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Exam 4-DWB > Hepatitis causes, presentation, and labs > Flashcards

Hepatitis causes, presentation, and labs Flashcards

1
Q

What are the causes of hepatitis

A
  1. Viruses
  2. Alcohol
  3. Drugs
  4. poisons
  5. idiopathic
    6 autoimmune related
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2
Q

Viruses that cause hepatitis

A
  1. hepatitis A, B, D, C, E, G
  2. Epstein-barr
  3. cytomegalovirus
  4. rubella
  5. Herpes simplex
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3
Q

Drugs that are potential causes of hepatitis

A
  1. some OTCs
  2. prescription medications
  3. steroids
  4. anesthetics
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4
Q

Autoimmune issues that are potential causes of hepatitis

A
  1. common in lupus patients

2. more common in women than men

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5
Q

Natural history of acute viral hepatitis that leads to recovery

A
  1. acute illness leading to recovery
  2. can be clinical or subclinical
  3. recovery and immunity
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6
Q

Natural history of acute viral hepatitis that leads to chronic infection

A
  1. no recovery
  2. clinical or subclinical illness
  3. continued viral activity and related complications
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7
Q

HPI for acute viral hepatitis: general symptoms

A
  1. Fatigue
  2. fever
  3. arthralgia
  4. myalgia
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8
Q

HPI for acute viral hepatitis: skin symptoms

A
  1. rash

2. pruritis

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9
Q

HPI for acute viral hepatitis: HEENT

A

jaundice

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10
Q

HPI for acute viral hepatitis: GI

A
  1. abdominal pain
  2. anorexia
  3. Nausea/vomiting
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11
Q

Past medical history for acute viral hepatitis

A
  1. medications
  2. alcohol/tobacco use
  3. occupational risks
  4. high-risk sexual activity
  5. sick contacts
  6. travel
  7. Poisoning
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12
Q

Focused PE for acute viral hepatitis

A
  1. Vital signs
  2. skin
  3. HEENT
  4. Cardiac/respiratory
  5. abdomen
  6. Neuro
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13
Q

HPI for chronic hepatitis infection

A

asymptomatic until advanced disease or other events such as coinfections trigger consideration of viral hepatitis;
highly variable course

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14
Q

Past medical history for chronic hepatitis infection

A
  1. same as acute with high risk sexual activity, sick household contacts, etc.
  2. injection-drug use;
  3. tattooing
  4. immigration
  5. incarceration/group home placement
  6. day care
  7. piercing
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15
Q

focused PE for chronic hepatitis infection

A
  1. Vital signs
  2. skin
  3. HEENT
  4. cardiac/respiratory
  5. abdomen
  6. neuro
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16
Q

ALT {SGPT} transaminases

A
  1. leaked into serum via damage to ALT-rich tissues or changes in cell membrane permeability
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17
Q

ALT {SGPT} transaminase is most sensitive and specific marker for

A

viral liver infections;

it “tells all”

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18
Q

AST {SGOT}

A
  1. found in highly metabolic tissue such as heart, liver;

2. elevated in hepatitis

19
Q

Elevated ALT {SGPT} differentials

A
  1. fatty liver
  2. alcoholic liver
  3. drug/chemical toxicity
  4. hemachromatosis
20
Q

Elevated AST {SGOT} differentials

A
  1. MI
  2. acute pancreatitis
  3. musculoskeletal trauma
  4. acute hemolytic anemia
  5. severe burns
21
Q

What is the characteristic transaminase pattern in viral hepatitis

A

ALT and AST 5-8 times the upper lift of normal

22
Q

AST 2 times ALT can indicate what

A
  1. alcoholic hepatitis
  2. alcoholic cirrhosis
  3. liver congestion
  4. liver mets
23
Q

what is alkaline phosphatase

A

enzyme in cells lining liver, biliary tract, and bone

24
Q

differential diagnosis for elevated alkaline phosphatas

A
  1. vitamin D deficiency
  2. mets/neoplastic disease
  3. cholestasis
  4. infiltrative liver disease {tumors. abscesses}
  5. granuloma
25
Q

How do you determine if elevated alkaline phosphatase is because bone or liver

A

isoenzymes

26
Q

Bilirubin

A

by-product of RBC recycling

27
Q

Bilirubin is produced by

A
  1. liver
  2. spleen
  3. bone marrow
28
Q

indirect bilirubin

A

unconjugated in the spleen

29
Q

direct bilirubin

A

conjugated in the liver, travels to bowel through the bile ducts

30
Q

elevated indirect {unconjugated} bilirubin

A

hemolysis

31
Q

elevated direct {conjugated} bilirubin

A
  1. hepatic dysfunction
  2. viral hepatitis
  3. obstruction of bile flow by stones, tumors, etc.
32
Q

lactic dehydrogenase {LDH} is found in

A
  1. liver
  2. heart
  3. kidney
  4. muscle
33
Q

lactic dehydrogenase {LDH} source is differentiated by

A

isoenzymes

34
Q

lactic dehydrogenase {LDH} elevation differentials

A
  1. MI
  2. hemolytic anemias
  3. tumors
35
Q

LFTs with acute viral hepatitis

A
  1. AST: prejaundice increase up to several thousand units not prognostic
  2. ALT: later increase up to several thousand units; not prognostic;
  3. ALP, LDH elevated but specifics require isoenzymes
36
Q

Bilirubin with acute viral hepatitis

A

increased

37
Q

CBC with acute viral hepatitis

A
  1. low total WBC, leukopenia;
  2. low polys, bands: bandemia
  3. high lymps: lymphocytosis
38
Q

H/H with acute viral hepatitis

A

mild anemia

39
Q

Albumin with acute viral hepatitis

A

high or low

40
Q

Prothrombin time with acute viral hepatitis

A

high or low;
prolonged duration indicates impending liver failure;
need to test for specific viral markers

41
Q

IgD results from and relates to

A

B lymphocyte differentiation and relates to antigen receptors

42
Q

IgM aids

A

early immune response and activates complement

43
Q

IgG acts as

A

primary, long-term antibody against viruses/bacteria, fixes complement

Exam 4-DWB (20 decks)

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