Hepatitis Flashcards
Chronic hepatitis characterized by circulating autoantibodies (not thought to be part of the pathophysiology) & high levels of serum globulin concentrations
autoimmune hepatitis
Treatment for autoimmune hepatitis
corticosteroids. azathioprine 2nd line
Genetic disease due to autosomal recessive gene HFE. Most common single gene disorder
hemachromatosis
Increased iron load leads to eventual cirrhosis, cardiomyopathy, DM, and hypogonadism
hemochromatosis
When do symptoms of hemochromatosis usually present?
age 40 or when iron stores reach 15-40g
Classic presentation of hemochromatosis
cutaneous hyperpigmentation w/ diabetes & cirrhosis
Gold standard for confirmation of hemochromatosis in addition to elevated serum transferrin saturation and elevated serum ferritin
liver biopsy
The mainstay of treatment for hemochromatosis is phlebotomy. What lifestyle modifications should a patient also make?
avoid red meat, Fe vitamins, ETOH, and the handling/eating of raw seafood. Get Hep A&B vaccines
Autosomal recessive disease that affects copper metabolism. Organ damage due to copper build up in the liver and brain
Wilson’s disease
Generally presents between 1st-3rd decades with liver disease, neurologic and psych symptoms
Wilson’s Disease
Pathognomic for Wilson’s disease
kayser-fleischer rings in the eyes
Treatment for Wilson’s disease
chelation therapy w/ D-penicillamine
Can occur within hours of a large alcohol binge & if continues to drink can progress. May have tender hepatomegaly. Transaminases mildly elevated. Can also occur in obese individuals and pregnancy
fatty liver
Physical exam may reveal spider angiomas, palmar erythema, gynecomastia, parotid enlargement, testicular atrophy, ascites, encephalopathy
fatty liver
Distinguishing feature of transaminases associated with fatty liver disease that is rarely seen in other forms of liver disease
AST: ALT ratio usually greater than 2:0
Histology finding associated with fatty liver disease
Mallory bodies
Treatment of fatty liver disease
alcohol cessation, glucocorticosteroids for severe cases, possible liver transplant
Most common cause of liver failure in the US
drug induced liver injury (DILI)
Common group of drugs that induce asymptomatic elevations in liver enzymes without causing disease
statins
Most common drugs implicated in DILI in US
acetaminophen and antibiotics
Treatment for acetaminophen overdose
Activated charcoal if ingested within 2-3 hours. N-acetylcysteine for severe overdose
T/F All patients with liver tenderness and jaundice secondary to acetaminophen should received N-acetylcysteine
true
General signs of viral hepatitis on exam
jaundice, RUQ pain, hepatomegaly
Viral hepatitis where there is no chronic infection and no documentation of maternal-fetal transmission
hepatitis A
Fecal-oral route predominates. Close personal contact (e.g. household contact, sex contact, day care centers). Contaminated food/water
Blood exposure
hepatitis A
Serology results with positive IgM antiHAV, what does patient have?
acute hepatitis A
Major mode of transmission of Hep B in developed and underdeveloped countries
developed ususally sexual and underdeveloped usually perinatal transmission
Postexposure prophylaxis for hep B
first dose of vaccine. Administer HBIG at same time—different site than vaccine
Extrahepatic manifestations due to circulating immune complexes include: fever, rash, arthralgias/arthritis, polyarteritis nodosa, glomerular dz
hepatitis B
In hepatitis B, appears prior to onset of sx and if resolves becomes undetectable in 4-6 months. Persistance past 6 months indicates chronic infection
Hepatitis B surface antigen (HbsAg)
Intracellular antigen in affected hepatocytes. What does the rresence of Anti-HBc of IgM class indicates?
acute HBV infection
What does the presence of anti-HBs only indicate?
immunity to HBV by vaccination
Secretory protein. Marker of HBV replication and infectivity. occurs early in patients w/ acute infection
Hepatitis B e antigen (HbeAg)
Agent of choice for chronic HBV infection (ie those with HBeAg, high serum HBV DNA levels, and active liver disease/elevated LFTs)
Interferon or peginterferon
What is the cause for the majority of liver transplants in the US usually caused by IV drug use or sex with IV drug user?
hepatitis C
Most common complaint of hepatitis C
fatigue
What do you use to assess response to treatment in chronic HCV infection?
sustained HCV RNA negativity
Do liver transplants help HCV patients?
NO. a non-infected liver transplanted into an HCV infected patient becomes infected and decreases survival
Required for hepatitis D replication
hepatitis B
RNA virus. Enterically transmitted, waterborne virus. U.S. cases usually have travel history to endemic area. NO chronic form
hepatitis E
