GI MEGAQUIZ LIVER Flashcards
extrahepatic complications of chronic HBV
-due to circulating hep B antigen-antibody immune complexes
-polyarteritis nodosa- inflammation of medium sized vessels -> cancer sx
-glomerular disease
chronic HBV treatment
-based on circulating virus, HBeAg, LFTs, cirrhosis +/-
-nucleoside or nucleotide analog
-OR pegylated interferon
-fu and monitor for nontreated pts and cirrhosis pts
most important factor that increases progression of liver disease to chronic
-longer the duration of infection
-coinfection with hep D does not increase chance of becoming chronic
extrahepatic complications for HCV
-fatigue
-jaundice rare
-Hematologic diseases- essential mixed cryoglobulinemia and lymphoma
-Renal disease- membranoproliferative glomerulonephritis
-Autoimmune disorders- thyroiditis
-Dermatologic conditions- porphyria cutanea tarda and lichen planus
-Diabetes mellitus
chronic HVC treatment
-f/u monthly
-quantitivative HCV RNA test at 4 weeks of therapy
-virologic response to tx- viral load at 12 weeks after therapy
-fu- HCC screenings, LFTs, US, AFP, EGD
autoimmune hepatitis
-high autoantibodies and serum globulin concentration
-can affect anyone -> middle age women MC
-can follow viral illness- insidious
-asymptomatic - debilitation sx
-ANA and ASMA elevated*
-high bili, AST, ALT
-liver bx required
-tx- prednisone +/- azathioprine
-vaccinate
-monitor if cirrhosis
primary biliary cholangitis
-rare autoimmune- environmental trigger
-intrahepatic bile duct - small
-female > male
-high LFTs
-asymptomatic usually -> if any, pruritis, fatigue
-cholesterol deposits
-high alk phos, high AMA
-MRCP
-liver bx
-tx- ursodeoxycholic acid, fat soluble vitamins if deficient
-monitor bone density
-monitor if cirrhosis
-associated with sjrogens
primary sclerosing cholangitis
-intra and extrahepatic bile ducts affected
-large -> stent
-males > females
-associated with IBD (ulcerative collitis)
hemochromatosis
-increased accumulation of iron as hemosiderin in organs
-autosomal recessive - HFE +
-asymptomatic until > 40 in males and postmenopause in females
-heart failure, arrhythmias, type 2 diabetes, hypogonadism, cognitive changes, arthropathy, bronze colored skin
-high ferritin/iron/transferrin labs
-tx- phlebotomy
alcoholic liver disease
-steatosis
-steatohepatitis
-asymptomatic hepatomegaly - end stage cirrhosis
-rule out other causes of liver disease
-AST>ALT**, high alk phos, GGT, bili
-anemia, thrombocytopenia, prolonged PT, low albumin
-imaging to view fat, and r/o other liver disease
-bx not often necessary
-tx- lifestyle -> if severe, methyprednisone, pentoxifyline
nonalcoholic fatty liver disease (NAFLD)
-steatosis with or without inflammation
-nonalcoholic fatty liver- NAFL (steatosis) -> labs wnl
-nonalcoholic steatohepatitis- NASH -> mildly elevated aminotransferases and alk phos
-MC liver disorder
-obesity, diabetes, high triglycerides, meds
-RUQ pain, asymptomatic
-ALT > AST- NORMAL THOUGH
-REQUIRMENT FOR DX:
-r/o other causes of liver disease
-imaging or bx for steatosis
-no excessive EtOH
-normal LFTs**
nonalcoholic fatty liver disease tx and referral
-Weight loss-5-7% body wt
-Diabetes tx
-Hyperlipidemia tx
-Vaccinate
-Vitamin E if NASH
-Referral:
-LFTS remain elevated despite loss of ≥5 percent of body weight
-Clinical features of advanced liver disease (eg, ascites, splenomegaly, jaundice)
-Advanced Inflammation/fibrosis on liver biopsy
-Advanced fibrosis on a noninvasive liver assessment
-MELD> 10-refer for transplant
cirrhosis MC causes, classification, labs
-MC causes- chronic hep c, alcohol, NASH -> chronic inflammation or cholestasis
-fibrosis and nodular regeneration
-histologic classification- micronodular, macronodular, mixed forms
-elevated LFTs, bili
-thrombocytopenia, prolonged prothrombin time
-anemia
-high or low WBC
what features cause cirrhosis symptoms
-hepatic cell dysfunction
-portal hypertension
-portosystemic shunting
cirrhosis complications
-UGI bleeding - Varices, portal hypertensive gastropathy, or gastroduodenal ulcer
Ascites
-Spontaneous bacterial peritonitis
-Hepatorenal syndrome
-Hepatic encephalopathy
-Carcinoma of the liver
-prevention:
-low Na, restrict fluid, diuretics, TIPS
-avoid ACE inhibitor, NSAIDs, drugs heavy on liver
-tx infection
cirrhosis dx and tx
-US
-Liver Bx (gold std but not always necessary)
-Elastography vs fibrosure
-monitor and treat underlying
-end stage liver disease MELD > 10- transplant eval
hepatic encephalopathy
-CNS dysfunction
-ammonia high
-asterixis
-tx- control protein intake, lactulose
hepatocellular carcinoma
-Arise from parenchymal cells
-85% associated with cirrhosis
-Chronic hepatitis B and C infections, ETOH, NASH** hemochromatosis
-Men > women
-mass + on US
-bx
-PET scan for staging
-high AFP
Child-Pugh score
-grades liver disease severity
-bilirubin
-albumin
-prothrombin time
-ascites
-encephalopathy
causes of jaundice
-hemolysis
-obstruction
-genetic mishandling
-hepatocellular disease
unconjugated vs conjugated bilirubinemia
-unconjugated- hemolysis, genetic disease, drug rx
-stool and urine are normal
-conjugated- hepatocellular disease, obstruction, hereditary cholestatic syndrome
-urine dark, stool light
acute hepatitis phases
-prodromal- abrupt, nausea, vomiting, diarrhea, constipation, RUQ/epigastric pain, fatigue
-icteric phase- 5-10 days after, alcoholic stools
-convalescent phase- resolution of sx
-general signs: hepato and splenomegaly, lymphadenopathy, liver tenderness
acute hepatitis labs
-WBC normal to low
-proteinuria (kidney)
-bilirubinuria- precedes jaundice
-AST/ALT elevated
-PT/INR- prolonged
length of different acute hepatitis
-2-3 weeks usually
-6-9 hep A
-12 hep B
-B, D, C, G can become chronic
-incubation:
-Hep A- 28 days (2 weeks prior infectious stool)
-Hep B- 1-5 months
