to colume challenge diagnosis of exclusion- must do full AKI work-up

Question 35

What is the treatment of hepatorenal syndrome

Answer 35

increase MAP by 10-15 ICU- norepinephrine + albumin Not ICU- octeotride + midodrine (a1 agonist)+ albumin

Question 36

What is the treatment for Hepatitis B?

Answer 36

supportive for acute infections | IFN-a-2b or lamivudine for chronic

Question 37

Hepatitis C treatment?

Answer 37

old= ribavirin IFN | New- simepravir, sofosbuvir+ledipasvir, ombitasvir/paritaprevir/ritonavir

Question 38

What is the most common cause of chronic hepatitis?

Answer 38

Hepatitis C

Question 39

does Hep B or C have a more acute presentation?

Answer 39

Hep B, but only becomes chronic in 20%

Question 40

what is the mechanism of fibrosis in cirrhosis?

Answer 40

mediated by TGF-B secreted by stellate cells

Question 41

What are the 6 clinical features of cirrhosis

Answer 41

``` portal HTN Increased ammonia Increased estrogen jaundice hypoalbuminemia coagulopathy ```

Question 42

viral hepatitis, autoimmune hepatitis, hemachromatosis cause what pattern of hepatic damage?

Answer 42

periportal

Question 43

alcoholic hepatitis, NASH, CHF, bud chiari cause waht pattern of hepatic damage?

Answer 43

central vein

Question 44

In NASH is ALT or AST higher?

Answer 44

ALT>AST

Question 45

What is different about the biopsy in NASH from ALD?

Answer 45

greater fatty change than alcoholic type

Question 46

What are the iron labs for hemochromatosis?

Answer 46

up ferritin down TIBC Up serum Fe Up % saturation

Question 47

What distinguishes hemochromatosis from normal lipofuscin?

Answer 47

prussian blue stain

Question 48

what is the treatment for hemochromatosis?

Answer 48

phlebotomy

Question 49

What is the treatment for wilson's disease?

Answer 49

D penicillamine

Question 50

What has granulomatous destruction of intrahepatic bile ducts only?

Answer 50

PBC- florid duct lesions | antimitochondrial antibody

Question 51

PSC intra or extrahepatic?

Answer 51

both

Question 52

does PBC increase risk of cholagiocarcinoma?

Answer 52

No

Question 53

What are risk factors for HCC?

Answer 53

chronic hepatitis cirrhosis aflatoxins derived from aspergillus- induce p53 mutations

Question 54

What is an HCC patient at huge risk for>

Answer 54

Budd chiari syndrome | -->invasion of hepatic vein-->thrombosis-->infarction

Question 55

what does anti-HBe mean?

Answer 55

low infectivity

Question 56

What does anti-HBS indicate?

Answer 56

immunity (if it also has anti-HBe IgG, or antiHbc IgG) it means recovery vs. immunized

Question 57

What does antiHBc IgG mean?

Answer 57

chronic or prior exposure

Question 58

true or false- GGT is decreased in Alcoholic liver disease?

Answer 58

false elevated

Question 59

What is the difference between type A and B of drug induced hepatitis?

Answer 59

type A- dose dependent toxicity like tylenol and INH. | type B- unpredictable- occurs at therapeutic doses- nitrofurantoin