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Year2 GI Exam II > Hepatitis and Cirrhosis CIS - Unrein > Flashcards

Hepatitis and Cirrhosis CIS - Unrein Flashcards

1
Q

Case 21yo F jaundice, icterus, resting tremor

dark circles irises of eyes

AST and ALT elevated
bilirubin elevated

A

wilsons disease

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2
Q

primary biliary cirrhosis

A

middle aged females

anti-mitochondrial antibody**

alk phos and cholesterol elevated

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3
Q

anti-mito Ab

A

primary biliary cirrhosis

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4
Q

primary sclerosing cholangitis

A

males age 20-50yo

with ulcerative colitis

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5
Q

wilsons disease

A

auto recessive
kayser fleischer rings
parkinson like tremor
alk phos low

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6
Q

Hep A

A

fecal oral

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7
Q

Hep B

A

blood, body fluid, tissue

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8
Q

test for wilsons disease

A

best test - 24 hour urine copper**

ceruloplasmin - acute phase reactant - so not specific

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9
Q

55yo M abdominal ascites, edema, jaundice

  • US - small nodular liver
  • EKG cardiomyopathy
  • IV drug use
  • heavy alcohol
  • AST ALT elevated slightly
  • INR elevated
  • HBsAg - positive
  • Anti-HBs - negative
  • Anti-HBc - positive
  • ANti-HBe - positive
  • Anti-HCV - negative

ascites total protein high
SAAG low

A

Metastatic hepatocellular cancer**

serum albumin gradient

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10
Q

serum ascitic albumin gradient

A

SAAG
serum albumin - ascites albumin

correlates with sinusoidal pressure and is function of oncotic-hydrostatic balance

cirrhosis - high SAAG high ascites total protein low

malignant ascites - SAAG low ascites total protein high

cardiac ascites - SAAG high and ascites total protein high

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11
Q

SAAG low

ascites total protein high

A

malignant ascites

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12
Q

SAAG high

ascites total protein low

A

cirrhosis

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13
Q

SAAG high

ascites total protein high

A

cardiac ascites

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14
Q

52yo F 6 pack beer per day, injection narcotics, no jaundice, no abdomen pain

nodular liver edge and palpable spleen tip

AST and ALT elevated
alk phos elevated
anti smooth m Ab - 1:640

A

autoimmune hepatitis

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15
Q

autoimmune hepatitis

A

diagnosis of exclusion
-rule out viral hepatitis

fulminant liver enzyme elevation

perimenopausal women

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16
Q

anti smooth m Ab

A

autoimmune hepatitis

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17
Q

case 18yo F jaundice and icterus, no vaccines, IV injection

diarrhea after eating - cafeteria lady Hep A

ALT AST very elevated
total bilirubin elevated

A 
Anti HepA - positive
HBsAg - positive (active disease)
Anti-HBsAg - negative
IgM Anti-HBc - positive (acute) - chronic is IgG
HCV RNA - negative
Anti-HDV - positive
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18
Q

HBsAg

A

peak of Hep B disease

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19
Q

Anti-HBsAg

A

doesn’t rise until illness is over

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20
Q

Anti-HBc IgM

A

just before onset of symptoms

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21
Q

HCV RNA

A

detectable 1-3 weeks after infection

unless this persists as chronic infection

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22
Q

Hep D

A

super infection in chronic carrier state or co-infection with Hep B

surface Ag of Hep B required for Hep D to replicate

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23
Q

25yo F itching bad, 27 weeks pregnant, prenatal vits, icteric eyes

Alk phos elevated
bilirubin elevated

A

intrahepatic cholestasis of pregnancy

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24
Q

intraheptic cholestasis of pregnancy

A

2nd or 3rd trimester

mild elevation of bilirubin and alk phos

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25
Q

hyperemesis gravidarum

A

unrelenting nausea and vomiting that is 1st trimester disorder

resolved by week 16

elevated transaminases

no itching or cholestasis

26
Q

HELLP

A

hemolysis, elevated liver enzymes, low platelets

left threatening complication of pregnancy in 3rd trimester and requires urgent delivery

27
Q

acute fatty liver of pregnancy

A

leads to liver failure with elevated transaminaseas and abnormal INR

28
Q

Case 35yo M pruritis, RUQ pain, ulcerative colitis, prednisone tx

AST Alt elevated
Alk phos very elevated

perinuclear antineutrophlic cytoplasmic Ab - 1:1280

A

primary sclerosing cholangitis

29
Q

hemochromatosis

A

iron overload state with elevated transferrin

hyperpigmentation**

30
Q

acute cholecystitis

A

acute symptoms with eating fatty meal and females of late repro age who are overweight

5 Fs

31
Q

diagnostic test of choice for PSC

A

ERCP
-endoscopic retrograde cholangiopancreatography

dye lights up the biliary tree

arborization of the biliary tree**

32
Q

32yo M jaundice and icterus, Hep B and Hep A vaccines

needle stick from jaundice patient
6 beers / weekends
acetaminophen 2x daily

AST and ALT elevated
bilirubin elevated

Anti-HAV titer 1:640
HBsAg negative
Anti-HBs - titer 1:640
Anti-HBc - negative
Anti-HCV - Titer 1:640
A

Hep C

33
Q

1:640 titer

A

is a pretty strong response

based on dilution

34
Q

Hep A vaccine

A

offers lifelong immunity

fecal oral transmission

35
Q

Hep B

A

pt will have anti-HBs antigen

chronic Hep B - HBsAg positive

HBeAg - indicates ongoing replication

36
Q

49yo F increased skin pigmentation, RUQ pain, increased urination

  • 12 beers weekends
  • irregular pulse

ALT and AST elevated
alk phos elevated
ceruloplasmain normal

A

hemochromatosis

**pigmentation

irregular pulse - conduction abnormality in heart

37
Q

increased fluid intake and urinating more

A

diabetic

38
Q

polyphagia, polydypsia, polyuria

A

diabetic

39
Q

diabetic and hemochromatosis

A

iron deposit in pancreas - destruction

40
Q

diagnosis of hemochromatosis

A

transferrin saturation

ferritin - acute phase reactant - not specific

41
Q

tx of hemochromatosis

A

blood donation

42
Q

Case 39yo M malaise, jaundice, hepatomegaly

  • obese
  • alcohol use
  • polyuria and polydipsia
  • hypercholesterol
  • fatty liver

acetaminophen 650mg/day

AST and ALT elevated

gamma-glutamyl transferase elevated

bilirubin elevated

Anti-HBs positive

A

tx - weight loss and blood glucose control

GGT - specific for liver**

non-alcoholic alcoholic steatohepatitis

43
Q

ledipasvir/sofosbuvir

A

new tx for Hep C

very expensive**

44
Q

entecavir

A

tx for Hep B

45
Q

Case 30yo M jaundice, icterus, RUQ pain, crohns, Hep B vaccine
-INH prophylaxis - PPD skin test positive

ALT and AST elevated
bilirubin elevated

Anti-HBs - positive

A

INH toxicity

46
Q

co-infection

A

hep D on top of chronic hep B carrier

47
Q

superinfection

A

get both hep B and D same time

-more rare than co-infection

48
Q

Case 48yo F HTN control, elevated AST and ALT

IgM Anti-HBc - positive

A

if Anti-HBs positive in 3 months - indicates acute infection

in window period

49
Q

most sensitive marker for acute Hep B

A

anti-HBc IgM

50
Q

chronic Hep B

A

HBsAg

51
Q

Hep D

A

requires presence of HBsAg

52
Q

Case 64yo M confusion, icterus, jaundice, hepatomegaly, flapping tremor, handle of whiskey a day

US - fatty liver
ALT AST elevated
GGT elevated
bilirubin elevated
ammonia elevated
A

etiology of confusion and hepatic abnormalities
-ethanol

neuro sx - ammonia

tx - laculose

53
Q

AST > ALT by 2x

A

alcohol

also - GGT elevation disproportionately

54
Q

flapping tremor

A

asterixis

with alcoholics

55
Q

lactulose

A

tx of delirium due to high ammonia

transform the freely diffusible ammonia into ammonium (NH4+) which can no longer diffuse back into the blood

56
Q

Case 52yo F alcoholic liver disease and Hep B
-sudden increase abdominal girth and pain

  • mild BUN and Cr elevated
  • AST ALT elevated
  • alk phos elevated
  • bilirubin elevated
  • Anti-HBs - positive
A

spontaneous bacterial peritonitis

tx - drain - and antibiotics

57
Q

spontaneous bacterial peritonitis

A

no specific criteria

high index of suspicion ket to early diagnosis

58
Q

hepatorenal syndrome

A

decomposition of kidneys

activation of RAAS and renal vasoconstriction as result of systemic vasodilation

59
Q

reactivation Hep B

A

HBsAg positive
anti-HBc IgM negative
HBeAg may be positive

60
Q

Case 40yo F sudden jaundice, icterus, RUQ, palpable liver edge
-IV drug use

  • AST ALT elevated
  • bilirubin elevated
  • Anti-HBs - positive
  • Anti-HCV - positive
  • HCV-RNA - positive
A

chronic hep C infection with acute activation

61
Q

Case 56yo M chronic hep B, new abdomen pain, fever, ascites, no jaundice

US - hepatomegaly and portal vein thrombosis

A

hepatocellular carcinoma

all malignancies - hypercoagulable - portal vein thrombosis

62
Q

all cancer patients

A

hypercoagulable

Year2 GI Exam II (18 decks)

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