Chronic Hepatitis Flashcards
Define Chronic Hepatitis
chronic inflammation of more than 6 months
Common symptoms of chronic hepatitis
Fatigue
Malaise
Jaundice
Fever
What do Serum Fibrosure and US elastography evaluate?
Non-invasive way to evaluate fibrosis of the liver
Cirrhosis due to HCV risk factors
Male More than 5 drinks daily (shit...) Infection after 40 Immunocompromised Tobacco and Cannabis use
Autoimmune Hepatitis
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)
Treatment for autoimmune hepatitis
Symptomatic
Glucocorticoids can potentially help
What can excessive EtOH intake cause?
A good time
Fatty liver
Hepatitis
Cirrhosis
What is defined as excessive EtOH intake
Males: >80g/day
Females: >30-40g/day
4 oz whiskey
15 oz wine
4 beers
Symptoms of Alcoholic Liver Disease
Asymptomatic hepatosplenomegaly
Elevation of Liver tests (Bilirubin and ALP)
2:1 increase of AST:ALT
Hypoalbuminemia
CBC findings of Alcoholic Liver disease
Leukocytosis with left shift
Anemia (Macrocytic/Megaloblastic)
Thrombocytopenia
Elevated PT time
What is the treatment for Alcoholic Liver disease
stop drinking
Nutrition support including Thiamine to prevent Wernicke-Korsakoff
*GIVE THIAMINE WITH OR PRIOR TO GLUCOSE
Wernicke-Korsakoff Syndrome
“Wet, Wobbly, Wacky”
- Saccadic eye movement
- Confabulation
- Incontinence
Severe Alcoholic Hepatitis lab findings
Total bili >8-10 mg/dL and PTT > 6 sec
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?
DF: >32
Glasgow: >9
MELD: >21 (>14 are put on liver transplant list)
What is the most common cause of chronic liver disease in the US?
Non-Alcoholic Fatty Liver Disease
What are the main causes of NAFLD and what can patient’s develop?
Metabolic syndrome:
- Obesity
- the bedis
- High Triglycerides
Increased risk for CVD, CKD, CRC
Alpha 1 AntiTrypsin Deficiency
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
What genotype is associated with alpha-1 antitrypsin deficiency?
PiZZ on Chr. 14
Primary Biliary Cholangitis
autoimmune destruction of intrahepatic bile ducts and cholestasis
- Female predominance median age of 50
- Isolated elevation in ALP
- AMA Ab’s
- Increased IgM levels
Risk factors and PE findings for Primary Biliary Cholangitis
Recurrent UTI’s
Smoking
HRT
Hair dye?
PE: Pruritis, jaundice, xanthelasmas
Tx: Ursodeoxycholic Acid
Classic tetrad of Hemochromatosis
- Cirrhosis with HSM
- Abnormal pigmentation
- DM
- Cardiac Dysfunction
Hemochromatosis etiology
AR
HFE gene mutation on Chr. 6 resulting in abnormal sequestration of Iron in the liver, pancreas, heart, kidneys, balls, pituitary
Lab findings in Hemochromatosis
> 45% transferrin saturation with elevated serum ferritin
Treatment for Hemochromatosis
- Phlebotomy
- PPI to reduce intestinal iron absorption
- Deferoxamine
What 3 infectious agents are hemochromatosis patients at risk for?
Vibrio Vulnificus
Listeria Monocytogenes
Yersinia
Wilson Disease
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
What is seen on liver biopsy in patients with right-sided heart failure?
Nutmeg Liver- Chronic venous congestion causing stasis
What is “shock liver”
hepatitis caused by ischemia
- rapid elevation in AST/ALT greater than 5000 with a rapid rise in LDH
3 most common causes of cirrhosis
- Hep C
- EtOH
- NAFLD
Pathophysiology of cirrhosis
Liver cell injury–> Fibrosis–> diminished blood flow–> nodule formation
What is protective from cirrhosis?
Coffee and tea consumption
Common findings on PE of cirrhosis
Jaundice telangiectasias Gynecomastia Ascites Palmar Erythema Asterixis (Liver flap) Dupuytran's Contracture
What infection is Cryoglobulinemia seen in?
HCV
Nail changes associated with cirrhosis
Muehrcke lines- what lines separated by normal nail color
Terry Nails- darkening close to the distal nail secondary to hypoalbunemia
What must you rule out in a patient with ascites via an abdominal paracentesis?
Spontaneous Bacterial Peritonitis (SBP)
Primary biliary cholangitis Ab
Anti-mitochondrial (AMA)
Autoimmune hepatitis Ab
Type I: SMA (Anti-smooth muscle)
Type II: anti Liver-kidney (LKM)
If serology shows >250 PMN/mL what is the Ddx?
SBP
Treatment for HCC
Ablation or partial resection
Liver Transplant
Management of decompensated cirrhosis
No EtOH, drugs, or Tobacco
Acetaminophen
Monitor AFP and perform US every 6m looking for HCC
What are ascites?
accumulation of fluid in peritoneal cavity secondary to portal hypertension (most common cause)
SAAG score
Serum Albumin - Ascites Albumin
>1.1 is Liver issue
<1.1 is something else (Biliary, Nephrotic, Pancreatitis)
Hepatic Encephalopathy
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)
