Liver Flashcards
(63 cards)
1
Q
Most common cause of acute liver failure
A
Acetaminophen overdose
2
Q
Acute liver failure signs and symptoms
A
- Ascites
- Coagulopathy
-Jaundice - ## Encephalopathy/altered mental status (1-4 weeks after jaundice)
3
Q
Acute liver failure labs
A
- ALT and AST, bilirubin elevated
- INR elevated
- Leukocytosis (high WBCs)
- Hyponatremia, hypokalemia, hypoglycemia
4
Q
Acute liver failure: TX
A
hospitalize, may need transplant
5
Q
Hepatitis: acute and chronic
A
Viral is most common cause of both
6
Q
Which hepatitis viruses are transmitted fecal oral
A
A and E
- self limited
- abrupt onset
7
Q
How are hepatitis B, C, D transmitted?
A
- IV drug use
- tattoos
- infected mother
- blood transfusion
8
Q
Which hepatitis virus most commonly causes cholestatic hepatitis?
A
hepatitis A
- prominent jaundice and itching
- elevation in bilirubin, ALK phos
9
Q
Which hepatitis virus is the most common cause of relapsing hepatitis?
A
hepatitis A
- symptoms recur in weeks/months
- may see arthritis, vasculitis, excess protein in the blood
10
Q
Acute viral hepatitis: physical exam
A
- mild hepatomegaly with tenderness
- mild splenomegaly
- posterior cervical lymphadenopathy
11
Q
Acute Viral hepatitis (self-limited disease and relapsing hepatitis) treatment
A
outpatient (unless super dehydrated)
12
Q
Cholestatic hepatitis: tx
A
- Prednisone
- Ursodeoxycholic acid
- Cholestyramine (for itching, binds to cholesterol)
13
Q
Hep A: signs/sx
A
- fever (uncommon in other viral hepatitis)**
- icteric phase: jaundice peaks at 2 weeks
14
Q
How long does IgM antibody to HAV stay elevated?
A
3-6 months
IgM is test of choice***
15
Q
How long does IgG anti-HAV stay elevated?
A
lifelong
16
Q
Which hepatitis viruses have vaccines?
A
Hep A
Hep B
17
Q
When should the Hep A vaccine be given?
A
- at 1 year old
- MSM
- IV drug user
18
Q
Post exposure Hep A prophylaxis?
A
Vaccine for 1 -40 years
Immunoglobulin for <1 yr, >40 yr, or immunocompromised
19
Q
In whom is hepatitis E often more severe and fulminant?
A
pregnant lady
acute liver failure esp if in 3rd trimester
20
Q
Hepatitis E
A
- longer incubation than Hep A**
- Spread by swine/undercooked meat
21
Q
Hepatitis E: labs
A
- IgM first
- IgG second
- HEV RNA test confirms and quantifies HEV presence*** (stool or serum)
22
Q
Hepatitis E: prevention
A
- no vaccine
- no immunoglobulin
23
Q
Viral differences
A
Hep A and E: non-enveloped, not affected by bile/detergents
Hep B, C, D: enveloped, disrupted by bile/detergents
24
Q
Hep B: general
A
- DNA virus
- transmission via percutaneous and permucosal routes
- sexually transmitted
- May result in chronically infected state–>esp infants, kids
- Adults more likely to get asymptomatic/self-limited disease
25
What does HBeAg tell you?
marker of active infection
26
What does antibody to HBsAg tell you?
immunity to the surface antigen
27
If the patient has anti-HBs and anti-HBc what does that tell you?
Prior HBV infection
28
What labs would indicate chronic Hepatitis B infection?
HBsAg for >6 months
29
If patient has Hep B infection, is young, non-cirrhotic, low HBV DNA level what is the treatment?
Peginterferon alfa-2a
(SQ injections for 48 weeks)
-greater chance of seroconversion
Nucleoside analogues (ex. entecavir, tenofovir)
- inhibit HBV replication, don't eradicate HBV
- Oral medication
30
Hep B: passive immunization (ex. newborns of HBsAg moms)
1. Immunoglobulin (HBIG)
- give postexposure prophylaxis to casual sexual partners
2. HBV vaccine series
- 2 shots, 6 months apart
31
Who should be screened for Hepatitis C?
- high risk
| - Born between 1945-1965 [BABY BOOMERS]
32
Most common Hepatitis C genotype in US?
genotype 1
note: genotype 3 is hardest to treat
33
Hepatitis C: etiology/risk factors
- transmitted MC between IV drug users**
- Blood transfusion before 1992
- HIV (less likely to clear virus)
34
Hepatitis C: clinical presentation
- usually asymptomatic
- young women more likely to clear the virus (blacks less likely to clear)
- majority will develop chronic infection
35
Which lab is needed to diagnose acute Hep C infection?
HCV RNA test***
-if present >6 months =chronic infection
36
Hep B vs. Hep C in kids
Hep B - kids more likely to become chronic
Hep C - kids more likely to resolve spontaneously
37
In a patient with chronic Hep C, how do you tell if there is active infection?
+ screening test by EIA (antibodies against the virus)
38
If your patient has hepatitis C, what other things are important to do?
- screen for HIV
| - vaccinate for Hep B, and Hep A
39
What determines the treatment regimen for hep C?
genotype
40
What are the new Hep C drugs?
Direct-acting antivirals
-NS3-4 protease inhibitors (ex. Simeprevir)
-NS5B polymerase inhibitors (ex. Sofosbuvir)
41
What is the main offender for drug-induced liver injury?
- antibioticss (esp. Augmentin, Sulfonamides)***
- Acetaminophen
- Antituberulous Agents (Isoniazid and Rifampin)
42
What does Maddrey's discrimination function help you determine?
mortality during current hospitalization for alcoholic hepatitis
Tx: methylprednisolone and pentoxifylline help
43
Non alcoholic fatty liver disease, and nonalcoholic steatohepatitis: general
- asymptomatic, maybe RUQ pain
- elevated ALT
- <4 alcoholic drinks a day
44
Autoimmune hepatitis: general
-young to middle aged women
-high serum gamma-globulin level
+ANA
+smooth muscle antibody
45
Autoimmune hepatitis: Tx
Tx: Prednisone 30mg (taper over month) +/- azathioprine
46
Autoimmune hepatitis: prognosis/follow up
hepatologist every 3-6 months due to high relapse rate
47
Wilson disease
- impaired biliary copper excretion
- Autosomal recessive
- decreased serum ceruloplasmin
- Kayser-Fleicher rings
48
Wilson disease: tx
D-penicillamine
49
Which organs are affected by Alpha-1 antitrypsin deficiency
Lung and Liver
50
Primary Sclerosing Cholangitis
-Men 20-40
-Ulcerative colitis
-cholangiocarcinoma
+ P-ANCA
-Elevated: Alk Phos, Bilirubin
51
Primary Biliary Cirrhosis
-middle aged women
-fatigue and pruritis**
-xanthelasma/xanthoma
+Anti-mitochondrial antibody****
52
Primary Biliary Cirrhosis: Tx
1. Urodeoxycholic acid*
| 2. Cholestyramine (bile acid resin)
53
Primary Sclerosing Cholangitis: Dx
ERCP with stenting
-Ursodiol (reduces secretion of cholesterol)
Definitive -->most will need transplant
54
ESLD hepatic encephalopathy
- hepatocellular dysfunction leads to increased serum ammonia levels
- Neuropsychiatric abnormalities (grade1: short attention span, grade2: personality change, grade3: confusion disorientation, grade4: coma
55
ESLD: Tx for high ammonia in the blood
Lactulose and/or Rifaximin`
56
What happens to albumin in end-stage liver disease?
decreases
- more difficulty maintaining osmotic pressure of blood
- less carrying ability for small hydrophobic molecules
57
End Stage Liver disease: Sodium
- Chronically low - fluid overload
- Indirect marker of portal hypertension
- hyponatremia - risk of cerebral edema and neurologic changes
58
Model of End-Stage Liver Disease (MELD)
determines transplant eligibility
>15 MELD score is where 3 month survival starts dropping = consider for transplant
59
What are strong predictors of 3 month mortality
1. Total Bilirubin
2. INR
3. Cr
4. Na+
60
Hepatocellular Carcinoma (HCC)
MC risk factor = cirrhosis
Image every 6 months = alternating CT/MRI
Serum cancer marker = Alpha feto-protein
61
Cholangiocarcinoma: etiology
- cancer from bile duct epithelium
- Klatskin tumor --> if near bifurcation of the ducts
- MOST are adenocarcinomas
-Males, between ages 50-70
62
Cholangiocarcinoma: history and exam
- Painless jaundice
- pruritus
- fever, jaundice, RUQ pain (Charcots)
- palpable gallbladder
- hepatomegaly
- dark urine
- pale stools
63
Contraindications for liver transplant
- active EtOH or drug abusee
- HCC outside the liver
- Metastatic bile duct cancer
- Non-hepatic malignancy
- Severe cardiopulmonary disease
- Comorbidities (BMI>35)
- Psych/social issues
