Diseases Of The Liver - McGowan Flashcards
What HepB serology shows prior infection?
HBsAg
HBcAb IgG
HBeAb may or may not be present
What has a SAAG score of greater than 1.1?
hepatic congestion
Liver disease
Portal vein occlusion
What laundry list are complications for HCV?
Mixed cryoglobulinemia
Membranoproliferative GN
Increased risk non-Hodgkin lymphoma
genotype 3 –> hepatic steatosis
What causes 50% of HCV cases?
What are RFs?
IV drug use
Body piercing, tattoo, hemodialysis, blood transfusion
Is AST or ALT more specific for liver injury?
ALT
What weird substances can cause fatty liver?
Vinyl chloride
Carbon tetrachloride
Yellow phosphorus
Wilson’s affects what chromosome and gene?
What inheritance?
Treat how?
Ch. 13 ATP7B
AR
Oral penicillamine, liver transplant
Who is at risk for HBV?
Delivery method?
Prisoners, STI people
blood, sex, mother-to-baby delivery
In alcoholic liver disease, what can precipitate Wernicke-Korsakoff syndrome?
Glucose admin if thiamine is not co-admin’ed
What are RFs for chronic liver disease?
EtOH Transfusions Tattoos IVDU Viral hepatitis
IgM acute or chronic?
IgG?
Acute
Chronic
How do you diagnose HAV?
What do vaccinated pts show?
IgM anti-HAV
IgG anti-HAV
What has a SAAG score less than 1.1?
Hypoalbuminemia Anything w/ascites Ovarian disease Infections/peritonitis Malignant conditions Mediterranean fever Vasculitis
Hemochromatosis has increased iron absorption from where?
Iron accumulates where?
Treatment?
Duodenum
Heart, liver, pancreas, adrenals, testis, pituitary
Phlebotomy
What imaging would you want to do on someone with ascites and liver issues?
Why?
EGD
Looking for esophageal varices
Where is chronic HBV endemic?
Confers risk of what?
Asia
sub-Saharan Africa
HCC, cirrhosis
What medication association does HEV have?
Tacrolimus for immunosuppression from transplant
What drug and vitamin are associated with fibrosis and cirrhosis of the liver?
Methotrexate and Vitamin A
What meld score corresponds with class C child-pugh?
10-15
What HLA associations seen in PBC?
RFs?
Tx how?
DRB1 08 and DQB1
UTI, smoking, HRT, hair dye
Ursodeoxycholic acid
RUQ pain and tenderness, ascites, HSM, and jaundice indicates what?
Budd-Chiari
+anti-HCV but -HCV RNA means what?
Recovery from past infection
What meld score corresponds with class B child-pugh?
7-9
What condition is associated with severe memory issues and confabulate (make-up stories)?
Korsakoff syndrome
Pts with a Maddrey DF score above 32 have what?
Those with lower scores?
High short-term mortality, tx w/glucocorticoids can help
Low short-term mortality, don’t need glucocorticoids
Formula for SAAG?
Serum albumin - ascitic fluid albumin
What does the Glasgow alcoholic hepatitis score predict?
Those with a score greater than or equal to 9 had what?
Less than 9?
Mortality in alcoholic hepatitis
Received glucocorticoids had higher survival rates compared to those who didnt
NO survival benefit
What do the labs in cirrhosis reveal?
Macrocytic anemia
Dec WBC
Thrombocytopenia
Inc PT time
What is the major cause of acute hepatitis in central and SE Asia, Middle East, and North Africa?
Spread how?
HEV
Swine, waterborne
Which child-pugh class has the worst prognosis?
C
What grade is the following on the hepatic encephalopathy grading scale?
Somnolence to semistupor, responsive to verbal stimuli
Confusion
Gross disorientation, bizarre behavior
3
What HepB serology shows acute infection w/active replication?
HBsAg
HBcAg IgM
HBeAg
HBV DNA
What is the most important test to run on ascitic fluid?
What indicates SBP?
WBC count w/diff
PMN > 250 w/ > 75% white cells
What is increased in HBV?
Aminotransferases the most
Inc. alk phos and bilirubin
What meld score corresponds with class A child-pugh?
5-6
What is the threshold used to diagnose NAFLD in M and W?
M < 20g day
W < 30g day
What organisms are most commonly responsible for spontaneous bacterial peritonitis (SBP)?
E. coli or Klebsiella
S. Pneumo or viridans, streptococci, enterococcus
Autoimmune hepatitis has what serologic markers?
Treatment?
Increased risk for what?
+ANA, ASMA, Anti-LKM1
Steroids +/- azathioprine
Cirrhosis and HCC
What grade is the following on the hepatic encephalopathy grading scale?
Trivial lack of awareness
Short attention span
Impaired performance of addition
Euphoria or anxiety
1
What grade is the following on the hepatic encephalopathy grading scale?
Lethargy or apathy Minimal disorientation for time or place Subtle personality change Inappropriate behavior Impaired performance of subtraction
2
What condition is associated with AMA?
PBC
What is the #1 and #2 causes of acute liver failure?
What are the leading causes of death?
Acetaminophen (tylenol)
Drug reaction
Cerebral edema and sepsis
What is seen during the HBV window period?
What else is it called?
Anti-HBc IgM
aka HBcAb
What amt of drinking puts you at risk of alcoholic cirrhosis?
> 50g/day for over 10 years
How do you treat acetaminophen (tylenol) OD?
N-acetyl-cysteine (NAC) aka Mucomyst
What slows progression of chronic HCV?
What genotype has a higher risk for HCC?
Coffee
1b
What condition is associated with confusion, ataxia, and involuntary abnormal eye movements?
Wernicke Encephalopathy
OCP use puts pts at risk for what liver condition?
Hepatocellular adenoma (benign)
Budd chiari can occur in what state?
Is actually what?
Complicated by what?
What does imaging show?
Hypercoagulable
Hepatic v. Occlusion
HCC
Prominent caudate lobe
What causes a beads on a string pattern?
PSC
What grade is the following on the hepatic encephalopathy grading scale?
Coma
4
