Chronic Hepatitis And Cirrhosis

Question 0

Patient with ascites caused by portal hypertension as a complication of hepatic cirrhosis. Next step?

Answer 0

Perform a paracentesis to evaluating ascitic fluid and evaluate for spontaneous bacterial peritonitis

Question 1

Spontaneous bacterial peritonitis? How common?

Answer 1

Bacterial infection of ascitic fluid without any intra-abdominal source of infection. Occurs 10% to 20% of cirrhotic patients with ascites.

Question 2

The most common causes of chronic hepatitis?

Answer 2

1. Hepatitis B and C
2. Alcohol
3. Autoimmune hepatitis
   4 chronic exposure to drugs toxins

Question 3

Less common causes of chronic hepatitis?

Answer 3

1. Hemachromatosis
2. Wilson disease
3. Alpha-1 antitrypsin deficiency

Question 4

Test for autoimmune hepatitis?

Answer 4

AMA, anti-LKM (liver kidney microsome)

Question 5

Test for hemachromatosis?

Answer 5

High transferrin saturation, High ferritin

Question 6

Test for Wilson’s disease?

Answer 6

Low serum ceruloplasmin

Question 7

Ways to test for hepatitis C?

Answer 7

1. ELISA test to detect anti-HCV antibody

2. PCR to detect HCV RNA

Question 8

Percentage of patients who will develop chronic hepatitis from HCV infection? Percentage who will develop cirrhosis? Percentage who will develop hepatocellular carcinoma?

Answer 8

70 to 80% within 10 years
20% within 20 years
After getting cirrhosis, 1% to 4% annually develop HCC

Question 9

Treatment of choice for chronic hepatitis C? The side effects?

Answer 9

Pegylated alpha interferon (Flu like symptoms and depression) and ribavirin (Hemolysis)

Question 10

Symptoms of cirrhosis?

Answer 10

1. Portal Hypertension
2. Decreased liver function (jaundice, impaired synthesis of albumen, clotting factors, steroid hormone binding proteins)
3. Hepatic encephalopathy

Question 11

Portal hypertension: clinical presentation? Diagnosis? Treatment?

Answer 11

Ascites, splenomegaly, hypersplenism, encephalopathy, bleeding varices

Evaluation of portal bloodflow using Doppler ultrasound

Nonselective beta blockers (propranolol), Octreotide causes splanchnic vasoconstriction

Question 12

Ascites: clinical presentation? Diagnosis? Treatment?

Answer 12

Abdominal distention with peripheral edema

Finding free peritoneal fluid on physical exam

Sodium restriction, spironolactone, loop diuretics, Paracentesis

Question 13

Spontaneous bacterial peritonitis: clinical presentation? Diagnosis? Treatment?

Answer 13

Abdominal pain, fever, extension, decreased towel sounds

Ascitic fluid contains >250 polymorphonuclear neutrophils and confirmed with positive culture

IV antibiotics (cefotoxime or ampicillin/sulbactam)

Question 14

Most common organisms that cause spontaneous bacterial peritonitis?

Answer 14

E. coli, Klebsiella, enteric flora, enterococci, pneumococci

Question 15

Liver cirrhosis leads to a decrease steroid hormone binding globulin. Effect?

Answer 15

Increased amounts of free estrogen which lead to formation of

1. Spider angiomaya
2. Palmer erythema
3. gynecomastia

Question 16

Most common cause of ascites?

Answer 16

Portal hypertension as a consequence of cirrhosis

Question 17

Pathogenesis of ascites?

Answer 17

1. Decrease effective circulatory blood volume because of portal hypertension (underfill theory)
2. Inappropriate renal sodium retention being to hyperlipoidemia (Overfill theory)
3. Decreased plasma oncotic pressure

Question 18

Serum ascites albumin gradient?

Answer 18

Serum albumin - ascitic albumin

If >1.1 caused by portal hypertension (Cirrhosis, portal vein thrombosis, Bud-Chiari syndrome, CHF, constrictive pericarditis)

If <1.1 Non-portal hypertension (Peritonitis, pancreatic ascites, bowel obstruction, serositis, nephrotic syndrome)

Question 19

End stage developments of hemochromatosis?

Answer 19

Diabetes, cirrhosis of the liver, hypogonadisn, arthropathy, cardiomyopathy, bronze skin

Question 20

Patient with ulcerative colitis presents with liver problems. Cause?

Answer 20

Sclerosing cholangitis

Question 21

Alkaline phosphatase elevated 2 to 5 times above normal baseline and otherwise asymptomatic patient?

Answer 21

Primary biliary cirrhosis