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GI 2 Exam 2 > Clinical DSA 4: Hepatobiliary - Acute Hepatitis and Liver Failure > Flashcards

Clinical DSA 4: Hepatobiliary - Acute Hepatitis and Liver Failure Flashcards

1
Q

Etiologies of acute hepatitis

A

*Infectious (mostly viral)
*Drugs/toxins
Budd chiari
Shock

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2
Q

Which diagnosis?

Acute onset (within 8 weeks of insult)
N/V, jaundice, elevated AST/ALT that eventually falls
Rapidly rising bilirubin
Rapidly shrinking liver, hepatic encephalopathy (elevated ammonia)
Coagulation abnormalities (INR>1.5)
Usually due to APAP toxicity

A

Acute (fulminant) liver failure

[ALF]

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3
Q

ALF diagnostics

A

Rapidly rising bilirubin and prolongation of PT/INR even as AST/ALT rise and fall

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4
Q

Tool used to assess risk of hepatotoxicity after ingestion of APAP

A

Rumack-Matthew Nomogram

Plots APAP concentration vs time after ingestion

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5
Q

What AST/ALT is diagnostic of APAP toxicity?

A

AST/ALT > 5000

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6
Q

Treatment/Management of acute liver failure

A

Consider transfer to transplant center

N-acetylcysteine (NAC) in APAP overdose per Rumack-Matthew nomogram

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7
Q

Eitiologies of ALF

A
  1. APAP*
  2. Idiosyncratic drug rxn
  3. Viral hep, poison mushrooms, shock, budd-chiari, fatty liver of pregnancy
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8
Q

Complications of ALF

A
  1. Cerebral edema and death*
  2. Multi organ failure and death if untreated
  3. mortality rate >80% if in deep coma
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9
Q

Which hepatitis virus?

Acute only, contaminated water or shellfish
N/V, Jaundice, RUQ pain
Dark urine, acholic stools
Aversion to smoking
Elevated AST/ALT, bilirubin, ALP (hepatocellular and cholestatic)

A

HAV

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10
Q

Which hepatitis virus?

Acute (90% recover) or chronic (10%)
Transfer via blood, sex or perinatal
Variable clinical picture, N/V, Jaundice, RUQ pain
Polyarteritis nodosa, glomerularnephritis, serum sickness
Elevated AST/ALT, PT/INR (hepatocellular)
Bilirubin, ALP not exceedingly high

A

HBV

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11
Q

Which hepatitis virus?

Acute or chronic
Transmitted through blood
N/V, Jaundice, RUQ pain
Requires HBV coinfection

A

HDV

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12
Q

Which hepatitis virus?

Mostly chronic
Transmitted thru blood (transfusions, IVDU, fisticuffs, needles)
Clinically mild and asymptomatic until cirrhosis
Waxing and waning AST/ALT
Occasionally may have Abs in serum w/o RNA meaning recovery from previous infection

A

HCV

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13
Q

Which hepatitis virus?

Acute, Chronic in immunocompromised
Transmission is fecal-oral via waterborne epidemics or undercooked organ meat (spread by swine)
N/V, Jaundice, RUQ pain
Aversion to smoking
Fulminant can happen in pregnant patients*
Transplant pts treated w/ tacrolimus progress to chronic*

A

HEV

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14
Q

HAV vaccine available?

A

Yeah!

its self limited tho

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15
Q

HBV vaccine available?

A

Yeah!

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16
Q

HDV vaccine available?

A

Not directly. Vaccinate against HBV because it requires coinfection

17
Q

HCV vaccine available?

A

NOPE!!!

Patients w/ chronic liver disease should be vaccinated against HAV and HBV

18
Q

HEV vaccine available?

A

NOPE!!!

its self limited tho

19
Q

Complications of HBV

A

Chronic HBV carries substantial risk for cirrhosis and HCC

especially with HDV superinfection

20
Q

Complications of HCV

A

Cirrhosis, HCC, HIV coinfection

mixed cryoglobulinemia

21
Q

HCV prevention and screening

A

Screen boomers

Screen everyone over 18 at least once

22
Q

Drug induced liver injury (DILI) and drug induced hepatitis eitiology

A

Dose dependent drug toxicity (APAP most common)

Idiosyncratic

23
Q

DILI treatment/management

A

Withdraw suspected agent, most will resolve quickly after

24
Q

What diagnosis?

RUQ pain, nausea, malaise, pruritis, jaundice after ingestion of drug
Mimics acute cholecystitis
May present with systemic hypersensitivity (eosinophilia)

A

DILI or drug induced hepatitis

Complication is fulminant liver failure

25
Q

Treatment for APAP overdose

A

n-acetylcysteine (NAC)

ICU and transplant center

26
Q

APAP overdose stage?

N/V, abdominal pain, sweating, general discomfort, pale
Normal LFTs

A

Stage 1

days 0-1

27
Q

APAP overdose stage?

Liver injury develops
RUQ pain
Rise in LFTs (ALT, AST, ALP bili)

A

Stage 2

days 1-3

28
Q

APAP overdose stage?

Hepatotoxicity peaks
Rapid and severe hepatic failure
Encephalopathy and hypoglycemia
Glucose, lactate and phosphate abnormalities
Coma and death
A

Stage 3

3-5 days

29
Q

APAP overdose stage?

Recovery stage for those who survive

A

Stage 4

days 5-8

30
Q

What diagnosis?

Occlusion of hepatic vein of IVC
Hypercoagulable state (IBD, OCPs, pregnancy, polycythemia vera)*
Nutmeg liver (centrilobular congestion)*
Hepatomegaly
RUQ pain and tenderness
A

Budd-Chiari syndrome

occlusion of flow to hepatic vein or IVC

31
Q

Diagnosic test for Budd-Chiari

A

Contrast enhanced color ultrasound (CEUS)
Pulsed-Doppler ultrasound

Shows prominent caudate liver lobe

GI 2 Exam 2 (7 decks)

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