DSA 5: Approach to the Hepatobiliary Patient (Acute Hepatitis / Liver Disease) Flashcards
How does acute (fulminant) liver failure (ALF) present?
1) Massive hepatic necrosis
2) Impaired consciousness
3) Occurs within 8 weeks of onset
What is the primary etiology of acute (fulminant) liver failure?
Acetaminophen overdose
What drugs can cause AST/ALT elevations but rarely cause true hepatitis or ALF?
Statins
What are the leading causes of death associated with ALF?
Cerebral edema (brainstem compression) and sepsis
What causes the deep coma associated with ALF?
Hepatic encephalopathy
What happens to the liver during ALF?
What happens to bilirubin levels?
What happens to PT?
1) Shrinks
2) Rises
3) Prolongs
What occurs when ALF presents with an INR of greater than 1.5?
Life threatening coagulation abnormalities
How should ALF be treated?
1) Liver transfer
2) N-Acetylcysteine (NAC) in Acetaminophen OD
What are the main causes of acute hepatitis?
1) Viral
2) Drugs
3) Ischemia
What is seen on PE for acute hepatitis?
1) RUQ tenderness
2) Jaundice
3) Stools may be acholic
What type of virus is hepatitis A?
Single-stranded RNA
What is the duration of HAV?
Acute
What is the most common risk factor for HAV?
International travel
What is the route of transmission for HAV?
Fecal-oral
What labs are elevated for HAV?
1) AST/ALT
2) Bilirubin and Alkaline phosphatase
What forms of anti-HAV are detectable in serum soon after onset?
IgM and IgG
Detection of IgM anti-HAV is an excellent test for diagnosing?
IgG anti-HAV (in the absence of IgM anti-HAV) indicates?
1) Ongoing acute hepatitis A
2) Previous exposure to HAV and immunity
Can HAV become chronic?
No
What type of virus is HBV?
Partially double-stranded DNA
HBV may be associated with what cutaneous symptom?
Polyarteritis nodosa
What are routes of transmission for HBV?
1) IV drug use
2) Sexual contact
3) Perinatal (mother to baby)
Perinatal transmission of HBV is endemic in what areas of the world?
1) Sub-Saharan Africa
2) Southeast Asia
When may HBsAg-positive mothers transmit HBV?
There is a risk as high as 90% of what occuring in these infants?
1) At delivery
2) Chronic infection
What labs are seen markedly elevated early in the course of HBV (higher than HAV infection)?
AST/ALT
Can HBV become chronic?
Yes, 5-10% of cases
What complications can arise from HBV?
1) Cirrhosis (especially if HDV superinfection)
2) Hepatocellular carcinoma