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GI - 2 > Chronic Liver Disease - part 1 > Flashcards

Chronic Liver Disease - part 1 Flashcards

1
Q

What characterizes Chronic Hepatitis?

A

Chronic inflammatory reaction in the liver for at least 6 months

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2
Q

List some common causes of Chronic Hepatitis and what complication they can all result in?

A
  • Viral
  • Autoimmune
  • Alcohol
  • NAFLD
  • Genetic
  • Heart
    == CIRHOSIS
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3
Q

Main transmission for Chronic Viral Hepatitis B?

A

Mother - to - baby

  • 90% chance infant will get chronic infection
  • The younger the child at time of infection, the more likely it will become chronic
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4
Q

What skin manifestation is seen with Hepatitis B?

A

Cutaneous Polyarteritis Nodosa

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5
Q

Main transmission for Chronic Viral Hepatitis C?

A

Blood (fighters), Needles

– HIV pts commonly co-infected

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6
Q

Symptoms of Hepatitis C?

A

Mild and Asymptomatic

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7
Q

What lab findings will be in the serum to diagnose Chronic Viral Hepatitis C?

A

HCV RNA + Ab

Ab W/O RNA = prior infection

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8
Q

AST/ALT and serum cholesterol levels for Chronic Viral Hepatitis C?

A

Normal AST/ALT

LOW serum cholesterol

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9
Q

What should patients with chronic liver disease get to try and protect them against Hepatitis C?

A

Hepatitis A and B vaccines

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10
Q

Possible complication of Chronic Viral Hepatitis C?

A

Mixed Cryoglobulinemia

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11
Q

Most common type of Autoimmune Hepatitis?

A

Type 1 (classic) = anti-smooth muscle

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12
Q

Most common type of Autoimmune Hepatitis?

A

Type 1 (classic) - anti-smooth muscle

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13
Q

Autoimmune Hepatitis usually presents in females with an insidious onset. Describe what you will see with the patient?

A

Healthy appearing young woman with stigmata of cirrhosis

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14
Q

Autoimmune Hepatitis usually presents in females with an insidious onset. Describe what you will see with the patient?

A

Healthy appearing young woman with stigmata of cirrhosis

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15
Q

What antibodies will be (+) with Autoimmune Hepatitis Type 1?

A

SMA (smooth muscle antibody)

IgG (hypergammaglobulinemia)

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16
Q

What is the treatment for Autoimmune Hepatitis?

A

Glucocorticoids and monitor liver function

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17
Q

AST/ALT levels and bilirubin levels for Autoimmune Hepatitis?

A

AST/ALT > 1000

Elevated Bilirubin

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18
Q

Alcohol-Induced Liver Disease patients often deny?

A

Alcohol use

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19
Q

Describe the progression of Alcohol-Induced Liver Disease

A
  • Steatosis (fatty liver) = asymptomatic hepatomegaly
  • Alcoholic Hepatitis (steatohepatitis)
    = Jaundice, ascites, RUQ pain, GI bleed, encephalopathy
  • Cirrhosis and liver failure
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20
Q

Steatosis - > Alcoholic Hepatitis -> Cirrhosis is seen with?

A

Alcohol-Induced Liver Disease

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21
Q

What part of the continuum that is Alcohol-Induced Liver Disease can be reversible with withdrawal of alcohol?

A

Fatty liver (steatosis)

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22
Q

AST:ALT ratio with Alcohol-Induced Liver Disease?

A

2:1

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23
Q

What will be seen on liver biopsy of Alcohol-Induced Liver Disease?

A

Mallory bodies (alcoholic hyaline)

24
Q

Treatment for Alcohol-Induced Liver Disease?

A 
Abstain from alcohol
Daily multivitamin
Thiamine 100mg
Folic acid 1 mg
Zinc
25
Q

What should be monitored and why when patients have Alcohol-Induced Liver Disease?

A

Glucose because glucose administration can require an increased Thiamine requirement to avoid Wernicke-Korsakoff

26
Q

Those with Alcohol-Induced Liver Disease may be eligible for a liver transplant if they are off alcohol for at least?

A

6 months

27
Q

3 poor prognosis items for Alcohol-Induced Liver Disease?

A
  • Maddrey’s Discriminant Function > 32
  • Glasgow Alcoholic Hepatitis Score
  • Model for End stage Liver Disease (MELD) > 21
28
Q

Possible complications with Alcohol-Induced Liver Disease?

A

Wernicke - Korsakoff syndrome

29
Q

Wernicke Encephalopathy

A

Confusion, Ataxia, Abnormal eye movements

= Give thiamine and it will reverse

30
Q

Korsakoff Syndrome

A

Confabulation and memory issues

= Permanent

31
Q

What is the most common cause of Chronic Liver Disease in US?

A

Non-Alcohol Induced Fatty Liver Disease (NAFLD)

32
Q

How do you prevent NAFLD?

A

Physical activity and coffee

33
Q

Who is at increased risk for NAFLD?

A

Metabolic syndrome patients (obese), etc.

34
Q

Symptoms of NAFLD?

A

Asymptomatic with hepatomegaly

35
Q

What will be seen on livery biopsy with NAFLD?

A

Mallory bodies and steatosis

– Looks the same as alcoholic hepatitis

36
Q

Treatment for NAFLD?

A

Lifestyle modifications

37
Q

Alpha 1 Antitrypsin Deficiency arises how?

A

Genetic;

  • Deficiency causes alpha 1 antitrypsin to accumulate in liver cells
  • Liver damage occurs
  • Decreased release of protease inhibitor
38
Q

With Alpha 1 Antitrypsin Deficiency, there is decreased release of protease inhibitors, what does that cause?

A

Protease activity is NOT stopped!!

== Pulmonary emphysema

39
Q

Symptoms of Alpha 1 Antitrypsin Deficiency?

A

Panacinar emphysema of lower lung lobes in young patients

40
Q

What lung lobes are affected with Alpha 1 Antitrypsin Deficiency?

A

Lower

41
Q

What gene on chromosome 14 will have severely decreased Alpha 1 Antitrypsin?

A

PiZZ

42
Q

Hemochromatosis is inherited how and involves what gene?

A 
Autosomal recessive
HFE mutation (c282y)
43
Q

Hemochromatosis involves increased iron being absorbed at _____ and is stored in tissues as _____

A

Duodenum

Increased Hemosiderin

44
Q

Describe the progression of Hemochromatosis

A
  • Asymptomatic with increased iron saturation
  • TETRAD = heart failure, diabetes, bronze skin, cirrhosis with hepatomegaly
  • Arthropathy and erectile dysfunction
45
Q

What is the Tetrad that will be seen later with Hemochromatosis?

A

Heart failure
Diabetes
Bronze skin
Cirrhosis with hepatomegaly

46
Q

Hemochromatosis involves iron overload; greater than ____ saturation

A

> 45% transferrin saturation

47
Q

Who should be screened for HFE mutations?

A

ALL 1st degree family members

48
Q

Treatments for Hemochromatosis?

A
  • Phlebotomy = depletes iron stores along with deferoxamine
  • Avoid iron
  • Liver transplant
49
Q

Wilson Disease is inherited?

A

Autosomal recessive

50
Q

Describe what happens with Wilson Disease

A
  • Excessive Copper absorption
  • Impaired copper excretion into the bile via the liver
  • Copper will not be incorporated into Ceruloplasmin
51
Q

Where will copper accumulate with Wilson Disease and what blood issue does it cause?

A

Brain, liver, eye and also causes hemolytic anemia

52
Q

Signs of Wilson Disease?

A

Neurologic manifestations
Behavior/emotional changes
Kayser-Fleischer ring around the eye

53
Q

Signs of Wilson Disease?

A

Neurologic manifestations
Behavior/emotional changes
Kayser-Fleischer ring around the eye

54
Q

Kayser-Fleischer ring around the eye will be seen with?

A

Wilson Disease

- impaired copper excretion

55
Q

Lab results with Wilson Disease?

A

LOW ceruloplasmin

MRI shows copper in brain

56
Q

Treatment for Wilson Disease?

A

Oral Penicillamine to aid chelated copper excretion

57
Q

Treatment for Wilson Disease?

A

Oral Penicillamine to aid chelated copper excretion

GI - 2 (61 decks)

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