Acute/ Chronic Hepatitis Flashcards
List the differential diagnosis for acute hepatitis
How do you start evaluating acute liver failure?
- Ultrasound of liver
- check flow
- density
- AST/ALT/ALP/Bili/DBili/Albumin
- liver panel
- Viral Hepatitis Panel, HSV titers, Quant PCR
- PT/INR, CBC, Coombs test
- INR: synthetic function of liver
- platelets
- coombs: autoimmune hemolytic anemia
- ANA/ anti-mitochondrial Ab/ anti-LKM1
- autoimmune hepatitis
- Ammonia, LDH
- hemolysis will jack up LDH
- APAP level, Tox Screen, EtOH
Treatment hyperammonemia?
Describe the different grades of hepatic encephalopathy
laculose – antibiotic to reset gut flora
Usually start noticing at grade 2
grade is completely symptom based, not based on ammonia level
Symptoms associated with acute liver failure?
Not necessarily going to clinically see the seizures
Lab abnormalities you would expect to see in someone with aute liver failure?
b/c liver is involved in glucose metabolism, so altered mental status can be from hypoglycemia
What is the treatment for acetaminophen overdose?
In addition to liver problems, what other organ failure is frequently seen with acetaminophen overdose?
- N-acetylcysteine (scavenger of free radicals)
- best if started early
- IV
- Part of problem w/ acetominophen is that it depleted glutathione, which is the natural scavenger of free radicals in the liver
- Acute renal failure (70%)
- urine sodium (fractional excretion of sodium) = very low w/o diuretics
- possibly similar to hepatorenal syndrome
If patient is unconscious, how do you determine the timeline?
Draw initial tylenol level & check again in 3 hours
Rumack-Matthew Line gives us a timeline due to natural & expected decay of the tylenol
What is the treatment for ethylene glycol or methanol toxicity?
- Fomepizole (alcohol dehydrogenase inhibitor)
What is a complication that can result after massive hepatocellular necrosis?
What type of treatment will these patients benefit from & how do we determien who these patients are?
- secondary inflammatory response
- benefit from steroids
- Maddrey hepatitis discriminantory function
- >32, benefit from steroids
Treatment for acute hepatitis B?
What is the caveat?
- Very uncommon to treat Hep b
- expensive & lots of complications
- Interferon-alpha - not used much anymore
- mental comorbidity
- Entecavir or tenofovir
- only for decomplensated liver failure
- significnat onlyg immune activation
- ALT >2x ULN and virla load greater than 10^5 copies/mL
- AASLD guidelines
Under what conditions is Hepatitis B most likely to cause chronic infection?
Why is chronic infection of Hep B particularly dangerous?
Post-exposure treatment of an adult?
- vertical transmission
- can cause cancer
- treat during immune clearnce phase and reactivation – treated for about a year
- goal of treatment is to reduce inflammation, not cure
- Post-exposure prophylaxis includes HepB vaccine & HepB immune globulin
Treatment of acute Hepatitis C?
- We do not usually treat acute hepatitis C, we usually wait to see if they will develop an chronic infection
- Oral direct acting antivirals
Treatment for acute fatty liver of pregnancy?
- how viable is the baby vs. how sick is the mom
Treatment of autoimmune hepatitis?
immune suppression
How do you treat hyperbilirubinemia?
What is the additional concer of this with children?
- kernicterus
- worry where bilirubin can precipitate out & cause brain damage
- CVVH
- hemofiltration
Treatment for Hyperammonemia?
sodium phenylbuteyrate– experimental
phenobarbital- seizures & get ammonia down
Important supportive care considerations for treating a patient with hepatitis?
