hepatitis Flashcards
Which organ should you think of if a patient complains of arthralgia or myalgias?
Think about the liver
What symptoms can a patient present with if they have acute viral hepatitis?
General: fatigue, fever, arthralgia, myalgia
Skin: rash, pruritis
HEENT: jaundice
GI: abdominal pain, anorexia, nausea/vomiting
What areas should you focus on with physical exam of someone with acute viral hepatitis?
Vital signs Skin HEENT Cardiac, respiratory systems Abdomen Neuro
Which lab is most sensitive and specific marker for viral liver infections
ALT
ALT or AST differentials? Fatty liver Alcoholic liver Drug/chemical toxicity Hemachromatosis
ALT
ALT or AST differentials? MI Acute pancreatitis Musculoskeletal trauma Acute hemolytic anemia Severe burns
AST
AST two times ALT
Alcoholic hepatitis
alcoholic cirrhosis
liver congestion
liver metastases
Enzyme in cells lining liver, biliary tract, bone
Differentials
Vitamin D deficiency
Metastatic/neoplastic disease
Cholestasis
Infiltrative liver disease (tumors, abscesses)
Granuloma
Alkaline Phosphatase
What do you look at to determine the source for the elevated alkaline phosphatase?
Look at isoenzymes to differentiate between bone or liver
Which do you look at (direct or indirect) bilirubin when assessing for viral hepatitis?
Direct (conjugated) ***Also present with Hepatic dysfunction Obstruction of bile flow possibly stones tumor
Found in liver, heart, kidney, muscle
Source differentiated through isoenzymes
Differentials: MI, hemolytic anemias, tumors
Lactic Dehydrogenase (LDH)
LFTs AST: prejaundice increase up to several thousand units; not prognostic ALT: later increase up to several thousand units; not prognostic ALP, LDH: elevated; specifics require isoenzymes Bilirubin: increased D/T CBC: Low total WBC, leukopenia Differentials Low polys, bands: bandemia High lymphs: lymphocytosis H/H: mild anemia Albumin: +/- Prothrombin time: +/-
Acute Viral Hepatitis Lab Results
What could a prolonged prothrombin time (PT) indicate in a patient with acute viral hepatitis?
Prolonged duration indicates impending liver failure; need to test for specific viral markers
acts as primary, long-term antibody against viruses/bacteria, fixes complement
IgG
think G for GONE as in the acute infection is gone.