Hepatic Disorders

Question 1

cirrhosis s/s

Answer 1

portal HTN, ascites, gastro-esophageal varices, splenomegaly (thrombocytopenia), encephalopathy

Question 2

cirrhosis wu

Answer 2

• high INR & low albumin (dec protein prod)
• high conj bili (dec processing) & eventual inc unconj bili
• US (ascites, portal vein thrombosis)
• Dx para (true ascites (sAlbumin:peritoneal alb of > 1.1) vs SBP)
• liver bx
• EGD (varices screen)

Question 3

cirrhosis mgmt

Answer 3

• ascites: salt restrict, diuretics, tx para, TIPS if refract, abx for 2ndary inf
• encephalopathy: lactulose (reduce ammonia)
• tx viral if present
• no EtOH
• Hep A, B imm
• transplant (MELD)

Question 4

prognostic tools

Answer 4

Child-Pugh (1 yr survival rate) and MELD (liver transplant eval)

Question 5

Hepatitis eti

Answer 5

viral (MC), toxins (EtOH), meds, industrial organic solvents, infection, autoimmune dz, NASH

Question 6

hepatitis s/s

Answer 6

• acute: malaise, mya/arthralgia, F, N/V/D, HA, anorexia, dark urine, scleral icterus, abd pain, tender hepatomegaly, LAD, splenomegaly
• chronic: malaise, weak, cirrhosis sx if sev

Question 7

Hep A (source/trans, imm?, acute/chronic?, misc)

Answer 7

• fecal/oral
• yes (exp for travelers, drug users, chronic liver dz)
• acute (RUQ pain, N/V)
• “infectious hep”: comps of fulminant (necrotic) hep, cholestatic hep

Question 8

Hep B (source/trans, imm?, acute/chronic?, misc)

Answer 8

• blood, parenteral, sex, dialysis, tattoos
• perQ, mucosal, TRANSPLACENTAL
• imm all infants/adolescents/high risk/perinatal pd
• chronic (unless cleared: ususally limited, interferon/INF)
• “serum hep”: chronic inc risk of cirrhosis & HCC
• DNA

Question 9

Hep C (source/trans, imm?, acute/chronic?, misc)

Answer 9

• blood, parenteral, sex, IVDU, transfusions
• perQ/mucosal
• chronic: silent progression (tx: Harvoni, ribavirin)
• # 1 cz of liver transplant (bx for staging)

Question 10

Hep D (source/trans, imm?, acute/chronic?, misc)

Answer 10

• blood
• perQ/mucosal
• chronic
• need Hep B to get Hep D

Question 11

Hep E (source/trans, imm?, acute/chronic?, misc)

Answer 11

• fecal/oral
• imm for Hep B
• acute (b9, self-limited)
• inc sev in preg, rare in US (endemic in India, Mexico, Iraq, N Africa)

Question 12

HBsAg (-)
Total anti-HBc (-)
anti-HBs (-)

Answer 12

susceptible to infection

Question 13

HBsAg (-)
Total anti-HBc (+)
anti-HBs (+)

Answer 13

immune due to infection

Question 14

HBsAg (-)
Total anti-HBc (-)
anti-HBs (+)

Answer 14

immune due to hep B vacc

Question 15

HBsAg (+)
Total anti-HBc (+)
IgM anti-HBc (+)
anti-HBs (-)

Answer 15

acutely infected

Question 16

HBsAg (+)
Total anti-HBc (+)
IgM anti-HBc (-)
anti-HBs (-)

Answer 16

chronically infected

Question 17

HBsAg (-)
Total anti-HBc (+)
anti-HBs (-)

Answer 17

either: recovering from acute inf, distantly immune (low level of anti-HBs), susceptible w/ false + anti-HBc, or chronic inf w/ rare non-detectable HBsAg

Question 18

B9 liver neoplasms

Answer 18

• Hemangioma (MC, small, asx, incidental)
• hepatic adenoma (assoc w/ long-term estrogen use, can rupture/bleed = resect)
• focal nodular hyperplasia (poss congenital malform, resect)
• hamartoma (malform)
• cysts: simple, infectious, polycystic liver, biliary cystadenoma, Von Meyenburg complex (multiple, small nodular/cystic lesions)

Question 19

malignant liver neoplasms (RF, WU)

Answer 19

• EtOH, autoimmune hep, viral hep, alpha-1 antitrypsin deficiency, Wilson’s dz (excess copper, Kayser-Fleischer ring of eyes, tx w/ penicillamine)
• elevated AFT indicate malignancy

Question 20

hepatocellular carcinoma (HCC)

Answer 20

• malignant
• h/o chronic liver dz/cirrhosis (screen high risk q 6 mos w/ US)
• suspect if cirrhotic pt decompensates
• labs nonspecific (trend AFP)
• Dx img shows multiphasic tumor
• Tx: resect, radiofreq ablation, palliative embolization, transplant (MELD)

Question 21

metastatic dz (liver mets)

Answer 21

MC malignant hepatic neoplasm in Western world