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Medicine I: Gastroenterology > Acute, Autoimmune and Chronic Hepatitis > Flashcards

Acute, Autoimmune and Chronic Hepatitis Flashcards

1
Q

Know the principal functions of the liver.

A
  • Metabolism of Carbohydrate and Fatty acids
  • Production of serum proteins – including factors involved in coagulation cascade and lipids
  • Synthesis: Fat-soluble vitamins (A, D, E, K)
  • Bile transport
  • Detoxification of blood from gut
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2
Q

Know the labs that are used to evaluate the synthetic function of the liver as well as the presence of inflammation (hepatocellular and cholestatic injury).

A
  • Synthetic function: Albumin and Prothrombin time (PT) (Factors II, VII, IX and X)
  • Inflammation of Liver: ALT/AST/Gamma GGT
  • Biliary obstruction: Alkaline phosphatase & total bilirubin
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3
Q

What are the various causes of acute hepatitis (ie: viral, autoimmune, drugs etc.)?

A

Viral Hepatitis: A, B/D, C, E, EBV, CMV, HSV

Drugs;
– Ethanol, Tylenol (have to overdose on it), Halothane
– Anabolic steroids, Estrogens, Erythromycin, Sulfa, NSAIDs

Toxins: Jamaica Bush tea, W. Mushrooms, energy drinks

Vascular: hypotension, Budd-chiari

Autoimmune Hepatitis

Metabolic disorders: Wilson’s disease, A1AT

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4
Q

What are the various causes of chronic hepatitis (ie: viral, autoimmune, drugs etc.)?

A

Viral Hepatitis: B and C

Drugs: methotrexate, INH, amiodarone

Alcohol

NAFLD (fatty liver disease)

Autoimmune: Autoimmune hepatitis, Primary biliary cirrhosis (PBC),

Primary sclerosing cholangitis (PSC)

Metabolic: A1AT,Hemochromatosis,Wilson’s

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5
Q

Understand the basic diseases associated with autoimmune/hereditary.

A

Autoimmune
– Personal or FHx of liver/diabetes/thyroid

Genetic (FHx)
– Diabetes, Cardiac, Arthritis, HFE
– Neuropsychiatric problems (Wilson’s)
– Emphysema out of proportion to age/smoking hx (A1AT)

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6
Q

What is Primary Biliary Cirrhosis (PBC)?

A

CLD that destroys the bile ducts

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7
Q

What are the signs and symptoms of PBC?

A 
fatigue
itching
jaundice
diarrhea
swollen abd/feet
cholesterol deposits
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8
Q

How do we diagnose PBC?

A

signs/symptoms
blood test
liver biopsy

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9
Q

How do we treat Wilson’s disease?

A

lifetime D-Penicillamine

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10
Q

What labs and imaging studies are used to diagnose hepatocellular cancer and cholestatic patterns?

A
  • Screening methods: AFP > 400 ng/mL, CT scan, U/S, MRI; PE = friction rub
  • Cholestasis: BR, ALP, 5-Nucleotidase and gamma-GGT
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11
Q

Know the basic metabolic causes of hepatitis.

A

Alcoholic Liver Disease and Non-alcoholic Fatty Liver Disease.

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12
Q

What are the characteristics of Alcoholic liver disease?

A
  • Spectrum of ALD
  • Can present as acute hepatitis and jaundice
  • AST/ALT ratio 2-3:1
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13
Q

What is the treatment for Alcoholic liver disease?

A

Stop ETOH or refer to rehab program (EtOH hepatitis NOT an indication for OLTx)

Severe alcoholic hepatitis may require Steroids

Pentoxifylline*

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14
Q

What are the characteristics of Non-acoholic fatty liver disease?

A

Condition that resembles alcohol-induced liver disease but occurs in patients who are not heavy drinkers

Strong associations with obesity, dyslipidemia, hyperinsulinemia and insulin resistance, and overt type II diabetes

Spectrum: Steatosis -> NASH -> cirrhosis

Ratio of AST/ALT usually <1

Typical fatty infiltration seen on ultrasound,CT or MRI

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15
Q

What is the treatment for non-alcholic fatty liver disease?

A

No good treatment. Advise on treating diabetes and lose weight. Vitamin E helpful in steatohepatitis.

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16
Q

Of the viral causes of hepatitis, what are the routes of infection?

A

A: Feces; Fecal-oral

B: Blood/Blood-borne body fluids ; Percutan/ permucosal/ vertical

C: Blood/Blood-borne body fluids; Percutaneous/ permucosal

D: Blood/Blood-borne body fluids; Percutaneous/ permucosal

E: Feces; Fecal-oral

17
Q

Know the possible outcomes of HBV – understand Antigen and Antibody relationships – what results demonstrate infection, replication and immunity?

A

k

18
Q

Understand the serologic markers of HBV and the possible outcomes of HBV – understand Antigen and Antibody relationships – what results demonstrate infection, replication and immunity?

A

k

19
Q

When does each Hep virus evolve to chronic hep?

A
  • Hepatitis A - Never
  • Hepatitis B – >90% (perinatal acquisition) to <5% (adult infection)
  • Hepatitis C - 60-80%
  • Hepatitis D - 2% (coinfection) to 90% (superinfection)
  • Hepatitis E - Occasionally in immunosuppressed patients
20
Q

Chapter 44 - What is the definition of fulminant liver disease? What are the potential complications and what is the main treatment?

A

?

21
Q

What is hepatitis?

A

Inflammation of the hepatocytes, caused by toxins and viruses

22
Q

What are the causes of hepatitis?

A

5 hepatitis virus noted (A, B, C, D, E) – Oral/Fecal

23
Q

What are the clinical manifestations of hepatitis?

A

Skin and scleral icterus
Hepatomegaly
Dark urine and light stools

24
Q

What labs results would you expect in a patient with hepatitis?

A

Elevated AST and ALT (10-20X normal)
Prothrombin time
Serology testing

25
Q

What are the characteristics of Hepatitis A?

A
  • Transmitted fecal-oral route, shellfish
  • No chronic hepatitis
  • Incubation 20-40 days

Serology

Treatment: Vaccine

26
Q

What are the characteristics of Hepatitis B?

A
  • Spread by direct contact with blood or body fluids. Sexual contact.
  • Acute and chronic disease
  • Incubation 60-100 days

Treatment: Interferon and Ribavirin, Prophylaxis, Vaccine

27
Q

What are the characteristics of Hepatitis C?

A
  • Main cause of post-transfusion hepatitis
  • Transmitted by blood and body fluids
  • Time to seroconversion is 6 weeks
  • 70% develop chronic hepatitis
  • There is a link between hepatitis C and hepatocellular cancer

Serology: Hepatitis C antibody

Treatment: Chronic: Alpha interferon and Ribavirin

28
Q

What are the characteristics of Hepatitis D?

A
  • Delta hepatitis
  • Transmitted parenterally
  • Seen only in conjunction with Hepatitis B

Serology: Hepatitis delta antibody

Treatment: Hepatitis B vaccine

29
Q

What are the characteristics of Hepatitis E?

A
  • Transmitted fecal-oral route
  • Contaminated food and water
  • No chronic disease
  • No test available to test for hepatitis E

Medicine I: Gastroenterology (16 decks)

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