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PANCE 2.0 > GI #8 > Flashcards

GI #8 Flashcards

1
Q

Transmission of Hepatitis E Virus (HEV)

A

Fecal-oral (contaminated food, water, blood transfusions, and mother-to-child transmission)

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2
Q

Treatment for Hepatitis E

A
  • No treatment needed (self-limiting infection)

- Not associated with a chronic state (similar to HAV)

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3
Q

Hepatitis ___ has the highest mortality due to fulminant hepatitis during pregnancy, especially during the third trimester

A

Hepatitis E

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4
Q

What does Hepatitis D require?

A

Defective virus that requires Hepatitis B virus to cause co or superimposed infection

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5
Q

How does Hepatitis D work with Hepatitis B?

A

-HDV uses HBsAg as its envelope protein

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6
Q

Transmission of Hepatitis D

A

-Primarily parenteral (exposure to blood or blood products)

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7
Q

How do you prevent Hepatitis D?

A

Hepatitis B vaccination

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8
Q

What is unique about Hepatitis C?

A

85% of patients with HCV develop chronic infection

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9
Q

-Hepatitis C is the most common _____

A

infectious cause of chronic liver disease, Cirrhosis, and liver transplantation in the US

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10
Q

MC transmission of Hepatitis C

A

-Parenteral: IVDU, needlestick injuries, blood transfusion before 1992

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11
Q

Although most patients with Hepatitis E, D, and C are asymptomatic, what are some symptoms they may develop?

A

Fatigue, myalgia, nausea, RUQ pain, jaundice, dark urine, clay-colored stools
Hepatomegaly

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12
Q

Screening test for Hepatitis C

A

-HCV antibodies (positive within 6 weeks)

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13
Q

Confirmatory test for Hepatitis C

A

HCV RNA (more effective than antibodies)

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14
Q

Most effective way to determine effective treatment options for Hepatitis C?

A

Genotyping

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15
Q

Although there are treatment options for Hepatitis C, what are some associated risks with having this condition?

A

-Increased risk for cirrhosis, hepatocellular carcinoma, and liver failure

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16
Q

Treatment regimens for Hepatitis C

A
  • Ledipasvir-Sofosbuvir

- Two antivirals together

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17
Q

Transmission routes for Hepatitis B

A
  • Percutaneous
  • Sexual
  • Parenteral
  • Perinatal
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18
Q

Review Hepatitis B serologies

A

see above

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19
Q

What are some risk factors for hepatocellular carcinoma

A
  • Chronic liver disease (HBV, HCV, HDV, cirrhosis)

- Aflatoxin B1 exposure (Aspergillus)

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20
Q

Symptoms of hepatocellular carcinoma?

A
  • Many asymptomatic

- Malaise, weight loss, jaundice, abdominal pain, hepatosplenomegaly

21
Q

How do you diagnose hepatocellular carcinoma?

A
  • Contrast-enhanced CT or MRI of liver

- Liver biopsy

22
Q

Explain the surveillance of hepatocellular carcinoma?

A

-US every 6 months (with or without alpha-fetoprotein)

23
Q

Management for hepatocellular carcinoma

A

-Surgical resection if confined to lobe and not associated with cirrhosis

24
Q

What is Budd-Chiari Syndrome

A

-Hepatic venous outflow obstruction leading to decreased liver drainage with subsequent portal hypertension and cirrhosis

25
Q

Budd-Chiari Syndrome is the MCC of _____ in children

A

portal hypertension

26
Q

Symptoms of Budd-Chiari Syndrome

A
  • Classic Triad: ascites, hepatomegaly, RUQ pain

- Rapid development of acute liver disease (jaundice, hepatosplenomegaly)

27
Q

Initial screening of choice for Budd-Chiari Syndrome

A
  • US

- If US non diagnostic, CT or MRI performed

28
Q

What is the gold standard diagnostic for Budd-Chiari Syndrome?

A

Venography

29
Q

Although a liver biopsy is rarely performed, what is congestive hepatopathy generally described as in Budd-Chiari Syndrome?

A

Nutmeg liver

30
Q

Treatment options for Budd-Chiari Syndrome?

A
  • Shunt decompression of liver (TIPS)
  • Angiography with stunting
  • Diuretics for ascites, low sodium diet, large volume parecentesis
31
Q

What exactly is cirrhosis?

A

-Mostly irreversible liver fibrosis with nodular regeneration secondary to chronic liver disease

32
Q

Causes of Cirrhosis

A
  • MCC: Chronic hepatitis C
  • Alcohol, Chronic HBV, HDV
  • Nonalcoholic fatty liver disease (obesity, DM, hypertriglyceridemia)
33
Q

Symptoms of cirrhosis

A
  • Fatigue, weakness, weight loss, muscle cramps, anorexia

- Ascites, gynecomastia, spider angioma, telangiectasias, caput medusa, jaundice, Duputren’s contractures

34
Q

If the patient has hepatic encephalopathy with cirrhosis, what are the symptoms?

A
  • Confusion and lethargy (increased ammonia levels toxic to the brain)
  • Asterixis
  • Esophageal varices
35
Q

Management for cirrhosis

A
  • Avoid alcohol and hepatotoxic medications, weight reduction, HAV and HBV vaccine
  • Treat underlying cause
  • Liver transplant is definitive
36
Q

Treatment for encephalopathy

A
  • Lactulose or Rifixamin
  • Neomycin is second-line
  • Protein restriction
37
Q

Treatment for ascites

A
  • Sodium restriction
  • Diuretics (Spironolactone, Furosemide)
  • Paracentesis
38
Q

Treatment for pruritus

A

-Cholestyramine reduces bile salts in the skin leading to less irritation

39
Q

What staging system is used for cirrhosis?

A

Child-Pugh Classification

40
Q

What factors are taken into account when using the model end-stage liver disease calculation (MELD)?

A
  • Serum Albumin
  • INR
  • Serum Creatinine
41
Q

How does lactulose work in hepatic encephalopathy?

A

-Bacterial flora converts lactulose into lactic acid, neutralizing ammonia in patients with hepatic encephalopathy

42
Q

Adverse effects of lactulose?

A

-bloating, flatulence, diarrhea

43
Q

What is spontaneous bacterial peritonitis?

A

Infection of ascitic fluid WITHOUT perforation of the bowel (complication of cirrhosis)

44
Q

MC organism associated with spontaneous bacterial peritonitis?

A

E. Coli

45
Q

Symptoms of spontaneous bacterial peritonitis

A
  • Fever, chills, abdominal pain, increasing girth, diarrhea
  • Ascites (shifting dullness, fluid wave)
  • Abdominal tenderness
46
Q

What is the test of choice for spontaneous bacterial peritonitis? What determines need for treatment?

A

Paracentesis

-Cell count 250 cells/mm3 or greater

47
Q

Even though paracentesis is the test of choice, what is the MOST accurate test for spontaneous bacterial peritonitis?

A

Culture

48
Q

Treatment for spontaneous bacterial peritonitis?

A

Cefotaxime or Ceftriaxone

49
Q

Because spontaneous bacterial peritonitis frequently recurs, what is the prophylaxis after initial occurrence?

A

-Lifelong prophylaxis with Bactrim (Trimethoprim-Sulfamethoxazole) or Norfloxacin

PANCE 2.0 (62 decks)

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