Hepatology Flashcards
What are the physical exam findings of liver disease?
ascites, anorexia, jaundice, spider angiomas, palmar erythema, caput medusae
What are the syndromes that must be considered with highly elevated AST/ALT?
viral hepatitis, autoimmune hepatitis, hemochromatosis, ischemic hepatitis, alcoholic hepatitis
What syndromes must be considered with Normal AST ALT
dubin johnson syndrome, rotor’s
What syndromes must be considered with elevated alk phos?
cholestasis, malignancy, PBC, PSC, gall stones
What are the manifestations of chronic hepatitis C?
heme: mixed cryoglobinuria, renal: membranoproliferative glomerulonephritis, skin: porphyria cutanea tarda, lichen planus
endocrine: increased risk of diabetes
Symptoms of amebic abscess
RUQ pain, endemic area travel, elevated alk phos, diarrhea, tender liver mass
What are the treatment options for patients who are gallstone symptomatic but poor surgical candidates?
ursodeoxycholic acid
What are the treatment options for asymptomatic gallstone patients?
don’t treat! (unless malignancy risk)
What are (and are not) the indications for ERCP?
ARE: ampullary tumors, early intervention in pancreatitis, chronic pancreatitis, exploration of bile ducts
ARE NOT: after acute pancreatitis attack has resolved
Who are the patients that should be treated for Hepatitis B?
acute liver failure, complications of cirrhosis, advanced cirrhosis with high HBV DNA
What drug can cause a mild hepatitis?
INH
What is the mechanism of non alcoholic fatty liver disease?
insulin resistance leading to increased lipolysis, triglyceride synthesis and hepatic uptake of fatty acids
What are the various causes of elevated AST/ALTs?
Autoimmune hepatitis, Hep B, Hep C, Drugs, Ethanol, fatty liver, growths, hemodynamic disorders, iron
What is the cause of acute cholecystitis?
stone obstructing bile duct
What are the symptoms associated?
RUQ pain, fever, nausea, vomiting
Describe HEP E
can progress to fulm. hepatitis in pregnant women during 3rd trimester; spread fecal orally; rare in US
What is fulm hepatitis?
hepatic encephalopathy that develops within 8 weeks of acute liver failure
What is tx of pancreatitc pseudocyst?
drainage only if perists or gets infected
What is hemorrhagic pancreatitis?
retroperitoneal bleeding and hemorrhagic pancreas - presents with Grey Turner or Cullen sign
What are the contraindications for Hep C treatment?
uncontrolled depression, ongoing alcohol use
What lab values might indicate a progression to fulm hepatitis?
increasing PTT, decreases transaminases
What are the symptoms of PBC?
pruritis, fatigue, xanthomas, steatorrhea, portal hypertension
How is PBC treated?
ursodeoxycholic acid
What are causes of markedly elevated transaminases?
ischemic, drugs, viral hepatitis
What is the purpose of the following markers? HbsAg HbeAg HbcAg AntiHbsAg AntiHbcAg
acute infectivity - precedes symptoms (acute infection)
infectivity, active virus
undetectable
indicates immunity, clearing infection (non-infectivity)
IgM - acute phase; IgG - recovery phase
What is rotor’s syndrome?
benign defect in hepatic storage of conjugated bilirubin
Gilbert’s syndrome
mild unconjugated hyperbilirubinemia caused by fasting, illness, etc.
Dubin Johnson syndrome
benign condition of conjugated hyperbilirubinemia and black liver
What does a hyatid cyst look like?
well defined cyst with egg shell calcifications
What causes hyatid cysts?
Echinococcus infections - spread by contact with dogs
What is the test for Wilson’s disease?
Ceruloplasmin levels
What is the test for autoimmune hepatitis?
Anti smooth muscle antibody Titer
Describe the substrates for gluconeogenesis
alanine (converted to pyruvate), G3P from adipose, lactate
What are the infectious risks for patients with hemochromatosis?
listeria monocytogenes and other siderophilic organisms
What serotypes of hepatits are most responsive to therapy?
2 and 3
