Clinical Approach to the Hepatobiliary Patient: Acute Hepatitis and Acute Liver Failure Flashcards
how do you treat an acetaminophen overdose?
N-acetylcysteine aka NAC (mucomyst)
what is acute (fulminant) liver failure (ALF)?
massive hepatic necrosis with impaired consciousness occurring within 8 weeks of the onset of illness
what is the #1 cause of ALF?
acetaminophen
what are the AST/ALT levels in acetaminophen toxicity?
> 5000 u/L
how do you make the diagnosis of acute HAV?
HAV Ab= IgM anti-HAV
what does it mean if a patient has IgG anti-HAV (in the absence of IgM anti-HAV)?
they had a previous exposure to HAV, non-infectivity, and immunity
where is HBV endemic?
sub-saharan africa and southeast asia
what is HBV associated with?
glomerulonephritis, serum sickness, and polyarteritis nodosa
what are the diagnostic features of HBV? (labs not serology)
elevated AST/ALT but normal alk phos and bilirubin; elevated INR
how is HDV transmitted?
via blood
how do you make the diagnosis of HDV?
HDV Ag (IgG or IgM= infection) or HDV RNA
what are the complications associated with HCV?
cirrhosis, HCC, HIV co-infection; mixed cryoglobulinemia
what is the most sensitive indicator of HCV infection?
HCV RNA
how do you treat HCV?
curable with proper antiviral treatment; there is no vaccine though
what is the primary prevention for HCV?
birth cohort screening of persons born between 1945-1965 for HCV infection; all over 18 should have at least once in a lifetime screening for HCV
how is HEV spread?
by swine
where is HEV endemic?
asia, middle east, north africa, central america, india
can HEV become chronic?
yes- in immunocompromised hosts
what are the complications associated with HEV?
there is a high mortality rate in pregnant women due to fulminant liver failure
what are some examples of direct hepatotoxins?
mushroom poisoning, acetaminophen (tylenol, APAP, Paracetamol), tetracyclines, valproic acid
how do you make the diagnosis of DILI?
based on history and temporal relationship, exclude other causes of liver disease, it may be associated with eosinophilia; no AMA
what are the healthy dose limits for acetaminophen?
3 grams/24 hours for healthy liver or 2 grams/24 hours in liver disease
what is the critical ingestion-treatment interval for maximum protection against hepatic injury?
0-8 hours
what do you use to assess prognosis of acetaminophen toxicity?
use rumack-matthew nomogram
what is the screening test of choice for BUDD-CHIARI syndrome?
contrast-enhanced (CEUS) color or pulsed-doppler US
what do imaging studies show in budd-chiari syndrome?
occlusion/absence of flow and a prominent caudate liver lobe
what does biopsy typically look like in budd-chiari syndrome?
centrilobular congestion (nutmeg liver)
