Acute and Chronic Hepatitis

Question 1

Hepatocellular

Cholestatic processes

Bilirubin

Answer 1

H- AST/ALT elevated

C- AlkPhos elevated (AST/ALT <10x ULN)

Variable in each

Question 2

Acute vs chronic liver dz

AST/ALT
Albumin
PT/INR
AlkPhos

Answer 2

Acute- >10x ULN
Albumin- low in chronic/acute fulminant
PT/INR- elevated in chronic/acute fuminant
AlkPhos- 2x ULN (acute)
4x ULN (chronic)

Question 3

AST/ALT < 1000 possible etiologies

Answer 3

Alcoholic liver dz
A1AT
Autoimmune hep
HepB/C
Drug
Hemochromatosis
NAFLD
Wilson

Question 4

Simple steatosis

Answer 4

Intracellular fat vacuoles

Macrovesicualr

Question 5

Steatohepatitis vs Cirrhosis

Intracellular fat vacuoles/macrovesicular
Hepatocyte ballooning degen and necrosis
PMNs
Mallory bodies
Portal fibrosis
Nodules

Answer 5

S- yes, yes, yes, yes, yes, no

C- y/n, y, y, y, bridging, y

Question 6

AST/ALT > 1000 etiologies

Answer 6

Viral Hep
Ischemic hepatopathy (shock liver)
Toxins (aceto, drugs, shroom)

Question 7

Alcoholic liver dz

Lab values

Answer 7

AST/ALT <300
AST/ALT 2:1

Leukocytosis
Macrocytosis (nutrient def)
Thrombocyto (BM hypoplasia, splenic sequestration)

Question 8

Alk Phos elevated

Elevated protein low albumin think?

Answer 8

Autoimmune hepatitis

Question 9

Autoimmune hepatitis class 1 and 2

ages
M or F?

Answer 9

1- infant to elderly
2- children

Both female

Question 10

Acute hepatitis vs chronic

Portal tract
Hepatocytes
Bile canaliculi

Answer 10

A- scant mono infiltrate
Balloon degen, apop/necrosis
Cholestasis

C- dense mono infiltrate
Portal/central vein fibrosis
Apop/necrosis
No cholestasis

Question 11

Treat HepC

Treat HepB

Answer 11

RNA Polymerase inhibitors

DNA polymerase inhibitors