Hepatobiloary Flashcards
MC and most characteristic symptom of liver disease
Fatigue
Hallmark symptom of liver disease, the most reliable marker of severity
Jaundice
Jaundice is detectable in what bilirubin levels
> 25 mg/dL (>43 umol/L)
Clinically helpful approach to diagnosis of alcohol dependence and abuse
CAGE questionnaire
Suggestive of chronic alcoholism and chronic alcoholic disease
Dupuytren contracture
Parotid enlargement
Kaysher-Fleischer rings
Wilson’s Disease
pANCA
Primary sclerosing cholangitis
Mitochondrial antibody
Primary biliary cirrhosis
Useful assessment of the severity and stage of liver damage, prediction of prognosis and monitoring and respinse to treatment
Liver biopsy
Evaluation of liver transplantation candidates
MELD
Clinical staging of cirrhosis
Chikd-Pugh
MELD components
bilirubin
crea
protime
More specific transaminase indicator of liver injury
SGPT/ALT
Albumin levels suggesting chronic liver diseases
<3 g/dL
Inactivates HAV
Boiling for 1 min
Contact with formaldehyde and chlorine
UV irradiation
First virologic marker detectable in the serum
HBs
May be the only serologic evidence of current or recent HBV infection during the gap or window period
Anti HBc
Qualitative marker of early chronic HBV infection
HBe
Quantitative marker of early chronic HBV infection
HBV DNA
Major route of transmission of HBV
percutaneous inoculation
Account for most casesnof transfusion-transmitted hepatitis
HCV
Greatest impact on transmission in HBV
Perinatal transmission
Intimate sexual contact
Pathogenesis of Chronic HBV infection
Defective Cellular Immunity
Requires HBV for its replication and expression
HDV
MC genotype of HCV
Genotype 1
Associated with essential mixed cryoglobinemia
HCV
Severe histologic findings in Acute Viral Hepatitis
Bridging hepatic necrosis
may be seen in methyldopa toxicity
Fulminant Hepatitis
B
E
D
(with massive hepatic necrosis)
False-positive IgM Anti-HAV is seen
Presence of Rheumatoid Factor
Gold standard to establish diagnosis of HCV
HCV RNA assay
More sensitive test for HBV replication
HBV DNA
May produce serum-sickness like syndrome
Acute HBV
Likelihood of chronicity after acute infection
HCV
Treatment of Acute Hep C
PEG + Ribavirin
MCC of acute liver failure
Drug-induced liver injury
May cause centrilobular zonal necrosis
Carbon tetrachloride
Trichloroethylene
May cause periportal injury
Yellow phosphorus poisoning
May cause massive hepatic necrosis
Octapeptides of Amanita phalloides
May cause hepatocellular injury indistinguishable from that of viral hepatitis
Isoniazid
Ciprofloxacin
MC form of hepatocellular injury
Spotty necrosis in the liver lobule with predominantly lymphocytic infiltrate
Most frequently implicated antibiotic among cases of drug-induced liver injury
Amoxicillin-Clavulanic
“Ductopenic” cholestasis
Carbamazepine
Levofloxacin
Hepatocellular vs cholestatic reaction
R value > 5: hepatocellular injury
R value < 2: cholestatic
2-5 mixed
Gastric lavage in Acetaminophen ingestion
Should be done within 30 mins otherwise ineffective
Blood levels of acetaminophen predictive of development of severe damage
> 300 ug/mL 4 hours after ingestion
Treatment for sodium valproate toxicity
IV carnitine
Causative agent in TMP-SMX hepatotoxicity
Sulfamethoxazole component
Causes chronic viral hepatitis
B
C
D (superimposed on chronic hep B)
Three major forms of ALD
Fatty Liver
Alcoholic Hepatitis
Cirrhosis
Quantity of ethanol in men produces fatty liver
40-80 g/day
1 beer = 12 g of alcohol
Quantity of ethanol in men produces hepatitis or cirrhosis
160 g/day x 10-20 years
Initial and MC histologic response to increased alcohol ingestion
Fatty Liver
Hallmark of Alcoholic hepatitis
Injured hepatocyte with ballooning degeneration, spotty necrosis, PMN infiltration and fibrosis in the perivenulae and perisinusoidal space of Disse
Heralds severe alcoholic hepatitis
PT >5s Anemia Alb <2.5 mg/dL Bil >8 mg/dL renal failure ascites
MELD score with significant mortality
> /= 21
Cornerstone of Alcoholic hepititis
Complete abstinence from alcohol
Preferred treatment for Alcoholic Hep with Discriminant function >/= 32 or MELD = 21 without comorbids
Prednisolone x 4 weeks then taper for 4 weeks
Alternative: Pentoxyfylline x 4 weeks
MC chronic liver disease in many parts of the world
NAFLD
Highest risk of advanced liver fibrosis
NASH in >45-50 years old + overweight/obese or with T2DM
Gold standard for establishing the severity of liver injury and fibrosis
Liver biopsy
