DSA 5: Acute Hepatitis and Acute Liver Failure Flashcards
what is the etiology of acute (fulminant) liver failure (ALF)
massive hepatic necrosis w/ impaired consciousness occurring w/i 8 weeks of the onset of illness
1. acetaminophen
- idiosyncratic drug rxn
increased risk w/ DM & outcome is worse w/ obesity
statins can casue increase AST/ALT but rarely cause true hepatitis or ALF-no longer Cl in liver dz
What are possible complications of ALF
cerebral edema (brainstem compression) & sepsis are the leading causes of death
mortality rate is exceedingly high (>80% pt w/ deep coma)
what is the Hx/PE of ALF
rapidly shrinking liver size + rapidly rising bilirubin level + marked prolongation of the PT + clinical signs of confusion, disorientation, ascities, edema = hepatic failure w/ encephalopathy –> deep coma (cerebral edema)
life-threatening coagulation abnormalities (INR > 1.5)
what is diagnositic of ALF
labs = rapidly rising bilirubin levels + marked prolongation of PT even as AST/ALT decreases
acetaminophen toxicity - AST/ALT > 5,000 u/L
ammonia level elevated –> encephalopathy & intracranial HTN
how do you treat/manage ALF
support the pt - maintain fluids, circulation and respiration; control bleeding, correction of hypoglycemia & tx other complications
protein intake should be restricted
give oral lactulose/neomycin
meticulous intensive care + prophylactic ABx= one factor that improves survivial
early transfer to transplant center for liver transplantation should be considered
N-Acetylcysteine in acetominophen OD
what is the etiology of acute hepatitis
viral, drugs, ischemia
What are Hx/PE findings of acute hepatitis
stool - acholic
fever, malaise, myalgia, arthalgia, N/V, dirrhea, constipation
PE: RUQ pain = tenderness over liver, jaundice, hepatomegaly, skin changes
what is diagnositic of acute hepatitis
CMP (AST/ALT, total bilirubin, ALP)
PT/INR
acetaminophen level
viral hepatitis serology
what are treatments and managements of acute hepatits
some self-limited
based on etiology - NAC, supportive, anti-viral, stop offending meds, gastric lavage, ABx, liver transplant
what family does HAV belong to?
what is the duration, RF and transmission
ssRNA
duration: acute; incubation = 2-3, up to 6 weeks
RF: international travel; contaminated water/food; inadequately cooked shellfish
transmission: fecal-oral route
what is the presentation of HAV?
anorexia, N/V, malaise, constant/mild RUQ or epigastrum, aversion to smoking
stool may be acholic
illness more severe in adults than children
acute only
what labs help diagnose HAV
marked increase in AST/ALT
increased bilirubin and ALP = cholestasis
Anti-HAV early in illness; both IgM & IgG anti-HAV soon after onset
detection of IgM anti-HAV = excellent test for diagnosing acute hep A
if IgG anti-HAV - indications of previous exposure, non=infectivity and immunity
Is there a vaccine for HAV?
what is the mortality?
Vaccine available
good prognosis; low mortality
what family does HBV belong to?
what is the duration, RF and transmission
partially dsDNA
duration - 2-26 week incubation, acute resolves 2-3 weeks & chronic = 5-10%
RF: M-sex-M, inject drugs, hemodialysis center, healthcare workers
transmission:
- parentral
- sexual
- perinatal : endemic in sub-saharan Africa & SE Asia (HBs-Ag (+) mom transmit HBV at delivery; risk of chronic infxn (90%)
- percutaneous (needle stick)
what is the presentation of HBV?
fever (low-grade), enlarged & tender liver, jaundice
aversion to smoke, N/V, anorexia
association w/ polyarteritis nodosa, glomerulonephtritis, serum sickness
acute (90% recover)
5-10% is chronic
what labs help diagnose HBV
normal-low WBC
increased ALT/AST early in course
no cholestatic pattern
increased bleed risk
many Ag, Ab, HBV DNA. useful for Dx