Henderson- Liver Transplant and Hepatitis Flashcards
indications name for liver transplants
MELD 3.0
liver tranplant evaluation indications:
MELD 3.0:
low serum albumin
sex
special indications for liver tranplant
HCC
portopulmonary HTN
hepatopulmonary syndrome
____ was made to hopefully increase allocation for liver transplants to sick patients
MELD 3.0
special indication for transplant that deals with cirrhotic liver with tumor present
HCC
current criteria for liver transplant for HCC patient
UCSF
single lesion </= 6.5 cm
</= 3 nodules w/ large </= 4.5cm
maximal tumor burden </=8 cm
no vascular invasion or extrahepatic invasion
UCSF criteria
complication of portal HTN and patient has liver cirrhosis and pulmonary HTN
Porto-pulmonary HTN
pulmonary vasodilation (takes O2 longer to travel across membrane)
porto-pulmonary HTN
dyspnea (sob)
R ventricle overload
porto-pulmonary HTN
screening for porto-pulmonary HTN
echo
ECHO and pulse ox
main symptom is dyspnea
porto-pulmonary HTN
screening tool for hepatopulmonary syndrome
Pulse ox (and then ABG if <94%)
to diagnose hepatopulmonary syndrome
Echo (seeing bubbles from R to L in heart after third cardiac cycle)
low MELD
transplantation needed due to gastric compression
liver labs normal
polycystic liver disease
autoimmune
recurrent cholangitis
PSC
risk for rare cholangiocarcinoma
indication for liver transplant
PSC
workup for liver transplant for everyone
cross sectional abd imaging
ECHO w/ bubbles
pulse ox; ABG
what age to screen for colon cancer
45
what age to screen for prostate cancer (PSA)
> 50
ischemic heart disease evaluation for low risk patients
stress test
ischemic heart disease for evaluation for high risk patients
heart cath
what does a liver transplant recipient have to have
someone to help them
RNA virus
acute
Hep A and E
DNA virus
acute
not curable
Hep B
RNA virus
acute and chronic
treat everyone
Hep C
incidence of _____ has gone up since COVID
Hep A
fecal-oral transmission (food handlers, sexual contact, drug abuse)
Hep A and Hep E
presentation for hepatitis
jaundice
RUQ pain
AST/ALT > 1000
hx
super infectious and will be really bad for pregnant or immune compromised patients
Hep A
RNA
acute
patient works on farm (Asia, midwest)
Hep E
travel hx important for ___
Hep E
___ and ____ severe in pregnant and immunocompromised patients
Hep A and Hep E
incorporates host DNA and becomes a part of you (not curable)
Hep B
DNA virus
acute presentation
10% will develop chronic infection
Hep B
40 fold more infectious than HIV
PWID (people who inject drugs)
blood transfusion screening
Hep B
4 diseases where you will see AST/ALT> 1000
viral hepatitis
autoimmune hepatitis
Tylenol toxicity
shock liver
dx Hep B
HBsAg +>6 months
can you treat Hep B
no, just suppress it
treat EVERY patient with this
Hep C
estimate what with Hep C patient
fibrosis
Screen_____ for Hep C
everyone
lives in cytoplasm
HCV
lives in nucleus
HBV
normal vaginal intercourse is not a risk for this
Hep C
extremely sexually transmissible
Hep A, E, B
if patient w/ HCV has fibrosis (cirrhosis), what are they at risk for
HCC
fibrosis assessment for HCV if you treat patient
Fibroscan
antivirals SOFOSBUVIR + LEDIPASVIR
to treat Hep C in 8-12 weeks
stop viral genome replication
HCV Ab + shows what
person has been exposed to Hep C
what shows if patient is infected with Hep C
viral load (SVR)
when to test SVR (viral load) after ending treatment for Hep C
12 weeks later
SAg+
eAg+
eAb-
AST elevated
DNA (viral load) 20,000
treat for Hep B
SAg +
eAg-
eAb+
DNA (viral load) 2,000
AST elevated
treat for Hep B
SAg +
eAg+
eAb-
HBV DNA >100
AST normal
dont treat for Heb B
SAg+
eAg-
eAb+
HBV DNA >100
AST normal
dont treat for Hep B
viral load of 200,000 in pregnant woman
treat for Hep B
this antibody appears after person has cleared Hep B infection
HBsAb
