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GI II Exam 2 > Chronic Hepatitis > Flashcards

Chronic Hepatitis Flashcards

1
Q

Define Chronic Hepatitis

A

chronic inflammation of more than 6 months

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2
Q

Common symptoms of chronic hepatitis

A

Fatigue
Malaise
Jaundice
Fever

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3
Q

What do Serum Fibrosure and US elastography evaluate?

A

Non-invasive way to evaluate fibrosis of the liver

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4
Q

Cirrhosis due to HCV risk factors

A 
Male
More than 5 drinks daily (shit...)
Infection after 40 
Immunocompromised
Tobacco and Cannabis use
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5
Q

Autoimmune Hepatitis

A

Type I: Anti-smooth muscle + ANA
Type II: Anti-liver/kidney microsomal (LKM)

Mainly Female 30-50’s
Progressive jaundice, epistaxis, amenorrhea
Hepatocellular type chemistry (elevated AST/ALT)

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6
Q

Treatment for autoimmune hepatitis

A

Symptomatic

Glucocorticoids can potentially help

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7
Q

What can excessive EtOH intake cause?

A

A good time

Fatty liver
Hepatitis
Cirrhosis

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8
Q

What is defined as excessive EtOH intake

A

Males: >80g/day
Females: >30-40g/day

4 oz whiskey
15 oz wine
4 beers

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9
Q

Symptoms of Alcoholic Liver Disease

A

Asymptomatic hepatosplenomegaly
Elevation of Liver tests (Bilirubin and ALP)
2:1 increase of AST:ALT
Hypoalbuminemia

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10
Q

CBC findings of Alcoholic Liver disease

A

Leukocytosis with left shift
Anemia (Macrocytic/Megaloblastic)
Thrombocytopenia
Elevated PT time

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11
Q

What is the treatment for Alcoholic Liver disease

A

stop drinking
Nutrition support including Thiamine to prevent Wernicke-Korsakoff

*GIVE THIAMINE WITH OR PRIOR TO GLUCOSE

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12
Q

Wernicke-Korsakoff Syndrome

A

“Wet, Wobbly, Wacky”

  • Saccadic eye movement
  • Confabulation
  • Incontinence
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13
Q

Severe Alcoholic Hepatitis lab findings

A

Total bili >8-10 mg/dL and PTT > 6 sec

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14
Q

What are the cutoff numbers for the Maddrey’s Discrimination Function, Glasgow Alcoholic Hepatitis Score, and MELD Scores that indicate glucocorticoid use and poor prognosis?

A

DF: >32
Glasgow: >9
MELD: >21 (>14 are put on liver transplant list)

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15
Q

What is the most common cause of chronic liver disease in the US?

A

Non-Alcoholic Fatty Liver Disease

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16
Q

What are the main causes of NAFLD and what can patient’s develop?

A

Metabolic syndrome:

  • Obesity
  • the bedis
  • High Triglycerides

Increased risk for CVD, CKD, CRC

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17
Q

Alpha 1 AntiTrypsin Deficiency

A

AR disorder
low levels of a1-antitrypsin leads to loss of inhibition of proteases which leads to liver damage.
- Pulmonary emphysema in lower lobes in young people
- MOST COMMON diagnosed hepatic disorder in children and infants

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18
Q

What genotype is associated with alpha-1 antitrypsin deficiency?

A

PiZZ on Chr. 14

19
Q

Primary Biliary Cholangitis

A

autoimmune destruction of intrahepatic bile ducts and cholestasis

  • Female predominance median age of 50
  • Isolated elevation in ALP
  • AMA Ab’s
  • Increased IgM levels
20
Q

Risk factors and PE findings for Primary Biliary Cholangitis

A

Recurrent UTI’s
Smoking
HRT
Hair dye?

PE: Pruritis, jaundice, xanthelasmas

Tx: Ursodeoxycholic Acid

21
Q

Classic tetrad of Hemochromatosis

A
  1. Cirrhosis with HSM
  2. Abnormal pigmentation
  3. DM
  4. Cardiac Dysfunction
22
Q

Hemochromatosis etiology

A

AR
HFE gene mutation on Chr. 6 resulting in abnormal sequestration of Iron in the liver, pancreas, heart, kidneys, balls, pituitary

23
Q

Lab findings in Hemochromatosis

A

> 45% transferrin saturation with elevated serum ferritin

24
Q

Treatment for Hemochromatosis

A
  1. Phlebotomy
  2. PPI to reduce intestinal iron absorption
  3. Deferoxamine
25
Q

What 3 infectious agents are hemochromatosis patients at risk for?

A

Vibrio Vulnificus
Listeria Monocytogenes
Yersinia

26
Q

Wilson Disease

A 
AR disorder in ATP7B protein 
Impaired copper excretion and failure to incorporate it into ceruloplasmin 
- Hemolytic Anemia
- Psychiatric problems
- Kayser-Fleischer rings

Tx: Oral Penicillamine

27
Q

What is seen on liver biopsy in patients with right-sided heart failure?

A

Nutmeg Liver- Chronic venous congestion causing stasis

28
Q

What is “shock liver”

A

hepatitis caused by ischemia

- rapid elevation in AST/ALT greater than 5000 with a rapid rise in LDH

29
Q

3 most common causes of cirrhosis

A
  1. Hep C
  2. EtOH
  3. NAFLD
30
Q

Pathophysiology of cirrhosis

A

Liver cell injury–> Fibrosis–> diminished blood flow–> nodule formation

31
Q

What is protective from cirrhosis?

A

Coffee and tea consumption

32
Q

Common findings on PE of cirrhosis

A 
Jaundice
telangiectasias
Gynecomastia
Ascites
Palmar Erythema
Asterixis (Liver flap)
Dupuytran's Contracture
33
Q

What infection is Cryoglobulinemia seen in?

A

HCV

34
Q

Nail changes associated with cirrhosis

A

Muehrcke lines- what lines separated by normal nail color

Terry Nails- darkening close to the distal nail secondary to hypoalbunemia

35
Q

What must you rule out in a patient with ascites via an abdominal paracentesis?

A

Spontaneous Bacterial Peritonitis (SBP)

36
Q

Primary biliary cholangitis Ab

A

Anti-mitochondrial (AMA)

37
Q

Autoimmune hepatitis Ab

A

Type I: SMA (Anti-smooth muscle)

Type II: anti Liver-kidney (LKM)

38
Q

If serology shows >250 PMN/mL what is the Ddx?

A

SBP

39
Q

Treatment for HCC

A

Ablation or partial resection

Liver Transplant

40
Q

Management of decompensated cirrhosis

A

No EtOH, drugs, or Tobacco
Acetaminophen
Monitor AFP and perform US every 6m looking for HCC

41
Q

What are ascites?

A

accumulation of fluid in peritoneal cavity secondary to portal hypertension (most common cause)

42
Q

SAAG score

A

Serum Albumin - Ascites Albumin
>1.1 is Liver issue
<1.1 is something else (Biliary, Nephrotic, Pancreatitis)

43
Q

Hepatic Encephalopathy

A

Alteration in mental status in the presence of liver failure. Ammonia typically elevated but NOT correlated with severity (don’t monitor)

Tx: Lactulose (acidifies colon to trap basic ammonia in it to be excreted)

GI II Exam 2 (16 decks)

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