GI #8 Flashcards
Transmission of Hepatitis E Virus (HEV)
Fecal-oral (contaminated food, water, blood transfusions, and mother-to-child transmission)
Treatment for Hepatitis E
- No treatment needed (self-limiting infection)
- Not associated with a chronic state (similar to HAV)
Hepatitis ___ has the highest mortality due to fulminant hepatitis during pregnancy, especially during the third trimester
Hepatitis E
What does Hepatitis D require?
Defective virus that requires Hepatitis B virus to cause co or superimposed infection
How does Hepatitis D work with Hepatitis B?
-HDV uses HBsAg as its envelope protein
Transmission of Hepatitis D
-Primarily parenteral (exposure to blood or blood products)
How do you prevent Hepatitis D?
Hepatitis B vaccination
What is unique about Hepatitis C?
85% of patients with HCV develop chronic infection
-Hepatitis C is the most common _____
infectious cause of chronic liver disease, Cirrhosis, and liver transplantation in the US
MC transmission of Hepatitis C
-Parenteral: IVDU, needlestick injuries, blood transfusion before 1992
Although most patients with Hepatitis E, D, and C are asymptomatic, what are some symptoms they may develop?
Fatigue, myalgia, nausea, RUQ pain, jaundice, dark urine, clay-colored stools
Hepatomegaly
Screening test for Hepatitis C
-HCV antibodies (positive within 6 weeks)
Confirmatory test for Hepatitis C
HCV RNA (more effective than antibodies)
Most effective way to determine effective treatment options for Hepatitis C?
Genotyping
Although there are treatment options for Hepatitis C, what are some associated risks with having this condition?
-Increased risk for cirrhosis, hepatocellular carcinoma, and liver failure
Treatment regimens for Hepatitis C
- Ledipasvir-Sofosbuvir
- Two antivirals together
Transmission routes for Hepatitis B
- Percutaneous
- Sexual
- Parenteral
- Perinatal
Review Hepatitis B serologies
see above
What are some risk factors for hepatocellular carcinoma
- Chronic liver disease (HBV, HCV, HDV, cirrhosis)
- Aflatoxin B1 exposure (Aspergillus)
Symptoms of hepatocellular carcinoma?
- Many asymptomatic
- Malaise, weight loss, jaundice, abdominal pain, hepatosplenomegaly
How do you diagnose hepatocellular carcinoma?
- Contrast-enhanced CT or MRI of liver
- Liver biopsy
Explain the surveillance of hepatocellular carcinoma?
-US every 6 months (with or without alpha-fetoprotein)
Management for hepatocellular carcinoma
-Surgical resection if confined to lobe and not associated with cirrhosis
What is Budd-Chiari Syndrome
-Hepatic venous outflow obstruction leading to decreased liver drainage with subsequent portal hypertension and cirrhosis
Budd-Chiari Syndrome is the MCC of _____ in children
portal hypertension
Symptoms of Budd-Chiari Syndrome
- Classic Triad: ascites, hepatomegaly, RUQ pain
- Rapid development of acute liver disease (jaundice, hepatosplenomegaly)
Initial screening of choice for Budd-Chiari Syndrome
- US
- If US non diagnostic, CT or MRI performed
What is the gold standard diagnostic for Budd-Chiari Syndrome?
Venography
Although a liver biopsy is rarely performed, what is congestive hepatopathy generally described as in Budd-Chiari Syndrome?
Nutmeg liver
Treatment options for Budd-Chiari Syndrome?
- Shunt decompression of liver (TIPS)
- Angiography with stunting
- Diuretics for ascites, low sodium diet, large volume parecentesis
What exactly is cirrhosis?
-Mostly irreversible liver fibrosis with nodular regeneration secondary to chronic liver disease
Causes of Cirrhosis
- MCC: Chronic hepatitis C
- Alcohol, Chronic HBV, HDV
- Nonalcoholic fatty liver disease (obesity, DM, hypertriglyceridemia)
Symptoms of cirrhosis
- Fatigue, weakness, weight loss, muscle cramps, anorexia
- Ascites, gynecomastia, spider angioma, telangiectasias, caput medusa, jaundice, Duputren’s contractures
If the patient has hepatic encephalopathy with cirrhosis, what are the symptoms?
- Confusion and lethargy (increased ammonia levels toxic to the brain)
- Asterixis
- Esophageal varices
Management for cirrhosis
- Avoid alcohol and hepatotoxic medications, weight reduction, HAV and HBV vaccine
- Treat underlying cause
- Liver transplant is definitive
Treatment for encephalopathy
- Lactulose or Rifixamin
- Neomycin is second-line
- Protein restriction
Treatment for ascites
- Sodium restriction
- Diuretics (Spironolactone, Furosemide)
- Paracentesis
Treatment for pruritus
-Cholestyramine reduces bile salts in the skin leading to less irritation
What staging system is used for cirrhosis?
Child-Pugh Classification
What factors are taken into account when using the model end-stage liver disease calculation (MELD)?
- Serum Albumin
- INR
- Serum Creatinine
How does lactulose work in hepatic encephalopathy?
-Bacterial flora converts lactulose into lactic acid, neutralizing ammonia in patients with hepatic encephalopathy
Adverse effects of lactulose?
-bloating, flatulence, diarrhea
What is spontaneous bacterial peritonitis?
Infection of ascitic fluid WITHOUT perforation of the bowel (complication of cirrhosis)
MC organism associated with spontaneous bacterial peritonitis?
E. Coli
Symptoms of spontaneous bacterial peritonitis
- Fever, chills, abdominal pain, increasing girth, diarrhea
- Ascites (shifting dullness, fluid wave)
- Abdominal tenderness
What is the test of choice for spontaneous bacterial peritonitis? What determines need for treatment?
Paracentesis
-Cell count 250 cells/mm3 or greater
Even though paracentesis is the test of choice, what is the MOST accurate test for spontaneous bacterial peritonitis?
Culture
Treatment for spontaneous bacterial peritonitis?
Cefotaxime or Ceftriaxone
Because spontaneous bacterial peritonitis frequently recurs, what is the prophylaxis after initial occurrence?
-Lifelong prophylaxis with Bactrim (Trimethoprim-Sulfamethoxazole) or Norfloxacin
