Clinical Approach to the Hepatobiliary Patient: Acute Hepatitis and Acute Liver Failure

Question 1

how do you treat an acetaminophen overdose?

Answer 1

N-acetylcysteine aka NAC (mucomyst)

Question 2

what is acute (fulminant) liver failure (ALF)?

Answer 2

massive hepatic necrosis with impaired consciousness occurring within 8 weeks of the onset of illness

Question 3

what is the #1 cause of ALF?

Answer 3

acetaminophen

Question 4

what are the AST/ALT levels in acetaminophen toxicity?

Answer 4

> 5000 u/L

Question 5

how do you make the diagnosis of acute HAV?

Answer 5

HAV Ab= IgM anti-HAV

Question 6

what does it mean if a patient has IgG anti-HAV (in the absence of IgM anti-HAV)?

Answer 6

they had a previous exposure to HAV, non-infectivity, and immunity

Question 7

where is HBV endemic?

Answer 7

sub-saharan africa and southeast asia

Question 8

what is HBV associated with?

Answer 8

glomerulonephritis, serum sickness, and polyarteritis nodosa

Question 9

what are the diagnostic features of HBV? (labs not serology)

Answer 9

elevated AST/ALT but normal alk phos and bilirubin; elevated INR

Question 10

how is HDV transmitted?

Answer 10

via blood

Question 11

how do you make the diagnosis of HDV?

Answer 11

HDV Ag (IgG or IgM= infection) or HDV RNA

Question 12

what are the complications associated with HCV?

Answer 12

cirrhosis, HCC, HIV co-infection; mixed cryoglobulinemia

Question 13

what is the most sensitive indicator of HCV infection?

Answer 13

HCV RNA

Question 14

how do you treat HCV?

Answer 14

curable with proper antiviral treatment; there is no vaccine though

Question 15

what is the primary prevention for HCV?

Answer 15

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

Question 16

how is HEV spread?

Answer 16

by swine

Question 17

where is HEV endemic?

Answer 17

asia, middle east, north africa, central america, india

Question 18

can HEV become chronic?

Answer 18

yes- in immunocompromised hosts

Question 19

what are the complications associated with HEV?

Answer 19

there is a high mortality rate in pregnant women due to fulminant liver failure

Question 20

what are some examples of direct hepatotoxins?

Answer 20

mushroom poisoning, acetaminophen (tylenol, APAP, Paracetamol), tetracyclines, valproic acid

Question 21

how do you make the diagnosis of DILI?

Answer 21

based on history and temporal relationship, exclude other causes of liver disease, it may be associated with eosinophilia; no AMA

Question 22

what are the healthy dose limits for acetaminophen?

Answer 22

3 grams/24 hours for healthy liver or 2 grams/24 hours in liver disease

Question 23

what is the critical ingestion-treatment interval for maximum protection against hepatic injury?

Answer 23

0-8 hours

Question 24

what do you use to assess prognosis of acetaminophen toxicity?

Answer 24

use rumack-matthew nomogram

Question 25

what is the screening test of choice for BUDD-CHIARI syndrome?

Answer 25

contrast-enhanced (CEUS) color or pulsed-doppler US

Question 26

what do imaging studies show in budd-chiari syndrome?

Answer 26

occlusion/absence of flow and a prominent caudate liver lobe

Question 27

what does biopsy typically look like in budd-chiari syndrome?

Answer 27

centrilobular congestion (nutmeg liver)