Hepatitis and Cirrhosis Flashcards
Autoimmune hepatitis
Type 1 and 2
Occur in women
Often have other autoimmune dz
Autoimmune hepatitis tx
Corticosteroids
Azathioprine 2nd line
Hemochromatosis
Mostly in caucasians
Iron overload form increased absorption
Leads to cirrhosis, cardiomyopathy, diabetes, hypogonadism.
How much iron does it take for hemochromatosis to manifest symptomatically?
around age 40 OR when iron stores reach 15-40 grams.
Females have delayed sx
Classic hemochromatosis S/S
Cutaneous hyperpigmentation (bronzing)
Diabetes
Cirrhosis
Gold standard for hemochromatosis dx
Liver biopsy
Hemochromatosis tx
Phlebotomy every 2-4 months
Avoid alcohol, red meat, iron
Wilson’s dz
Hepatolenticular degeneration Autosomal recessive Affects copper metabolism Copper build up in liver and brain. Easily treated if diagnosed early
Wilsons Dz presentation
Presents btw 1st and 3rd decade.
Liver dz of young child
Neuropsych sx
Kayser-Fleischer rings
Copper ring Iin eyes
For dx of wilsons dz
Wilsons dz tx
If not treated, fatal
Chelate for tx
3 stages of alcoholic liver dz
Fatty liver
Alcoholic hepatitis
Fibrosis and cirrhosis
Fatty liver
Mostly asymptomatic
Can occur within hrs of binge
Tender hepatomegaly
May occur in obesity and preg
Alcoholic hepatitis
Asymptomatic to very ill
Anorexia, weight loss, abd pain
Jaundice
Fever
ALcoholic hepatitis physical findings
Spider angiomas Palmar erythema gyenecomastia Parotid enlargement testicular atrophy ascites encephalopathy
Alcoholic hepatitis lab findings
AST:ALT ratio greater than 2
Anemia
Hyperbilirubinemia
Is alcoholic hepatitis reversible?
Usually, but may progress
Most common cause of liver failure in the US?
Drug-induced Liver Injury
DILI
Drug-induced liver injury
APAP, Abx
How to tx APAP OD?
N-acetylcysteine
S/S of Viral Hepatitis
Can be asymptomatic Malaise and fatigue Anorexia, N/V Myalgias Pale stools, dark urine Jaundice RUQ pain
Viral hepatitis tx?
Supportive
Manage sx
Does HAV cause a chronic infection?
No
HAV route of transmission
Fecal oral mostly
Close contact, sex, food, blood
HBV route of infection?
Sexual contact Perinatal Breaks in skin, injectables Organ transplant Transfusions (RARE)
HBV post-exposure tx
Vaccine and
HBIG in different body site
Extrahepatic HBV manifestations
Fever Rash Arthralgias Polyarteritis nodosa Glomerular dz
HbsAg
Hepatitis B surface antigen
Appears prior to onset of sx
Persistence past 6 mo indicated chronic infection
dissapears within 4-6 months in infection
HbcAg
HBV CORE antigen
Indicates acute infection
Anti-HBsAg
Follows disappearance of HBsAg.
Persists for life
*Just presence of this means immunity by vaccination.
*Presence of this AND HBsAg indicated HBV carrier.
Chronic HBV Tx
Interferon
But not in pts w/ decompensated cirrhosis
Majority of liver transplants in the US are from?
HCV
Risk for HCV transmission
IVDU
Sex
Jail, blood transfusion
which cancer does HCV lead to?
HCC
HCV serology
80-100% of pts remain HCV RNA positive
60-80% have persistent liver enzyme elevation.
HCV Tx
Peginterferon
Ribavirin
HDV
Required HBV for replication
Parenteral, close contact transmission
Low risk of chronic infxn
High risk of superinfection
HEV
Waterbourne RNA virus
No chronic form
Spread by fecally contaminated water
HGV
Does not cause hepatitis in humans.
Protective in HIV patients
Cirrhosis
Development of fibrosis of liver
Nodules
Impairment of function
Tx of hepatic encephelopathy
Lower ammonia levels by:
Lactulose
Enemas
