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Spring Round II Exams > clin med- hepatitis lectures > Flashcards

clin med- hepatitis lectures Flashcards

1
Q

At what point can you still reverse liver damage (alcohol related)

A

Steatosis

reversible after 4-6 weeks of abstinence

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2
Q

Alcoholic Liver Dz 3 main patterns of injury

A

Fatty liver (simple steatosis)
Alcoholic Hepatitis
Chronic Hep w Fibrosis or Cirrhosis

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3
Q

ALD risk factors

A

> 1 drink/day for women, >2 drinks/day for men

Pattern (daily, binge, fasting)

Obese

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4
Q

Fatty liver

A

A-sx, reversible and self limited (after 4-6 wks of abstinence)

Tx: lifestyle (weight loss and exercise) stop drinking

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5
Q

AH

Alcohol Hepatitis

A

Necrosis and fibrotic scarring

Sx can be none —-> severe

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6
Q

AH severe manifestations

A 
Hepatic encephalopathy
jaundice
Hepatosplenomegaly
Edema
Ascites
Variceal bleeding
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7
Q

AST/ALT ratio in Alcoholic Hepatitis

A

> 1.5

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8
Q

Mallory Denk body

A

Alcoholic Hepatitis

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9
Q

Histology of Alcoholic Hepatitis

A

Neutrophilic lobe inflammation
Clumps of Mallory Denk
Degranulation and fibrosis

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10
Q

Definite dx of Alcoholic Hepatitis

A

Liver biopsy

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11
Q

Confounding factors

A

reasons why Alcohol might not be the cause of the liver damage

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12
Q

Lilie Model

A

response to Steroid

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13
Q

Hepatic Encephalopathy

A

Ammonia travels to brain: neurotoxin

Tx: Lactulose
Sx: EKG change, tremor

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14
Q

4 grades of Hepatic Encephalopathy

A

syndrome of impaired brain fx w/ advanced liver dz

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15
Q

Asterixsis (hand tremor)

A

a sign of Hepatic Encephalopathy

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16
Q

Severe Alcoholic Hepatitis

A

Variceal bleeding
Ascites
Jaundice

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17
Q

Tx of Severe Alcoholic Hepatitis

A

Diuretics

Hepatic Enceph: Lactulose, Rifaximin

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18
Q

Severe Alc Hep diagnostics

A

MDF >32

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19
Q

Tx of Severe Alc Hep

A

Steroids, but stop if not effective after 7 days (using Lilie score)

Liver transplant if meds fail

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20
Q

Liver cirrhosis

A

Process of destruction, regeneration, necrosis, fibrosis and progressive deterioration

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21
Q

Compensated cirrhosis

12 yr survival

A

Portal pressure is not an issue (<10)
Splenomegaly
Anemia
AST elevation

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22
Q

Uncompensated Cirrhosis

<2 yr survival

A

Portal HYPERTENSION

Porto-systemic shunting

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23
Q 
Dupuytren's contracture
Spider nevi
Hepatic enceph
Jaundice
Muscle wasting
Portal HTN
Asterixis
A

Decompensated Cirrhosis

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24
Q

3 possible sites of obstruction causing Portal HTN

A

Prehepatic: Portal vein clot
Intrahepatic: Cirrhosis
Posthepatic: CHF, constrictive pericarditis

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25
Q

HCC surveillance

Hepatocell CA

A

US every 6 mo and AFP

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26
Q

TIPS

A

Transjugular Intrahepatic Portosystemic Shunt

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27
Q

Tx if you have decompensated cirrhosis and MELD score >15

A

Liver transplant

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28
Q

HepatoRenal syndrome

A 
Inc BUN (Azotemia)
prog rise in Cr
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29
Q

HepatoRenal synd

two subtypes

A

Type 1: rapidly progressing, multi organ failure (survival <4 wks)

Type2: assoc w refractory ascites (longer survival about 6mo)

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30
Q

Benign Liver lesions that require NO FURTHER TX

A

Cavernous hemangioma <4 cm
Focal nodular hyperplasia
Simple cyst (no sx)
Focal fatty change

31
Q

Benign Liver lesions REQUIRING further investigation

A

Adenoma
Liver abscess
Inflammatory pseudotumor
Atypical cyst or Large

Refer to GI/Hepatology

32
Q

High suspicion of Hepatocellular CA in

A

Cirrhosis

Hep B

33
Q

How to screen Cirrhotic pts for HCC

A

Platelet count

US elastography

34
Q

How to screen Hep B pts for HCC

A

US every 6 mo + AFP

35
Q

HCC sx

A

Sudden appearance of Ascites
Cachexia
Weight loss

36
Q

Dx of HCC

A

High AFP and ALP

Order: CT first, then Tri phasic MRI if CT not helpful

37
Q

DIAGNOSTIC For HCC

A

Liver biopsy

but try Tri phasic CT –> MRI first

38
Q

HCC tx

A

Resection rarely feasible
Liver transplant early stage
RFA/Microwave for small tumors
Chemo

39
Q

Most at risk for Fatty liver (steatohepatitis)

A

Asian indians

40
Q

Ratio of >1.5

A

Alcoholic liver dz

41
Q

Order of ALT values- Highest to lowest

A 
Shock
Acute hep
Alcohol
Chronic hep
Cirrhosis
Normal
42
Q

Progression of Fatty liver

A

NAFL (no evidence of liver cell injury) –> NASH (inflammation w liver cell injury) –> NASH Cirrhosis (cirrhosis + steatosis)

43
Q

NAFL

A

no injury

44
Q

NASH

A

hepatocyte injury present

45
Q

Two main risk factors for NAFLD

A

Obesity

DM2

46
Q

Fibroscan results indicating fatty liver

A

Fibroscan (VCTE) >5%

47
Q

HH

A

accum of IRON

48
Q

HH

A

Caucasians

Bronze skin, joint, cardiomegaly

49
Q

Triad of Bronze skin, DM, and Cirrhosis

A

HH

50
Q

Transferrin and

Ferritin values indicating HH

A

Transferrin> 45

Ferritin > 200 or 150 (men, women respectively)

51
Q

Tx for HH

A

Phlebotomy every 6 mo with CA screening (US and AFP)

52
Q

How is HH dx confirmed

A

HFE gene testing +/- liver bx

53
Q

Screen for HH if pt has

A 
Elevated AST/ALT
Abn iron studies
1st deg relative w HH
Evidence Liver dz
Sx of HH
54
Q

Wilson dz

A

Copper

Keyser fisher ring + Neuro

55
Q

Dx Wilson dz (copper)

A

24 hr Urinary copper

Confirm w Liver bx

56
Q

Tx of Wilson dz (copper)

A

Chelating agent

Liver transplant

57
Q

A1 deficiency

A

Inc risk:smoking
Panniculitis

Emphysema and or Neonatal cholestasis/childhood cirrhosis

58
Q

A1 deficiency tx

A

Liver transplant

59
Q

AIH: Autoimmune Hepatitis

A

Non spec sx
(fatigue, abd pain, pruritis, joint pain)

Acute onset if <30 days: hepatomegaly, tender, jaundice, splenomegaly, fever

60
Q

Serological markers for AIH: Autoimmune Hep

A

ANA
SMA
IgG
LKMA-1 (kids)

61
Q

Tx for AIH: Autoimmune Hep

A

Prednisone +/- Azothioprine

62
Q

Hep A

A

Asia, Africa
sanitation

Does NOT cause chronic
Flu like sx in prodrome

Icteric: jaundice, dark urine, pruritis, light colored stool, jaundice

63
Q

Hep A titers

A

IgM anti-HAV: Acute infection
M MEANS ACUTE

IgG anti-HAV: Immunity
G means you’re GOOD

64
Q

Tx for Hep A

A

Supportive

High risk: hospitalize

65
Q

Leading cause of Cirrhosis and Liver CA

A

Hep B

66
Q

Hep B

A

Usually becomes chronic in kids

Adults usually recover with immunity

67
Q

Acute Hep B is more severe in elderly of what age

A

> 60 YO

68
Q

Tx for Hep B

A

Supportive +/- Antiviral (only in acute liver failure or protracted course)

Hospitalize risky pts

69
Q

Hep C

A

MOST become Chronic

70
Q

Testing for Hep C

A

RNA viral load of Hep C Antibody

71
Q

Hep C screening

A

One time testing for ALL 18 YO or older

72
Q

Hep C tx

A

Stop drinking
DAAT
Vaccinae for Hep A and B

73
Q

Hep E is most dangerous in what term of pregnancy

A

2nd and 3rd trimester

Spring Round II Exams (10 decks)

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