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Gastroenterology > Liver > Flashcards

Liver Flashcards

(48 cards)

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1
Q

Criteria for liver transplant in paracetamol overdose

A

INR>3 at 48hrs, oliguria/cr>300, persistent acidosis

hypotension,hypoglycemia, thrombocytopenia,encephalopathy

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2
Q

Target antigen in AI hepatitis type 2

A

Cyp450 2D6 , associated with anti LKM in young adults

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3
Q

Strongest contraindication for use of interferon in treatment of viral hepatitis

A

Decompensated cirrhosis

Other- significant psychiatric illness, alcohol, low Hb, solid organ transplant

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4
Q

Diagnostic triad for PBC

A

Cholestatic LFT, positive AMA, histologic findings

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5
Q

Antibody predictive of poor clinical and biochemical response to therapy in AIH

A

anti-LKM

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6
Q

Indications for treatment in Hep B

A

Cirrhotics(even if if Hbe Ag positive or negative)
Hbe Ag+, Non cirrhotic- Rx if persistent DNA>20,000,ALT>2ULN
HbeAg -, non cirrhotic - Rx if DNA>2000, ALT>2ULN
[Normal ALT-25 females, 35- males]

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7
Q

Medication used to induce seroconversion

A

Interferon s/c weekly for 48weeks (30% chance of eAg seroconversion, 5-10% chance of sAg seroconversion)
Viral suppression - entecavir, tenofovir -life long

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8
Q

Rare s/e of tenofovir

A

Fanconi’s syndrome

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9
Q

Management of latent HBV with core Ab positive for chemo/ritux

A

Treat with entecavir/lamivudine to start before chemo/ritux and continue for 12-18months post chemo

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10
Q

Screening for HCC in HBV

A

Africans >20yrs, First degree relative with HCC, Asian men>50, women >40, A+TS >50, Cirrhotics

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11
Q

Risk of transmission for HBV in pregancy

A

Hbs ag positive, Hbe positive, Viral load above 1x105
Rx -commence in 3rd trimester tenofovir/ lamivudine
Cease 6 weeks post partum
Baby -HBIG, vaccination

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12
Q

Hepatitis C genotype common in Australia

A

1 and 3

Synergistic effect with alcohol

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13
Q

Hepatitis C extrahepatic manifestations

A

Autoantibodies 40-60%, T2DM, Mixed cryoglobulinemia, Membranoproliferative GN, lichen planus, porphyria cutanea tarda, lymphoma/splenic lymphoma

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14
Q

MOA and SE of Sorafenib for HCC

A

TK inhibitor, anti -VEGF, anti-angiogenesis

S/e- palmar plantar erythrodysesthesia(hand-foot syndrome), fatigue, rash

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15
Q

Optimal treatment regimen for Hep C

A

PEG-INF2alpha daily s/c for 4 weeks, then 3 times per week for 20 weeks

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16
Q

Management of HBV in pregnancy

A

Mild disease, low viremia -Rx commence when pregnant
Mild disease, high viremia-Rx in last trimester with tenofovir-can be ceased post partum
Mod liver disease, no cirrhosis -Rx before pregnancy,if responds -can stop treatment before pregnancy
Advanced liver disease-Rx before, during and post delivery

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17
Q

Most common side effect of ribavirin treatment in Hep C

A

Hemolytic anemia

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18
Q

Hepatitis B genotype with worst prognosis

A

Genotype C

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19
Q

Strongest predictor of development of cirrhosis and HCC in patients with hepatitis B

A

High circulating levels of HBV DNA

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20
Q

Which of the following features does not affect natural history of progression of Hepatitis C

21
Q

Absolute contraindication for liver transplantation

Study These Flashcards
A

Alcohol use(should be abstinent for 6 months)
Cardiopulmonary disease that cannot be corrected
Extrahepatic malignancy within 5 yrs

22
Q

Primary biliary cirrhosis features

Study These Flashcards
A 
Women >45yrs
AMA positive in 95% cases
Immune attack on small bile ducts only
Ursodeoxycholic acid slows progression
Transplantation for end stage liver disease -Bn>100
23
Q

Primary sclerosing cholangitis

Study These Flashcards
A

Sclerosis of large bile ducts
Strongly associated with UC
Complicated by cholangiocarcinoma in 10%
Ursodeoxycholic acid not useful

24
Q

Predictors of poor outcome in paracetamol overdose

Study These Flashcards
A 
INR>3at 48hr or 4.5 at any time
Oliguria or creatinine >200
Persistent acidosis with pH<7.3 or lactate>3
SBP<80 despite resuscitation
Hypoglycemia
Severe thrombocytopenia
Any degree of encephalopathy
25
Most common long term complication of liver transplantation
Metabolic syndrome
26
Causes of raised AST: ALT ratio
Alcoholic liver disease, NASH, Hep C with cirrhosis Cirrhosis from viral hepatitis Wilsons disease
27
Genotype of Hep C that predicts poor response to treatment
Genotype 3 Genotype 1a more difficult to treat than 1b Negative predictive factors in studies: Male gender, weight>75,non CC IL28B genotype, cirrhosis, HCV RNA>800000
28
Mx of treatment naïve Hep C genotype 3 without cirrhosis
8wks fixed dose combination of glecaprevir and pibrentasvir HCV genotype 2 -sobosfuvir and ribavirin for 12 weeks
29
Autoantibodies in AIH
ANA, anti-LKM, AMA
30
What defines chronicity in Hepatitis B
Hbs Ag persisting >6months
31
MC sideeffect of Ribavirin treatment
Haemolytic anemia
32
Conditions least likely to cause HCC
AIH, PBC, Wilsons
33
Risk factors for bleeding in esophagial varices
``` Varix size Child class Endoscope -cherry red spot, redwale sign Continued alcohol use HVPG>12 Previous bleed -60-70% ```
34
Criteria for liver transplantation in paracetamol poisoning
INR>6.5, Cr>300, Gr 3/4 encephalopathy
35
Liver transplantation criteria in non paracetamol liver failure
``` INR>6.5 or 3of 5 foll criteria Age <11or>40 Bn>300 Jaundice to coma time>7 days INR>3.5 Drug toxicity ```
36
Criteria for liver transplantation in HCC
Single lesion less than 5cm Upto 3 lesions, all <3cm No evidence of gross vascular invasion No regional node/distant mets
37
Risk factors for NAFLD
Obesity, Type 2DM, hyperlipidemia,insulin resistence | Genetic modifiers PNPLA3
38
Best diet for NAFLD patients
Mediterranean diet (olive oil, nuts, avocado), fish, green leafy vegetables
39
Most sensitive initial screening tool for HH
Fasting morning transferrin saturation Transferrin sats>45% detects almost all C282 homozygotes Ferritin>1000 (without other causes) may indicate need for liver Bx
40
Suveillance post HCC resection
CT 3 monthly for 1styear, 6monthly for 2nd year | Then USG 2yrly
41
Factors leading to clearance of Hep C
Younger age,female gender,MHC genes, IL-28B
42
Factors predictive of disease progression in Hep C
Older age, male,Histology, alcohol,obesity, high ALT,Co infection (HIV,HepB), insulin resistance
43
Hep B genotype with better response to INF
A and B
44
Hep B genotypes associated with severe liver disease
C and D
45
HBe seroconversion rate with oral nucleotides (entecavir/tenofovir)
10-20% per year
46
Advantages of INF Rx for HBV
Finite duration of therapy Higher rate of HbeAg loss in 1 year Higher rate of Hbs Ag loss with short duration of Rx No resistance
47
Advantages of oral nucleotides for HBV
Higher rates of HBV DNA suppression
48
Conditions where tenofovir prefered over entecavir
Pregnant women | If previous Lamivudine experienced (50% chance of entecavir resistance)

Gastroenterology (8 decks)

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