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GI Week 4 > DSA 6: Approach to Hepatobiliary Patient (Chronic Liver Disease / Cirrhosis) > Flashcards

DSA 6: Approach to Hepatobiliary Patient (Chronic Liver Disease / Cirrhosis) Flashcards

1
Q

Chronic hepatitis is described as a group of disorders characterized by a chronic inflammatory reaction in the liver for at least?

A

6 months

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2
Q

Chronic HBV has an association with?

Chronic HCV has an association with?

A

1) Polyarteritis nodosa

2) Mixed cryoglobulinemia

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3
Q

What is used to identify if there is presence or absence of fibrosis (cirrhosis) in chronic hepatitis?

A

1) Serum FibroSure

2) US elastography

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4
Q

Chronic HBV is endemic in?

90% of infants are infected via?

What causes a higher probability of chronicity?

A

1) Asia and sub-Saharan Africa
2) Maternal transmission
3) The younger the age at the time of HBV infection

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5
Q

Cirrhosis associated with chronic HCV progression increases in?

A

1) Males that heavily drink
2) Get infection after 40 yo
3) Immunocomp
4) Smoke

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6
Q

What common food and/or drink slows the progression of chronic HCV?

A

Coffee

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7
Q

Presence of what serology points towards chronic HCV?

A

HCV Ab and HCV RNA

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8
Q

Which type of autoimmune hepatitis is most common?

A

Type 1

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9
Q

What antibodies are associated with type 1 autoimmune hepatitis?

Which are associated with type 2?

A

1) Anti-smooth muscle Abs (SMA)

2) Anti-liver/kidney microsomal Abs (anti-LKM)

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10
Q

Classic autoimmune hepatitis (type 1) is most prevalent in what population?

A

Females ranging from 30-50 yo

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11
Q

What clinical features are associated with classic autoimmune hepatitis (type 1)?

A

1) Progressive jaundice
2) Epistaxis
3) Amenorrhea

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12
Q

What is the treatment for autoimmune hepatitis?

A

Glucocorticoids

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13
Q

What complications are associated with Autoimmune hepatitis?

A

Leads to cirrhosis and if left untreated can cause hepatocellular carcinoma

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14
Q

How much alcohol intake in a day can cause alcoholic liver disease over a 10 year span in men?

In women?

A

1) Exceeds 80 g/day

2) 30–40 g/day

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15
Q

What is the fatty liver (steatosis) caused by alcohol characterized by?

A

1) Asymptomatic hepatomegaly

2) Elevation in bilirubin and Alkaline phosphatase

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16
Q

What values are seen on CMP in regards to AST/ALT when a patient presents with alcoholic liver disease?

A

AST 2x greater than ALT

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17
Q

What is found on CBC with alcohol liver disease?

A

1) Leukocytosis with left shift

2) Anemia

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18
Q

What is a direct toxic effect of alcohol on megakaryocyte production or to hypersplenism?

A

Thrombocytopenia

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19
Q

What is seen on PT/PTT/INR with alcohol liver disease?

A

Marked prolongation of the prothrombin time

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20
Q

What is present on liver biopsy with alcohol liver disease?

A

Mallory-Denk bodies (alcoholic hyaline)

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21
Q

What supplements should be given to patients with alcohol liver disease?

A

1) Multivitamin
2) Thiamine
3) Folic acid
4) Zinc

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22
Q

Why is thiamine co-administered with glucose when treating alcohol liver disease?

A

Prevents Wernicke-Korsakoff syndrome

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23
Q

What should be given to patients with severe alcoholic hepatitis?

A

1) Steroids

2) Pentoxifylline

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24
Q

How long must patients abstain from alcohol to be considered for liver transplantation?

A

6 months

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25
Q

Alcohol liver disease is the most common precursor to what condition in the United States?

A

Cirrhosis

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26
Q

What is used to calculate Maddrey’s discriminant function (DF)?

What cutoff is associated with poor prognosis for alcohol liver disease?

A

1) PT and serum bilirubin

2) ≥32

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27
Q

Fatty liver is also known as?

A

Hepatic steatosis

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28
Q

What is the most common cause of chronic liver disease in the US?

A

Non-alcoholic fatty liver disease (NAFLD)

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29
Q

The principal causes and increased risk for NAFLD are?

A

Metabolic Syndrome:

1) Obesity
2) Diabetes mellitus (insulin resistance)
3) Hypertriglyceridemia

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30
Q

NAFLD causes an increased risk for?

A

1) CV disease
2) Chronic kidney disease
3) Colorectal cancer

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31
Q

What protects against the development of NAFLD?

A

Physical activity and coffee consumption

32
Q

What is used to assess liver stiffness that can be used to estimate hepatic fibrosis in NAFLD?

A

Ultrasound elastography

33
Q

What is seen on liver biopsy for NAFLD similar to alcohol liver disease?

A

Mallory-Denk bodies

34
Q

What autosomal recessive condition is the most commonly diagnosed inherited hepatic disorder in infants and children?

What complication does it cause?

A

1) Alpha-1 Antitrypsin deficiency

2) Pulmonary emphysema

35
Q

Which phenotype is associated with alpha-1 Antitrypsin deficiency and causes severe reductions in enzyme levels?

A

PiZZ

36
Q

What should be recommended to alpha-1 Antitrypsin deficiency patients to help manage the condition?

A

Smoking abstinence

37
Q

What chronic disease of the liver is characterized by autoimmune destruction of small intrahepatic bile ducts and cholestasis?

A

Primary Biliary Cholangitis

38
Q

What population is most affected by primary biliary cholangitis?

A

Women around 50 yo

39
Q

What are some risk factors for primary biliary cholangitis?

A

1) UTI
2) Smoking
3) Hormone replacement therapy
4) Hair dye

40
Q

What unique clinical manifestation is seen in primary biliary cholangitis?

A

Xanthelasma

41
Q

What will we find on lab for primary biliary cholangitis?

A

1) Antimitochondrial antibodies (AMA)
2) Increased alkaline phosphatase
3) Increased IgM levels

42
Q

How is primary biliary cholangitis treated?

A

Ursodeoxycholic acid

43
Q

Hemochromatosis is an autosomal recessive mutation of what gene on chromosome 6?

A

HFE gene

44
Q

What does hemochromatosis cause?

A

Increases accumulation of iron as hemosiderin in various organs including the liver

45
Q

While most symptoms are rarely recognized clinically before the patient’s 50’s, what are seen on H/P for hemochromatosis?

A

1) Cirrhosis with hepatomegaly
2) Abnormal skin pigmentation
3) DM
4) Heart failure
5) ED in males

46
Q

Prognosis of hemochromatosis is favorable with?

What is used in addition to this?

A

1) Phlebotomy therapy

2) PPI

47
Q

If the patients can’t tolerate phlebotomy due to hemochromatosis, anemia, or thalassemia what should we use to treat hemochromatosis?

A

Deferoxamine

48
Q

Risk factors for advanced fibrosis include?

A

1) Male sex
2) Excess alcohol consumption
3) DM

49
Q

Affected patients of hemochromatosis are at increased risk of infection with?

A

1) Vibrio vulnificus
2) Listeria monocytogenes
3) Yersinia enterocolitica

50
Q

Wilson disease is a rare autosomal recessive mutation of what gene on chromosome 13?

A

ATP7B

51
Q

What age group is mostly affected by Wilson disease?

A

Under 40

52
Q

What does Wilson disease cause?

A

1) Impaired copper excretion into bile

2) Failure to incorporate copper into ceruloplasmin

53
Q

What diagnostic findings point towards Wilson disease?

A

1) Low serum ceruloplasmin
2) Elevated hepatic copper concentration
3) MRI of the brain shows increased copper deposition

54
Q

How would a Wilson disease patient present?

A

Child or young adult with hepatitis, hemolytic anemia, and neuro abnormalities

55
Q

What is the pathognomonic sign of Wilson disease?

A

Brownish or gray-green Kayser-Fleischer ring (In the eye)

56
Q

What is the treatment for Wilson disease?

A

Oral penicillamine

57
Q

What association does right heart failure have with the liver?

A

Nutmeg liver due to congestion of liver

58
Q

Hepatojugular reflux is present with?

A

Heart failure

59
Q

What levels are markedly elevated in heart failure?

A

BNP

60
Q

What levels are elevated during shock liver (ischemia involved)?

A

1) Aminotransferase

2) LDH

61
Q

What is the pathophysiology seen in cirrhosis?

A

Fibrosis replaces normal liver and regenerative nodules are formed

62
Q

What are the most common causes of cirrhosis?

A

1) Hepatitis C
2) Alcoholic liver disease
3) NAFLD

63
Q

What is diagnostic and therapeutic for ascites and cirrhosis?

A

Abdominal Paracentesis

64
Q

How is the SAAG (Serum ascites albumin gradient) score calculated?

If it is >1.1 it is most likely related to?

If it is >250 PMNs/mL think?

A

1) Serum albumin – Ascites albumin
2) Portal hypertension
3) SBP

65
Q

Ascites is the pathologic accumulation of fluid in?

A

Peritoneal cavity

66
Q

What is the most common cause of ascites?

A

Portal hypertension secondary to chronic liver disease

67
Q

What diagnostic tool reliably establishes the presence of fluid?

A

Abdominal ultrasound

68
Q

What is the most important test for ascites?

A

A white blood cell count with differential

69
Q

Cirrhosis, Budd-Chiari syndrome, and liver metastases is seen with a SAAG score of?

Biliary leak, pancreatitis, and peritoneal carcinomatosis is seen with a SAAG score of?

A

1) Greater than 1.1 g/dL

2) Less than 1.1 g/dL

70
Q

What is characterized by alteration in mental status in the presence of liver failure?

A

Hepatic encephalopathy

71
Q

What levels are typically elevated in hepatic encephalopathy?

A

Ammonia

72
Q

How does hepatic encephalophy present on H/P?

A

Confusion, drowsiness, and asterixis (flapping tremor)

73
Q

What is used to treat hepatic encephalopathy?

A

Lactulose

74
Q

Exposure to what may contribute to etiology of hepatocellular carcinoma and causes a mutation in p53?

A

Aflatoxin

75
Q

How is hepatocellular carcinoma screened for?

A

Check AFP levels and perform US every 6 months

76
Q

What is considered in patients with worsening functional status based on the MELD/MELD-Na score?

A

Liver transplant

77
Q

What MELD score is required for liver transplant listing?

A

Greater than 14

GI Week 4 (12 decks)

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