8. Liver 1 Flashcards
Hep A Transmission
Fecal-Oral
Is Hep A generally acute or chronic?
Acute
What does the HAV IgM antibody tell us?
Active disease of Hep A
Hep E. Transmission
Fecal-Oral
Is there a vaccine for HEV?
No
Which type of Hep. can lead to acute liver failure in pregnancy: HAV or HEV?
HEV
Hep C Transmission
Blood (sex, childbirth)
Gold standard tests for diagnosing HCV
HCV RNA test (with PCR)-can detect viral RNA in blood.
If RNA decrease-recovery
If RNA same-chronic HCV
Hep B Transmission
Blood (childbirth and sex)
Who is most likely to get chronic infection of HBV?
Children under 6
Which type of Hep is most likely linked to liver cancer?
HBV
What does it mean if you see IgG antibodies in a patient with HBV?
Recovery
What does the HBe antigen tell us in HBV?
It is an active infection that is replicating
What do we expect to see during the onset of infection during the acute phase of HBV?
HBsAg (Hepatitis B surface Antigen)
IgM antibodies attacking the core antigens
IgG antibodies
What is needed to overcome HBV?
IgG
IgM can convert to IgG
Hep D needs what to infect a host?
HBV
In HDV, if the HDV IgM or IgG are present, what does this mean?
Active Infection
What would you expect to see on a liver biopsy of Hep B?
Granular eosinophilia “ground glass” appearance;cytotoxic T-cells mediated damage
Hepatocytes swelling, monocytes infiltration, and Councilman bodies are all seen in Hep ____ biopsy
A
Interferon-alpha is used to treat chronic Hep __ and ____.
B and C
Carrier state is common in Hep ____and _____.
B and C
(IgM/IgG) antibody to hep B core antigen means there is an acute/recent infection of hep B virus.
IgM
What would you give to a baby born to a mother with active hep B?
Anti-hepatitis B immunoglobulin
Which Hep virus can cause liver failure in pregnant mothers?
E (E for expectant mothers)
Which Hep infection is most likely to progress to cirrhosis or carcinoma?
C (C for Cirrhosis and Carcinoma)
If a patient is recovering from Hep B, what serologic markers would you expect to see?
Antibody to hep B surface antigen
Hep B early antibody
IgG antibody to Hep B core antigen
What color would you expect urine to be in patient with Hep A?
Dark
Which Hep viruses cannot be destroyed by the gut?
A and E (“naked viruses”)
Patients receiving needle injections at hospitals are possibly at risk for Hep _____and _____.
B or C
Granular eosinophilia “ground glass” appearance o the liver on biopsy is seen in Hep ____ and _____
D and B
IV drugs and ____are most common transmissions of hep C.
Blood transfusion
Newborns with Hep B have a high chance of developing (Acute/Chronic) infection.
Chronic
What would the Hep B e antigen indicate?
Active viral replication, high transmissibility, poor prognosis (BAD!)
Hep B has a (long/short) incubation period.
Long
Hep A has a (Long/Short) incubation period.
Short
A patient presents with purple, prurience, polygonal planar papules and plaques. She most likely has Hep____.
C
Patients with hep C have an increased risk for hypothyroidism and _______.
Diabetes mellitus
Hep E has a (long/short) incubation period
Short
A patient presents with joint pain, fever, and a rash. This is most likely Hep _______
B
Do most Hep B pt’s recover?
Yes
Hep C has a (short/long) recovery period?
Long
IgM marks _________infection in Hep A.
Active
Tx for Hep E is generally ____
Supportive
Which type of bilirubin can be excreted by the kidney?
Conjugated (water soluble)
What is a normal value of total serum bilirubin? (95% pop.)
1-1.5mg/dL
What does elevated conjugated hyperbilirubinemia indicate?
Liver or biliary tract disease
In a patient with significant muscle wasting from advanced liver disease, what might you expect to see in the blood sample?
High blood ammonia (liver is not able to detoxify ammonia and convert it to urea)
What type of enzymes are most helpful in recognizing acute hepatocellular diseases such as hepatitis?
Aminostranferases (ALT and AST)
This enzyme is primarily found in the liver and is a more specific indicator of liver injury (ALT or AST)?
ALT (L for LIVER)
What is the “general” normal range for aminotransferases?
10-40 IU/L
In acute hepatocellular disorders ______is generally higher than or equal to the ______.
ALT
AST
An AST: ALT ratio of ________is suggestive of alcoholic liver disease.
2: 1
* 3:1 highly suggestive
Serum albumin is synthesized by _______
Hepatocytes
Serum albumin has a _____half-life: ______days.
Long: 18-20
Why is the serum y globulin increased in cirrhosis?
Increased synthesis of antibodies which are directed against intestinal bacteria
*because the cirrhosis liver fails to clear bacterial antigens that normally reach the liver through the hepatic circulation.
Increases in IgA levels usually occur in _________
A for Alcoholic liver disease
Increases in IgM levels are common in ________
Primary biliary cirrhosis
Where are blood clotting factors generally made?
Hepatocytes
Are the serum half-lives of coagulation factors shorter or longer than albumin?
Shorter
What is the single best acute measure of hepatic synthetic function?
Coagulation Factor
Biosynthesis of factors II, VII, and X depends on vitamin _____
K
What is the first diagnostic test for patients whose liver tests suggest cholestasis?
Ultrasonography
What test would you use to distinguish between cystic and solid masses in the liver?
Ultrasound
Which of the Hep virus’s is a DNA virus?
Hep B (But replicates like a retrovirus)
Hep A incubation period.
4 weeks
When could you detect antibodies to HAV?
During the acute illness when serum aminotransferase is elevated and fecal HAV is still occurring. (3 mo)
After a person is infected with HBV what is the first detectable virologist marker?
HBsAg
*undetectable after jaundice
A common cause of Hepatitis in India, Asia, Africa, and Central America
Hep E.
Marked cholestasis is a common histology feature in Hep_____
E
*Bile can’t flow thru
HDV infection in the US is generally contracted via________
Blood and blood products
*Drug users
Hep ______is the most frequent indication for liver transplantation.
C
A diagnosis of Hep A is based on detection of ______anti-HAV during acute illness
IgM
What would you see in a blood test of someone with the Hep B vaccine?
Anti-HBs
If a patient presents with ascites, low serum albumin level, hypoglycemia and very high serum bilirubin what should you do?
Hospital admission asap!!
*Severe hepatocellular disease
The most feared complication of viral hepatitis.
Fulminant hepatitis (massive hepatic necrosis)
*RARE!
Who is at most risk for chronic infection after acute HBV infection?
Neonates
Down’s syndrome
Immunosuppressed (HIV)
Is full recovery likely in previously healthy adults with Hep B?
Yes, 99%
Tx for Hep C
24 week course of long-acting pegylated interferon + ribavarin
Med for severe pruritus (itching).
Cholestyeramine
Vaccines are available for Hep____,______, and ______.
Hep A, B, and E
The most common cause of acute liver failure.
Drug-induced liver injury
What drug is the most prevalent cause of acute liver failure in the west?
Acetaminophen
Tx for acetaminophen overdosage
Gastric lavage
Supportive measures
Activated charcoal (Or cholestyramine)
Most common agent implicated as causing drug-induced liver injury in the US :
Amoxicillin-Clavulanate
The most common chronic liver disease in the US
Nonalcoholic fatty liver disease
