Liver disorders

Question 1

hepatitis

Answer 1

acute or chronic hepatocellular damage

Question 2

most common cause of acute hepatitis

Answer 2

viral!!! toxins (like EtoH) is the second most common cause

Question 3

chronic hep

Answer 3

viral (hep BCD) also- Wilson’s dz, alpha 1 antirypsin deficiency, autoimmune dz, systemic dz

Question 4

how is hep A and E transmitted?

Answer 4

via Fecal-oral route

Question 5

hep BCD transmitted?

Answer 5

parenterally or by mucous membrane contact

Question 6

hep C risk of progression?

Answer 6

20% may progress to serous liver dz (RF: alcohol or coinfection w/ hep B or HiV

Question 7

CF of viral hepatitis

Answer 7

fatigue, maliase, anorexia, N, **tea-colored urine, vagje abdominal discomfort

Question 8

rx of A E

Answer 8

self-limited, mild, w/o long term sequalae

Question 9

hep B C

Answer 9

variable presentation

Question 10

hep D?

Answer 10

only seen w. hep B and associated w/ a more severe course

Question 11

common Lab findings for hep

Answer 11

aminotransferase elevations- even in hepatocellular damage, bilirubin >3.0–> scleral icterus, if not frank jaundice

*look at notes for serology

Question 12

how many types of hep c ar there?

Answer 12

type 1, 2 & 3

Question 13

what type of hep C has a better prognosis?

Answer 13

type 2/3, but type 1 is most common in US

Question 14

how else to evaluate hep?

Answer 14

liver bx- determine the level of fibrosis; sonography and alpha-fetoprotein help too

Question 15

tx of acute viral hep

Answer 15

supportive

Question 16

what should pts avoid?

Answer 16

alcohol

Question 17

tx Hep B and if positive for HIV

Answer 17

always tx HIV regardless of CD4 count- truvada! (emtricitabine/tenofovir disproxil fumarate)

Question 18

tx for hep C

Answer 18

vaccinate againse hep A and B, evaluate for level of fibrosis

Question 19

types of hep c tx

Answer 19

pegylated interferon w/ ribavirin- goal of therapy is reduction of viral RNA to undetectable at 6 mnths post therapy

Question 20

cirrhosis

Answer 20

irreversible fibrosis and nodular regeneration throughout the liver

Question 21

main causes of cirrhosis

Answer 21

45% alcohol, remainder assoicated w/ hepatitis BC or congenital disorders

Question 22

Clinical presentation of cirrhosis

Answer 22

weakness, fatigue, weight loss are common, N,V, anorexia

amenorrhea, impotence, loss of libido, gynecomastia,

abdominal pain and hepatomegaly

Question 23

late stage disease

Answer 23

ascites, plerual effusions, peripheral edema, ecchymoses, esophageal varices, signs of hepatic encephalopathy

Question 24

hepatic encephalopathy signes

Answer 24

asterixis, tremor, dysarthria, delirium and eventually coma

Question 25

spontaneous bacteril peritonitis-

Answer 25

fever, chills, worsening ascites, abdominal pain–> D and renal failure

Question 26

diagnostic studies

Answer 26

lab values-minimally abnormal until late in the dz

anemia, mild elevations of AST and alkaline phosphatase, increased y-globulin, decreased albumin, Prolonged PT

US, CT, MRI can confirm the size and number of nodules

Question 27

tx for cirrhosis

Answer 27

can use glucocorticosteroids, , abstinence from alcohol

Question 28

tx of ascites

Answer 28

salt restriction, bed rest, spironolactone 100 mg

Question 29

when do you use liver transplant

Answer 29

decompensated and w/ complications

Question 30

what can cause portal hypertension?

Answer 30

presinusoidal, sinusoidal, or postsinusoidal levels

sinusoidal being the c kliver capillaries

Question 31

what are presinusoidal causes of portal HTN?

Answer 31

schistosomiasis and portal vein thrombosis

Question 32

what are sinusoidal causes?

Answer 32

cirrhosis (from alcohol and Hep B/c)

Question 33

what are post sinusoidal causes of portal htn?

Answer 33

budd-chiari syndrome (hepatic vein occlusion, pericarditis, right sided HR)

Question 34

what are severe complications of Portal HTN?

Answer 34

varices that bleed!!

Question 35

PE of portal htn

Answer 35

• ascites,
• jaundic,
• “cherubic face”
• spider angioma,
• testicular atrophy
• gynecomastia
• palmar erythema
• caput medusa
• hemorrhoids

(think alcholic sx)

Question 36

portal HTN tx?

Answer 36

BB: decrease risk of bleeding

-endocsopic surveillance

Question 37

if pt does bleed in portal HTN?

Answer 37

large bore IV, volume
-then if emergency endocopy doesnt work and bleeding can be controlled:

balloon tamponade, vasporressin

transjugular intrahepatic portosystemic shuntingd

Question 38

if pt doesn’t have cirrhosis or good residual liver fxn,

Answer 38

surgical shunts will prolly work better

than TIPs

Question 39

Altered MS in pts with cirrhosis and portal HTN (encephalopathy?

Answer 39

indicator of poor hepatic reserve and would generally CI shunting until resolved
o Hepatic encephalopathy should be treated with TPN. Malnutrition can be quite severe and these patients are prone to vitamin and mineral deficiencies