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GI > Hepatitis & Cirrhosis > Flashcards

Hepatitis & Cirrhosis Flashcards

1
Q

Liver Function Tests

A 
Aminotransferases (ALT/AST)
Alkaline phosphatase (AP)
Gamma glutamyl transpeptidase (GGT)
Albumin
Prothrombin time (PT)
BIlirubin
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2
Q

Types of Autoimmune Hepatitis

A 
Type 1 (Classic)
Type 2 (ALK-1)
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3
Q

Who does type 1 autoimmune hepatitis affect?

A

Women of all ages

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4
Q

Who does type 2 autoimmune hepatitis affect?

A

Girls & young women

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5
Q

Clinical Manifestations of Autoimmune Hepatitis

A

Mostly asymptomatic
Advanced cirrhosis
Fulminant hepatitis

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6
Q

Labs for Autoimmune Hepatitis

A

Serological markers present

Aminotransferases more elevated than bilirubin & AP

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7
Q

Extrahepatic Manifestations of Autoimmune Hepatitis

A 
Hemolytic anemia
Thyroiditis
Celiac sprue
ITP
Type I DM
UC
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8
Q

Treatment of Autoimmune Hepatitis

A

Corticosteroids

Azathioprine (2nd line)

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9
Q

Acute Complications of Steroid Therapy

A 
HGN
Hyperglycemia
Insomnia
Psychosis
Gastric Irritaiton
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10
Q

Chronic Complications of Steroid Therapy

A 
Osteoporosis
PUD
Glaucoma
Cataracts
Immunosuppresion
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11
Q

Define Hemochromatotosis

A

Gene defect resulting in increased iron absorption in the intestinal tract from the diet

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12
Q

What does hemochromatosis eventually lead to?

A

Cirrhosis
Cardiomyopathy
DB
Hypogonadism

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13
Q

When do symptoms of hemochromatosis usually occur?

A

Around age 40
Iron stores reach 15-40 g
Females delayed due to menstruation & breast feeding

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14
Q

Clinical Manifestations of Hemochromatosis are Influenced by What

A 
Age
Sex
Alcohol use
Dietary iron
Menstruation & breast feeding
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15
Q

What factors accelerate the process of hemochromatosis?

A

Alcohol abuse

Hepatitis C

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16
Q

Classic Presentation of Hemochromatosis

A

Cutaneous hyperpigmentation
DM
Cirrhosis

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17
Q

Reversible Cardiovascular Manifestations of Hemochromatosis

A

Cardiomyopathy
Vibrio vulnificus
Conduction disturbances
Listeria monocytogenes

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18
Q

Reversible Liver Manifestations of Hemochromatosis

A

Pastcuerlla psudotubercullosis
Abdominal pain
Elevated LFTs
Hepatomegaly

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19
Q

Reversible Skin Manifestations fo Hemochromatosis

A

Bronzing

Grayness

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20
Q

Irreversible Liver Manifestations of Hemochromatosis

A

Cirrhosis

Hepatocellular CA

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21
Q

Irreversible Anterior Pituitary Gland Manifestations of Hemochromatosis

A

Gonadotropin insufficiency

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22
Q

Irreversible Pancreas Manifestations of Hemochromatosis

A

DM

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23
Q

Irreversible Thyroid Manifestations of Hemochromatosis

A

Hypothyroidism

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24
Q

Irreversible Genitalia Manifestations of Hemochromatosis

A

Primary hypogonadism

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25
Q

Irreversible Joint Manifestations of Hemochromatosis

A

Psuedogout

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26
Q

Diagnosis of Hemochromatosis

A

Clinical +
Elevated transferrin
Pathologic
Liver biopsy (gold-standard)

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27
Q

Treatment of Hemochromatosis

A 
Avoid red meat/ iron supplements
Avoid ETOH
Avoid raw seafood
Hepatitis A&B vaccinations
Phlebotomy: take off blood
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28
Q

Define Phlebotomy

A

Removal of 500 mL of blood

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29
Q

Goal of Phlebotomy

A

Hgb = 10-12 gm/dL

Ferritin

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30
Q

Maintenance Phlebotomy

A

Every 2-4 months

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31
Q

Define Wilson’s Disease

A

Organ damage due to copper build up in the liver & brain

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32
Q

Pathogenesis of Wilson’s Disease

A

Affects the carrier protein of copper

Impairs excretion of copper via bile

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33
Q

Clinical Manifestations of Wilson’s Disease

A

Varies & non-specific
Liver disease (young children)
Neurologic symptoms
Psychiatric symptoms

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34
Q

Diagnosis of Wilson’s Disease

A

Ceruoplasmin level
24 hour urine
Kayser-Fleischer rings in eyes

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35
Q

Treatment of Wilson’s Disease

A

Chelation therapy with D-penicillamine

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36
Q

Three Stages of Alcoholic Liver Disease

A

Fatty liver (statosis)
Alcoholic hepatitis
Alcoholic fibrosis & cirrhosis

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37
Q

Fatty Liver

A

Occur within hours of alcohol binge
Tender hepatomegaly
Transaminases mildly elevated
Can occur in obese individuals & pregnancy

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38
Q

Clinical Manifestations of Alcoholic Hepatitis

A 
Anorexia
N/V
Weight loss
Abdominal pain
Poor nutritional status
Jaundice
Fever
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39
Q

Physical Exam Findings in Alcoholic Hepatitis

A 
Spider angiomas
Palmar erythema
Gynecomastia
Parotid enlargement
Testicular atrophy
Ascites
Encephalopathy
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40
Q

Lab Findings in Alcoholic Hepatitis

A 
Leukocytosis
Anemia
Transaminases elevated
Increased alkaline phosphatase
Hyperbilirubinemia
Hypoalbunemia (severe disease)
Coagulopathy (severe disease)
Elevated ammonia level (severe disease)
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41
Q

Complications of Alcoholic Liver Disease

A 
Alcoholic fatty liver is reversible
Alcoholic hepatitis usually reversible
Cirrhosis
GI bleed
Esophageal varices
Gastritis/PUD
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42
Q

Treatment of Alcoholic Liver Disease

A

Cessation of alcohol
Nutrition
Vitamin B12 & folate supplements
Fluids
R/O other causes for fever, liver disease
Glucocorticosteroids for severe hepatitis
Liver transplant

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43
Q

Factors Influencing Toxicity in Toxic Hepatitis

A 
Excessive intake
Excessive cytochrome P450 activity
Decrease metabolism pathways to liver
Depletion of glutathione stores
Concomitant use of ETOH or other drugs
Comorbid illness
Advancing age
Nutritional status
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44
Q

Epidemiology of Drug-Induced Liver Injury (DILI)

A

Most common cause of liver failure in the US

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45
Q

Level of Injury in DILI

A 
Elevations in liver enzymes
Acute hepatitis
Cholestasis
Cytotoxic or mixed
Steatosis
Discontinuation of agent
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46
Q

Most common drugs implicated in DILI in the US

A

Acetaminophen

Antibiotics

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47
Q

Treatment of Acetaminophen Overdose

A

Acetaminophen level
Activated charcoal
N-acetylcysteine

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48
Q

Greater Risk of Developing Hepatotoxicity in Acetaminophen Intoxication

A

Ingestion of >7.5-10 g/day

Ingestions of

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49
Q

N-acetylcysteine recommended for

A

Patients with liver tenderness +
Elevated aminotransferasis +
Acetaminophen concentration >10 mcg/mL
Acetaminophen concentrations toxic by nomogram

50
Q

Types of Hepatitis

A 
HAV
HBV
HCV
HDV
HEV
HGV
GBV-C
51
Q

General Presentation of HAV, HBV, HCV, & HEV

A 
Malaise
Fatigue
Anorexia
N/V
Myalgias
Pale stools
Dark urine
Jaundice
52
Q

Physical Exam Findings for Hepatitis

A

Jaundice
RUQ pain
+/- hepatomegaly

53
Q

Labs for Hepatitis Diagnosis

A 
Elevated transaminases
Hyperbilirubinemia
Birirubinuria
Alkaline phosphatase mildly elevated
WBC normal to low
Prolonged PT
54
Q

Viral Hepatitis Management

A

Supportive care
Manage symptoms
No acetaminophen,
ETOH, & avoid other hepatitis viruses

55
Q

Epidemiology of HAV

A

Worldwide
US decreased due to vaccination
No chronic infection

56
Q

HAV Routes of Transmission

A

Fecal-oral route
Close personal contact
Contaminated food/water
Blood exposure

57
Q

SE of Hepatitis A Vaccination

A

Fever
Injection site reactions
Rash
Headache

58
Q

CBC Recommendations for Obtaining Hepatitis A Vaccination

A 
Clotting factor disorders
Chronic liver disease
Men having sex with men
Users of illicit drugs
Traveling to endemic countries
Anyone wishing to obtain immunity
59
Q

Postexposure Prophylaxis HAV

A

Hepatitis A vaccine

IG

60
Q

Situations for Postexposure Prophylaxis HAV

A 
Close personal contact
Sexual contact
Sharing IV needles
Child care centers
Food handler cases
Schools, hospitals, other work settings
61
Q

HBV Modes of Transmission

A 
Sexual contact
Perinatal
Horizontal
Percutaneous
Organ transplantation
Transfusions
62
Q

What is the major mode of HBV transmission in developed countries?

A

Sexual contact

63
Q

What is the major mode of HBV transmission in underdeveloped countries?

A

Perinatal

64
Q

Methods for HBV Transmission via Percutaneous Route

A

IVDU
Body piercing
Nosocomial

65
Q

HBV Prevention

A

Hepatitis B vaccine

66
Q

Post-exposure Prophylaxis

A

First dose of vaccine

Administer HBIG

67
Q

Chronic HBV Infection

A

Nonspecific symptoms
Exacerbations similar to acute infection
Cirrhosis
Hapatocellular CA

68
Q

Extrahepatic Manifestations in HBV Infection

A 
Fever
Rash
Arthralgias, arthritis
Polyarteritis nodosa
Glomerular disease
69
Q

Types of HBV Serology

A 
HbsAg
HbcAg:
Anti-HbsAg
HbeAg
HBV DNA assays
70
Q

Hepatitis B Surface Antigen (HbsAg)

A

Prior to onset of symptoms

Present

71
Q

Hepatitis B Core Antigen (HbcAg)

A

Intracellular antigen in affected hepatocytes

Acute infections

72
Q

Anti-HbsAg

A

Persists for life
Carriers of HBV
Present after disappearance of HbsAg
Only anti-HbsAg = immunization

73
Q

Hepatitis B E Antigen (HbeAg)

A

Secretory protein

HBV replication & infectivity

74
Q

HBV DNA Assays

A

Assess HBV replication
Recovery from HBV associated with disappearance of HBV DNA
Monitor chronic HBV

75
Q

Treatment for Chronic HBV

A

Interferon

Peginterferon

76
Q

Define Peginterferon

A

Modification of interferon so they don’t have to have it as often

77
Q

Indications for Treatment of HBV

A

HBeAG +
High serum HBV DNA
Active liver disease

78
Q

Contraindications for Interferon/Peginterferon

A

Decompensated cirrhosis

Carriers for HBV

79
Q

SE of Peginterferon

A 
Flu-like symptoms
Immunosuppression
Abdominal pain
N/V
Dry mouth
hair loss
Blurred vision
Depression
Anemia
80
Q

Other Medications for Treating Hepatitis B

A

Lamivudine (Epivir)
Adefovir (Hepsera)
Entecavir (Baraclude)
Telbivudine (Tyzeka)

81
Q

Epidemiology of HCV

A

Most common chronic liver disease
Decreasing in numbers in US
Majority of liver transplants in US

82
Q

Transmission of HCV

A 
IVDU/sex with IVDU
Jail 3+ days
Religious scarification
Blood transfusion
Struck/cut with bloody object
Pierced body parts
Immunoglobulin injection
Perinatal transmission
Solid organ transplant
83
Q

Who should be screened for HCV?

A 
Ever IVDU
Clotting factors before 1987
Blood/organs before July 1992
On chronic hemodialysis
Evidence of liver disease
Infected with HIV
Healthcare workers after exposure to HCV + blood/mucus
Children born to HCV + mothers
84
Q

Symptoms of Chronic HCV Infection

A

Fatigue

85
Q

Diagnosis fo HCV

A

HCV rises within 8 days to 8 weeks
Anti-HCV + within 12 weeks
Difficult to distinguish acute vs. chronic

86
Q

Management of HCV

A 
Assess severity of disease
ETOH cessation
no Tylenol
No jail
Vaccinate against Hep A & B
87
Q

Evaluation for Treatment of HCV

A

Liver biopsy
Test for HIV
Evaluate for other liver disease
Continued IVDU/ETOH abuse

88
Q

Treatment for Chronic HCV

A

Peginterferon
Ribavirin
Protease inhibitors

89
Q

How to assess for treatment response to HCV

A

HCV RNA -

Sustained RNA - 6 months after treatment

90
Q

SE of Peginterferon or Ribavirin

A 
Bone marrow suppression
Myalgias
Headaches
Low grade fever
Neuropsychiatric symptoms
Non-productive cough/dyspnea
Ischemic retinopathy
Retinal hemmorrhage
Thyroid dysfunction
Rash, hair loss, hearing loss, insomnia
91
Q

Protease Inhibitors

A

Showing promise
Very spend
Many SE

92
Q

Liver Transplantation for HCV Patients

A

New liver can be infected with HCV
Treatment with peg interferon + ribavirin may prolong survival
Younger liver that is already HCV + seems to help

93
Q

HDV

A

Requires HBV to replicated (HBsAG coat)

94
Q

HDV Genotypes & Locations

A

Genotype 1: western world
Genotype 2: eastern world
Genotype 3: Venezuela, Columbia, Brazil, Peruvian, & Amazon bases
5 others known

95
Q

Genotype 1 HDV

A

Increased risk for fulminant course

Progression to cirrhosis rapid

96
Q

Transmission of HDV

A

Parenteral
Close personal contact
Multiple transfusions
Contaminated dialysis equipment

97
Q

Clinical Features of HDV

A

Co-infection with HBV

Super-infection on top of chronic HBV

98
Q

Prevention & Treatment of HDV

A

Hepatitis B vaccine
IVIG for Hep B
Chronic HDV: pegintereron

99
Q

Epidemiology of HEV

A

Waterborne virus

No chronic form

100
Q

HEV Transmission

A

Fecally contaminated water
Blood transfusion in endemic areas
Mother to newborn

101
Q

Epidemiology of GBV-C

A

High incidence in US
Flavivirus
Doesn’t cause hepatitis in humans
Protective effect with co-infections with HIV

102
Q

Acute Hepatitis Complications

A

Cholestatis hepatitis
Raging fulminant hepatitis
Chronic hepatitis (Hep B, C, D)

103
Q

Typical Progression of Chronic Hepatitis

A

Chronic inflammation in portal areas
Necrosis/inflammation
Fibrosis
Cirrhosis

104
Q

Define Cirrhosis

A

Development of fibrosis of liver with formation of regenerative nodules
Results in impairment of synthetic, metabolic, & hemodynamic functions of liver

105
Q

Diagnostics of Cirrhosis

A

US
CT
MRI
Biopsy: gold standard

106
Q

How to determine etiology of cirrhosis?

A

History

labs

107
Q

Etiologies of Cirrhosis

A 
Alcohol hepatitis
Chronic HCV
Cryptogenic
Primary biliary cirrhosis (PBC)
Chronic HBV
Wilson's disease
Hemochromatosis
Non-alcoholic steatohepatitis
108
Q

Lab Abnormalities in Cirrhosis

A 
Elevated AST/ALT
Slightly elevated alkaline phosphatase
Bilirubin elevated
Albumin falls
PT increases
Hyponatremia
High levels of ADH
Pancytopenia
109
Q

Why Anemia in Cirrhosis?

A 
Acute/chronic GI bleed
Folate deficiency
Hypersplenism
Bone marrow suppression
Anemia of chronic disease
110
Q

Define Portal HTN

A

Increased blood pressure in the portal vein due to increased resistance to the blood passing through the vessels in the liver

111
Q

Portal HTN Results in

A 
Esophageal varices
Caput medusa
Hemorrhoids
Splenomegaly
Ascites
Palmar Erythema
112
Q

Management of Portal HTN

A

Remove ascitic fluid
Portal shunts
Treat liver disease
Liver transplant

113
Q

Reversible Neuropsychiatric Abnormalities in Hepatitis Encephalopathy

A

Cognitive abilities
Psychiatric state
Motor impairment

114
Q

Precipitating Causes of Hepatic Encephalopathy

A 
Cirrhosis
Hypovolemia
GI bleed
Hypokalemia/metabolic alkalosis
Hypoxia
Sedatives or tranquilizers
Hypoglycemia
Infection
Hepatoma/ vascular occlusion
115
Q

West Haven Criteria for HE Stage 0

A

Consciousness: normal
Intellect & behavior: normal
Neurologic: normal

116
Q

West Haven Criteria for HE Stage 1

A

Consciousness: mild lack of awareness
Intellect & behavior: shortened attention span
Neurologic: mild asterixis/tumor

117
Q

West Haven Criteria HE Stage 2

A

Consciousness: lethargic
Intellect & behavior: disoriented, inappropriate behavior
Neurologic: obvious asterixis, slurred speech

118
Q

West Haven Criteria HE Stage 3

A

Consciousness: somnolent but arousable
Intellect & behavior: gross disorientation, bizarre behavior
Neurologic: muscular rigidity, clonus, hyper-reflexia

119
Q

West Haven Criteria HE Stage 4

A

Consciousness: coma
Intellect & behavior: coma
Neurologic: decerebrate posturing

120
Q

Diagnosis of HE

A

Neurotoxins: ammonia & manganese
CT
MRI

121
Q

Treatment of HE

A 
Lactulose
Correct hypokalemia
Determine stage
Exclude non-hepatic causes of altered mental function
Low protein
Rifampin
Intubation
122
Q

SE of Lactulose

A 
Abdominal cramping
Bloating
Flatulence
Severe diarrhea or electrolyte abnormalities
Ileus
Hypovolemia

GI (20 decks)

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