Exam 2: Hepatitis And Acute Liver Failure

Question 1

Hepatitis

Answer 1

Inflammation of liver that can result in cell damage and liver dysfunction

Question 2

Hepatitis can be caused by

Answer 2

Alcohol abuse
Medications
Viruses

Question 3

Hepatitis can be

Answer 3

Acute or chronic

Question 4

Viral Hepatitis

Answer 4

Relatively common
Primarily affects liver
Different strains of viruses cause different types of hepatitis (A-E+)

Question 5

Hepatitis: Pathologic Lesions include

Answer 5

Hepatic cell necrosis
Scarring (with chronic disease)
Kupffer cell hyperplasia

Question 6

Hepatitis A (HAV) injury to hepatocyte is cause by

Answer 6

Host cell’s immune response

Question 7

Hepatitis B

Answer 7

Milder than Hep C, but can lead to chronic hepatitis or liver failure and death

Question 8

Transmission of Hepatitis B occurs through

Answer 8

blood and body fluid exposure, maternal-baby exchange.

Question 9

Antiviral drugs therapy for hepatitis B include but are not limited to

Answer 9

Telbivudine (Tyzeka)

Question 10

Telbivudine (Tyzeka)

Answer 10

Nucleoside analogue reverse transcriptase inhibitor

Treatment of Hepatitis B

Question 11

Telbivudine (Tyzeka): Adverse Effects

Answer 11

fatigue, headache, diarrhea, nausea, pain in joint and muscles

Question 12

Telbivudine (Tyzeka): Interactions

Answer 12

alpha-interferons (cause severe peripheral neuropathy)

Caution: Nephrotoxic drugs

Question 13

Dosage adjustments of Telbivudine (Tyzeka) is need in patients with

Answer 13

Renal insufficiency

Question 14

Hepatitis C

Answer 14

Leading cause of liver failure leading to liver transplantation
Symptoms initially mild, but lead to chronic

Question 15

Hepatitis C: Transmission

Answer 15

Infected blood and sexual contact.

Alcoholic disease can lead to development of hepatitis C.

Question 16

Hepatitis C: Treatment

Answer 16

• interferon (family of naturally-occurring proteins that are made and secreted by cells of the immune system; modulate the response of the immune system to viruses and cancer)
• ribavirin (Virazole)
• simeprevir (Olysio)
• sofosbuvir (Solvaldi)

Question 17

Ribavarin (Virazole)

Answer 17

Given orally, or by oral or nasal inhalation
Inhalation form (Virazole) used for hospitalized infants with respiratory syncytial virus (RSV) infections
Pregnancy X drug, inhalation form can’t be given by pregnant healthcare provider.

Question 18

Ribavarin (Virazole): MOA

Answer 18

Synthetic nucleoside analog
Works with RNA and DNA synthesis
Inhibits protein synthesis AND viral replication

Question 19

Sofosbuvir (Solvaldi)

Answer 19

First-in-class RNA polymerase inhibitor for the treatment of chronic hepatitis C
Sofosbuvir is considered “break-through” therapy.
First drug treatment for hepatitis C that can be given without interferon

Question 20

Sofosbuvir (Solvaldi): Side Effects

Answer 20

Few side effects (fatigue, headache, nausea, difficulty sleeping).
When taken with amiodarone (Cordarone or Pacerone) may cause slow heart rate which can lead to death.

Question 21

Sofosbuvir (Solvaldi) used in

Answer 21

Combination with ribavarin (Varizole).

Not to be used as mono therapy.

Question 22

Simeprevir (Olysio)

Answer 22

Protease inhibitor (PI)
Chronic hepatitis C
Approved in 2013
Pregnancy C, but when combined with interferon and ribavirin (Virazole) = Cat X

Question 23

Simeprevir (Olysio): Used in

Answer 23

Conjunction with standard hepatitis C treatments: interferon and ribavirin (Virazole).
Not to be used as monotherapy.

Question 24

Simeprevir (Olysio): Adverse Effects

Answer 24

Photosensitivity
Rash
Nausea
Pruritus

Question 25

Acute Liver Failure

Answer 25

Severe impairment or necrosis of liver cells without preexisting liver disease or cirrhosis. Rare

Question 26

Acute Liver Failure: Causes

Answer 26

``` Acetaminophen overdose (most common) Viral hepatitis (particularly Hepatitis B) Compound infection of delta virus Metabolic liver disorder ```

Question 27

Acute Liver Failure Pathophysiology

Answer 27

Edematous hepatocytes + patchy areas of necrosis + inflammatory cell infiltrates = disruption of the functional tissue of the liver (parenchyma)

Question 28

Acute Liver Failure usually develops

Answer 28

6-8 weeks after the initial symptoms of viral hepatitis or metabolic liver disorder. 5 days-8 weeks after acetaminophen overdose.

Question 29

Acute Liver Failure Symptoms

Answer 29

Anorexia Vomiting Abdominal pain Progressive jaundice

Question 30

Acute Liver Failure can lead to

Answer 30

Leads to ascites, GI bleeding -> which can lead to hepatic encephalopathy (lethargy, altered motor function) -> Coma (cerebral edema, ischemia, and brainstem herniation) Renal failure and pulmonary distress can occur

Question 31

Acute Liver Failure Lab Findings

Answer 31

Increased direct and indirect serum bilirubin Increased serum transaminases Increased blood ammonia Increased prothrombin time

Question 32

Acute Liver Failure Treatment

Answer 32

- Irreversible (60-90% of children die) - Rapid evaluation and critical care and support: airway, circulation, hemodynamics; infection control; acetylcysteine for acetaminophen overdose; monitor labs and assess for GI bleeding; nutrition (patient should be NPO) - Liver Transplant