Acute and Chronic Hepatitis... the sequel Flashcards
What’s one of the few things that can get liver enzymes over 10,000 (units)?
Acetominophen
Review: What’s the liver enzyme ratio to remember for alcoholic hepatitis?
> 3:1 AST:ALT
he says 3:1, Krok said 2:1…
What are the absolute levels of liver enzymes like in alcoholic hepatitis compared to other types of hepatitis?
They tend to be low, due to the nutritional deficiencies that go with alcoholism.
Non-hepatic causes of AST and ALT elevation?
Celiac, hypothyroidism, muscle problems
If you see elevated Alk Phos, you should think…
Cholestasis
Places other than liver that Alk Phos can come from?
bone, placenta, kidney
Which hepatitis viruses are spread enterically?
HAV and HEV
they’re non-enveloped
Trivia?: What’s the only hepatitis virus that’s a DNA virus?
HBV
What’s the post-exposure prophylaxis for HAV?
Immune globulin
Vaccination
What can a positive anti-HBc alone mean? (no HBs-Ag, no anti-HBs-Ab, no anti-HBc IgM)
Past infection, but immunity has waned.
False positive.
Very rarely - chronic infection.
What’s the significance of HBe-Ag?
It’s present when HBV is actively replicating - associated with high viral loads and contagiousness.
(can get a false negatives in some HBV strains with mutated pre-core Ag)
If a patient has high HBe-Ag, but normal liver enzymes, what’s going on?
They’re immune tolerant - the virus is there replicating a lot, but the immune system isn’t napalming the liver.
Review: What 3 drugs are the first-line therapy for chronic HBV?
Peginterferon alfa-2a
Tenofovir
Entecavir
What’s a good endpoint for treatment of HBV?
Loss of HBe-Ag.
Cure (loss of HBs-Ag and gain of anti-HBs IgG) only happens 5% of time.
What’s the leading cause of liver cancer in the US / world?
HCV
Does HCV have a lot of extrahepatic manifestations?
Yep… including necrotizing vasculitis, cryoglobulinemia, others.
Is HCV curable?
Yes, it seems so, and will be moreso soon.
What’s the old treatment for HCV?
PEGylated interferon + ribavirin.
How do you distinguish steatosis from steatohepatitis?
Biopsy
Best treatment for NAFLD?
Weight loss.
forget pioglitazone
Review: 2 drugs notorious for intrinsic drug-induced liver injury (DILI)?
Acetominophen
Methotrexate
Are people with existing liver disease more likely to get idiosyncratic DILI?
No.
Take-home point: Don’t be afraid to use statins if people need them.
What formula is used to evaluate biochemical patterns of DILI?
R value: Which is ( ALT / upper limit of normal) / (Alk Phos / upper limit of normal).
Different values suggest hepatocellular, cholestatic, or mixed patterns of injury.
Review: What’s Hy’s law?
Not-review: What’s quantitative version of this?
Hepaptocellular injury + jaundice from DILI predict at least 10% mortality.
Quantitative: ALT > 3x upper limit of normal and Total Bili > 2x upper limit of normal leads to at least 10% risk of mortality.
If you see AMA (fatigue, pruritis, and xanthomas), think…
PBC
