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SUMMED2 > GI-Liver Dz > Flashcards

GI-Liver Dz Flashcards

1
Q

What L/T hepatocellular destruction?

A

Hepatitis
Acute <6 mo- self limiting. D/T virus, drug, ETOH
Chronic >6mo unresolving, L/T cirrhosis

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2
Q 
This virus is fecal/oral/parenteral 
Incub is 15-50d
Adults
Mild severity w/ low mortality
MC
Related to poor hygiene, water supply, food-shellfish
SNF, Daycares
Travel
No chronic hepatitis
A 
HEP A
Vaccine Rec- Kid 2 at 12mo, 6-12apart
Travel- 3-4wk 1
Clotting d/o
Chronic Liver Dz
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3
Q

A 56 yo c/o 1 week h/o fatigue, flu-like symptoms, abdominal pain and nausea. He has been using berries from Costco in health shakes for the past 6 weeks. On PE he appears Well DevelopedWellNourshied, fatigued but in No Apperant Distrss; VSS; no icterus or jaundice, liver tender without HSM, neg Murphy’s sign, no peritoneal signs. What is work up?

A

HEP A
DX- GS* Serum anti-HAV IgM antibodies= acute illness
•+ Anti-HAV at peak onset** , remains positive 4-6 mos
•Serum ALT > AST- viral 800-1000K
•Bilirubin > 10 common jaundice
•IgG low at beg, high at end, immune
•Acute infection confers immunity

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4
Q

What is managment of Hep A?

A

Supportive
Recheck LFT, CBC w/in week for 1mo.
NO hepatic antibod recheck**
Recover 3-6mo

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5
Q

What is special about elderly population and Hep?

A

Fatal for elderly

Fatal if HEP A with Chronic HEP C

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6
Q

Which virus is ASSOC w/ paraenteral, oral, w/ incub 50-160day.
Transmission via Blood and vertical- IVDA
Any age
Severe w/ 1% mortality

A

HEP B

CP- severe flu like sx

Workup- CBC, LFT
#1 order HBsAG first
IF HBs AG POS then, HBeAG, ANTI HBc, Anti HBs

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7
Q

Mr. Vegas c/c severe fatigue, nausea, myalgia w/ RUQ pain. +HSM.
What is present early with Hep B and is a marker for HBV replication and degree of infectivity?

A

HBeAg

-HBsAg present 1-10w after acute exposure; undetectable after 6m
Screening
IF present for >6mo, chronic carrier

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8
Q

What is different parts of the virus that the pt has been exposed to in different ways ?

A 
C= core
S= surface- chronic
E= infectious acute
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9
Q

In order to have HEP D what does the person have to have?

A 
HEP B
Delta agent: defective virus particle
1.	Causes exacerbation for Hep B carriers
2.	Fulminant hepatitis
3.	Rapid cirrhosis
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10
Q

What indicates acute HEP B in labs and best indicator of HEP B prognosis?

A
  1. ALT, AST elevated up to 2000= ALT>AST
  2. **PTT or PT/INR - best prognosis. Elevation of INR >1.5
    Person bleeding more
  3. Recovery = N LFT’s in 1-4 months
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11
Q

Mr. Vegas has elevated INR and +HBsAG. What is treatment?

A

HEP B poor prognosis

  1. suppress viral replication
  2. NO CURE

Treat complication and indications:

  1. Prevent ARL, cirrhosis, fibrosis
  2. INR >1.5
  3. Fulminant hepattis
  4. Chemo, IMC pts
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12
Q

What is Persistent HBsAg > 6mo after acute infection?

A

Chronic HEP B
MC perinatal age 1-5yo
LC adults

CP-fatigue; acute exacerbations of infection that mimic acute hepatitis; hepatic failure

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13
Q

What confirms a Patient in low or nonreplicating phase / inactive carrier state?

A
  1. HBeAG negative + HBV <2000-Means Low virus replicating
  2. Persistent Positive HBsAg > 6 mo following acute infection
  3. remission by normal serum ALT concentrations
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14
Q

A 48 yo male presents for routine physical exam. No PMH, Meds, ROS. ALT 50, no known hepatitis risk factor is culture (born in Vietnam). No EtOH. VSS, PE neg. Pt may be suggestive of Hepatiis. What is workup?

A

HEP B Carrier/Chronic
HBsAG screen
CBC w/ platelets, PT/PTT INR
HCV, HDV, HIV

LABS -
anti-HBs negative -not immune, no vaccine
anti-HBc positive -current
or past infection
anti-HBc IgM negative -no current infection
HBeAg negative-low infectivity, indicates carrier state
HBV DNA
<2000 IU/mL -low viral replication
anti HDV-R/o viral co-infection:

HepatoCellular Carcinoma HCC -alpha-fetoprotein- AFP

  1. +/- Liver biopsy referral,
  2. INR
  3. +/-US

Manage-

  1. LFT, CBC w/ platelets
  2. Offer HEP A vacc
  3. Pt. Ed
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15
Q

What is the prognosis for immunocompromised pts Chronic Hep B?

A

IMC reactivation, progression
Non IMC pts
5 yr risk:
1. Liver disease 50%: cirrhosis, hepatic failure, HCC

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16
Q 
Which hep virus is transmitted SEX MC
Incubation 15-160d
Any age
Severe Mortality 1%
MC liver transplant cause- is it d/t HIGH hep bc donor
Slow progression
Services >1wk on implements
Asymptomatic
MC chronic liver DZ
30% HCC
LFTs high 6-12wks post exposure
A

HEP C

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17
Q

Who needs to have a HEP C screen out of the following pts. ?

  1. born in the United States 1945 and 1965
  2. IVDU, cocaine use
  3. received clotting factors made before 1987
  4. received blood/organs before July 1992
A

All of them +

  1. received blood from a donor who later tested positive for HCV
  2. chronic hemodialysis
  3. liver disease -elevated ALT level-
  4. HIV
  5. Children born to HCV-infected mothers
  6. needle stick injury or mucosal exposure to HCV
  7. sexual partner of an HCV-infected person
  8. Prisons
18
Q

What detects Hep C 2 weeks after exposure?

A

ANTI HCV ELISA•

More sensitive: PCR HCV RNA

19
Q

MR. RENO in prison has flu-like sx 5wks. What is your workup?

A 
HEP B
WBC >12-18K
Lymp >43
LFTs- still elevated 6-12wk post
ALT 788
AST 597
T bili >4
20
Q

What distinguish acute from chronic HEP C?

A

Previous PCR-NEG HCV RNA serology

Followed by nucleic acid testing- done if PCR +

21
Q

What is HCV interpretation if:
ANTI HCV- POS
HCV RNA- POS

A

Acute or chronic HCV

22
Q

What is HCV interpretation if:
ANTI HCV- POS
HCV RNA- NEG

A

Resolution of HCV

Acute HCV low viremia

23
Q

What is HCV interpretation if:
ANTI HCV- NEG
HCV RNA- POS

A

Early acute HCV

Chronic in HCV IMC

24
Q

What help determines the treatment of HCV?

A

Genotype 1- ANTIVIRAL
US G1= cure
Africa -G4= hard to treat

Other eval needed for TX
HIV, HEP A,B
Liver biopsy

TX- Cost Antiviral Therapy- $$$, Pschye, NO EtOH-
GOAL eradicate HCV RNA- viral undetectable after 24wks
Host factors large role in outcome

25
Q

What is late stage hepatic fibrosis; distortion of the hepatic architecture and the formation of regenerative nodules. Gradual onset?

A

1 DOC-**Harvoni 12wk

CIRRHOSIS

  1. irreversible in adv.
  2. Related to chronic HEPC
  3. HCC risk
26
Q

Mr. T has fatigue, anorexia, weight loss, nausea, abdominal pain for past 3mo. What will lab show if cirrhosis is suspected from Hx.

A

**CBC- Anemia, Thrombocytopenia
INC bilirubin, DEC albumin
INC INR/PT
INC NH4 ammonia - hepatic encephalopathy ,Get confusion, asterixis

27
Q

What PE finding show signs of hepatocellular failure?

A

All R/T Cirrhosis Dz.

a. Jaundice
b. Edema
c. Ascites- bacterial infx- broad spec
d. Electrolyte abnormalities
e. Bleeding disorders
f. Hepatomegaly- hidden by ascites
g. Portal hypertension

28
Q

The following is related to what:

  1. Bleeding from varices – MC esophagus and portal hypertension in their belly.
  2. Spontaneous bacterial peritonitis
  3. Hepatocellular CA
A

Complication of Cirrhosis

29
Q

Mr. T has fatigue, anorexia, weight loss, nausea, abdominal pain for past 3mo. Work up show
*Anemia, INC INR, INC Bilirubin. What is the treatment?

A

NO ETOH

  1. Diuretics- dec fluid
  2. Paraentesis
  3. VK inj- after INR increase
  4. Mulivitamins
  5. Lactulose
  6. Liver transplant
30
Q 
These drugs are related to what
•	Anabolic steroids
•	IV tetracycline
•	Acetaminophen
•       INH-VC
A

Direct hepatotoxicity

dose dependent

31
Q

Post TB, pt c/c Fever, RUQ pain, pruritus, skin rash, eosinophilia. LFT- INC ALT, AST? What could be cause

A

INH drug induced hepatitis

32
Q

Mr. Baynes has been drinking for over 40y. what is definitive dx procedure of his liver?

A 
BIOPSY
 what other s/s:
b.	Anorexia, fatigue, jaundice
c.	Tender HSM
d.	Fever, leukocytosis
e.	Elevated AST, GGT
g.	Cirrhosis
h.    hepatic encephalopathy
33
Q

What are MC sx of viral hepatitis?

A
  1. Jaundice
  2. Abdominal pian
  3. Flu-like- acute hit hard
  4. Tender Liver
  5. +/- spleenomegaly
  6. Post. Lymphadenopathy
    ALL worse in HEP B, C
34
Q

What are common Lab outcomes with HEP?

A
  1. Anemia

2. Lymphocytosis

35
Q

Who get HEP B Vaccine?

A 
Everyone
At birth
3- 0,2, 6mo
Post exposure prophlaxix
IVDA
All preg women get a Screen
36
Q

Pt labs from HEP B panel are: HBsAG NEG,
ANTI-HBC NEG,
ANTI- HBs NEG
What is DX?

A

Susceptible- Never had vaccine, no infection
HBsAG- surface antigen MEANs infection

ANTI-HBcore- antibody to antigen have or had infection

ANTI- HBs- antibody to surface antigen- immune vaccinated

IgM anti HBc- acute fight from infection

37
Q

Pt labs from HEP B panel are: HBsAG NEG,
ANTI-HBC POS
ANTI- HBs POS
What is DX?

A

Immune d/t natural infection

38
Q

Pt labs from HEP B panel are: HBsAG NEG,
ANTI-HBC NEG,
ANTI- HBs POS
What is DX?

A

Immune d/t HEP vaccine

39
Q 
Pt labs from HEP B panel are: HBsAG POS, 
ANTI-HBC POS,
IgM ANTI HBc POS
ANTI- HBs NEG
What is DX?
A

ACUTE infx

40
Q 
Pt labs from HEP B panel are: HBsAG POS, 
ANTI-HBC POS,
IgM ANTI HBcNEG
ANTI- HBs NEG
What is DX?
A

Chronic

41
Q

What is MCC of chronic liver dz WW?

A

Nonalcholic Fattly liver DZ- insulin resistance

CP- ASX, fatige, malasie, vague RUQ, abd pain
LABS- mild elevation, NEG HEPs
DX- USHepatic steatosis via imagine or biopys, NO ETOH, no PMH of liver dz

TX- Vaccinate HEP A,B, Statins, DM meds, Wt loss, NO ETOH

Monitor 3 and 6 mo

SUMMED2 (38 decks)

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