Rubin's 20: Liver & Biliary Flashcards Preview

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Flashcards in Rubin's 20: Liver & Biliary Deck (34):
1

Is Hep A ever chronic?

No

2

Hep A virus phylogeny:

SS RNA nonenveloped

3

Incubation period Heb A:

3-4 wks Prodrome is low grade temp, nausea, anorexia, fatigue, mylagia, malaise

4

LFTs in Hep A

ALT>AST before jaundice (then 500-600s) ALT is more liver specific

5

Steroids have what role in Hep A tx?

None

6

Virus type Heb B

DS DNA enveloped

7

Most common transmission Heb B

Perinatal (vagina) NOT placenta

8

Heb B serum markers:

Hep B surface ag Hep Be ag - responsible for virus replication Core - Hep Bc-ag and back Once HepB ag, immune

9

How do you tell if someone has had Hep B in the past?

Hep B CORE antiody - not part of vaccine series

10

Labs Hep B:

ALT>AST, in the thousands; Bili high

11

Chronic Hep B is a major risk factor for hepatocellular carcinoma in what cultural group?

Asians

12

Tx Chronic Hep B?

Antivirals ie epivir, tenofovir, adefovir, entecovir 1 per day for a year

13

Protect babies from Hep B vertical infection by:

immune globulin administration within 12 hours of being born

14

Tea-colored urine suggests?

Icteric phase Hep B infection

15

85% of patients with Hep C become...

chronic

16

Hep C is Sexual?

Not really, Hep B is sexually transmitted Hep C is blood (tattoos, IV drug use)

17

T/F: Most acute infections of Hep C go unnoticed.

True, 80% subclinical

18

Incubation Hep C:

60 days

19

Must test what to dx Hep C?

Hep C Ab; can't tell from AST/ALT because it's normal

20

Old tx Hep C?

Peg INF and ribavarin

21

New tx Hep c?

Sofosbuvir (genotype 1 and 2 - 12 weeks); simeprevir

22

Hep C what kind of virus?

RNA virus enveloped 6 main genotypes

23

Hep D what kind of virus?

ss RNA (defective RNA virus) expresses core antigen named HDAg (delta antigen) co-infection OR superinfection with Hep B

24

Labs Hep D?

HD-Ag HD-sAg

25

Transmission Hep E?

Fecal-oral

26

25% chance of WHAT in pregnant women with acute Hep E?

Death

27

Hep E - what kind of virus?

nonenveloped ssRNA

28

High lipase is most specific for:

Pancreatitis (moreso than amylase)

29

Metronidazole causes what rxn with alcohol?

Disulfiram-like rxn

30

Dx: High serum bilirubin, unconjugated; Mild jaundice Symptoms resolve with corticosteroids

Autoimmune hemolytic anemia Antibody-mediated erythrocyte destruction. Intravascular hemolysis leads to increased serum levels of unconjugated bilirubin which exceed the capacity of hepatocytes to conjugate it.

31

Why do some newborns develop jaundice?

Liver is still developing, cannot conjugate bilirubin fast enough

32

Dx: Necrotizing arteritis of medium-sized vessels that lead to pseudoaneurysm formation, renal thrombosis, inflammation and hemorrhage; A possible complication of chronic HBV infection due to circulating immune complexes

Polyarteritis nodosa

33

Primary biliary cirrhosis features what positive antibody test?

Anti-mitochondrial antibody

34

Infection with the liver fluke Clonorchis sinensis predisposes to what kind of cancer?

Cholangiocarcinoma