Hepatitis and Cirrhosis

Question 1

Hemochromatosis Classic presentation

Answer 1

cutaneous hyperpigmentation w/ diabetes & cirrhosis

Question 2

Wilson’s Disease

Answer 2

a.k.a. “hepatolenticular degeneration”
-Autosomal recessive
-Affects copper metabolism
-Organ damage due to copper build up in the liver and brain
Look for Kayser-Fleischer rings in eyes
Once diagnosed chelation therapy w/ D-penicillamine is the treatment of choice (lifelong)

Question 3

Fatty Liver (steatosis)/ alcoholic hepatitis Physical Exam

Answer 3

Spider angiomas
Palmar erythema
Gynecomastia
Parotid enlargement
Testicular atrophy
Ascites
Encephalopathy

Question 4

General Presentation Primarily seen w/ HAV, HBV, HCV, HEV:

Answer 4

Many cases can be asymptomatic especially in children
Usually prodrome after exposure:
Malaise and fatigue
Anorexia, N/V
Myalgia's
Pale stools, dark urine 
Jaundice

Question 5

Hepatitis A Virus

Answer 5

NO Chronic infection
Fecal-oral route predominates
Contaminated food/water
Blood exposure
Maternal-fetal transmission has NOT been reported

Question 6

Hep B Postexposure prophylaxis

Answer 6

Give first dose of vaccine

Administer HBIG at same time—different site than vaccine

Question 7

HBV Serology

Answer 7

1st: Hepatitis B surface antigen (HbsAg)
Appears prior to onset of symptoms
Persistence past 6 m = chronic infection
2nd:Hepatitis B core antigen (HbcAg), stays in body forever IgG
3rd: Anti-HBsAg
4th: Hepatitis B e antigen (HbeAg), will go away

Question 8

Key to chronic Hep B infection serology

Answer 8

Hepatitis B surface antigen is ALWAYS present

Question 9

Treatment for Chronic HBV Infection

Answer 9

Interferon or peginterferon is the agent of choice

Patients who have decompensated cirrhosis or are carriers SHOULD NOT receive treatments

Question 10

Side Effects of Peginterferon

Answer 10

Flu-like symptoms
Immunosuppression
Abdominal pain, N/V, dry mouth
Hair loss
Blurred vision
Depression
Anemia

Question 11

Hepatitis D

Answer 11

Requires HBV for replication
HBsAg coat
spread by needles

Question 12

Hepatitis E

Answer 12

RNA virus
NO chronic form
Spread by fecally contaminated water
Person-person transmission uncommon
CAN BE transmitted from mother to newborn

Question 13

Portal Hypertension Results in

Answer 13

Alternate “routes”: 
Esophageal varices 
Enlarged abdominal wall vessels(caput medusa)
Hemorrhoids 
Splenomegaly
Ascites (protein rich fluid)

Question 14

Hydroencephalitis Treatment

Answer 14

Need to lower ammonia levels via:
Lactulose:
giving enough so that the patient has 3-4 soft stools a day
SE: abdominal cramping, bloating, flatulence