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Diagnosis & Mgmt 1 > Heptology > Flashcards

Heptology Flashcards

1
Q

What do PTT and albumin levels reflect?

A

The liver’s synthetic capacity

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2
Q

What do AST/ALT levels reflect?

A

Markers of hepatic function

AST is not specific to the liver

ALT is more specific to liver function

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3
Q

What do the bilirubin/ GGT/ and alkaline phosphate measure?

A

hepatocyte’s ability to carry out synthetic function

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4
Q

What does elevated AST levels indicate?

A

Could mean MI or MS injury

Need elevated GGT to confirm hepatic origin

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5
Q

What does elevated ALT levels indicate?

A

toxic or drug induced damage

Viral or ischedmia hepaitis

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6
Q

What does a AST: ALT ratio >2 indicate?

A

> 2:1 AST:ALT means:

alcohol ingestion is culprit

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7
Q

What can abnormal ALT’s come from?

A

Avandia/Actos (diabetes med)

Liver Dx

Toxic or therapeutic meds

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8
Q

What can abnormal AST’s come from?

A

Alcohol

Statins

Tylenol

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9
Q

What can albumin levels be affected by?

A

liver disease

dietary protein

alcohol

trauma

corticosteroids

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10
Q

What can elevate PT levels?

A

a vitamin K deficiency

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11
Q

How can a vitamin K deficiency be ruled out?

A

Give 10mg of Vit. K IM

Check PT in 24 hours

If PT increases by 30%, it was Vit.K deficiency

If no change in PT, then it may be liver disease

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12
Q

When is an elevated alkaline phosphate level normal?

What can an elevated alkaline phosphate level indicate?

A

Normal in late pregnancy, childhood/adolescence

IF not, it could be cholestatic injury

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13
Q

What does elevated bilirubin levels mean?

A

cholestasis or liver damage

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14
Q

What is a sensitive indicator of liver damage?

A

GGT

  • perform this if AST or ALT levels are high, especially if ratio is >2
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15
Q

What at symptoms of abnormal LFTs?

A

anorexia

malaise

weight loss

PMH: hepatitis, abdominal surgery, blood transfusions before 1992

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16
Q

What are causes of abornoal LFTs?

A

Hepatitis (viral, alcoholic, A-G, drug-induced, autoimmune)

Cytomegalovirus

Epstein-Barr virus

NASH ( from uncontrolled DM)

Hemachromatosis (too much iron)

Wilson’s disease (too much copper)

Biliary disease

Alpha-1 antitrypsin disease (body doesn’t make enough protein to protect lungs and liver)

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17
Q

What abnormals do you expect to find on exam with abnormal LFTs?

A

Skin: spider angioma, palmar erythema, and jaundice (sx of cirrhosis)

Sclera is icterus (yellow)

Abdominal: ascites, RUQ tenderness, hepatomegaly, splenomegaly

Neuro: asterixis aka hand flapping

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18
Q

How to test for patient with abnormal LFTs, but patient is asymptomatic and physical is normal?

A

Repeat testing in 1-3 months

Educate: avoid fatty food and alcohol for 1-3 months before test

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19
Q

What tests should be done to diagnose liver disease?

A

Hep A, B and C

Iron, ferritin, Fe sat, ANA (auto-immune disease), anti-smooth muscle, ceruloplasmin (check copper), alpha 1 antitrypsin (check protein)

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20
Q

What test is needed for elevated LFT and GGT?

A

imaging studies to check for a tumor, granuloma or cholestasis

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21
Q

What is the differential diagnosis for elevated ALT and AST?

A

alcoholi or viral hepatitis

cytotoxic trugs

NASH- non-alcoholic steatohepatitis-fatty liver diseae

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22
Q

What is the differential diagnosis for elevated Alkaline phosphate?

A

obstruction of the biliary system via:

intrahepatic: medication or infiltrative
extrahepatic: gallstones

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23
Q

What differential diagnosis for elevated bilirubin?

A

hepatitis

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24
Q

What is jaundice?

A

yellowish staining of the skin, sclera, and mucous membranes by bilirubin- a bile pigment

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25
What is jaundice caused by in adults and infant/children?
obstruction, intrahepatic cholestasis or hetapcellular injury Older adults: stones or tumor
26
What is jaundice caused by in newborns?
indirect or unconjugated hyperbilirubinemia (physiologic jaundice)
27
What is jaundice caused by in infants/children?
hepatitis
28
When does physiologic jaundice normally occur? Why does it occur?
72-96 hours after birth Goes away 1-2 weeks after birth Due to immaturity of the liver and the slow processing of bilirubin by the liver
29
What is pathologic jaundice?
Any jaundice that isn't physiologic, has a pathologic underlying cause Bilirubin is 17+ in full term infant
30
When is jaundice painful?
when there is an obstruction Can be caused by gallstones, surgery and fever
31
When is jaundice painless?
in hepatitis, alcoholism,
32
What does dark urine and pale stools indicate?
conjugated bilirubinemia
33
What are the signs of liver disease in adults ?
jaundice bruising spider angiomas gynecomastia testicular atrophy palmer erythema may/may not have ascites
34
What are the signs of liver disease in infants?
general appearance, skin eyes
35
How are infants with jaundice treated?
Breastfeeding Phototherapy- maybe OR- treat underlying cause of elevated bilirubin If at risk for Kernicterus- give exchange transfusion
36
When should an infant with jaundice be referred to a specialist?
if obstruction is suspected, cholestasis, hepatic failure or symptoms >3months
37
What is cirrhosis?
Irreversible stage of chronic liver injury
38
How is cirrhosis treated?
Prevention is best treatment Address the cause of the cirrhosis
39
What are complications of cirrhosis?
ascites, peripheral edema, encephalopathy, infection, bleeding, renal dysfunction, electrolyte imbalances
40
What is the clinical presentation of cirrhosis?
fatigue easily bruising abdominal swelling ankel edema
41
How will chronic liver failure present?
palmar erythema, spider angiomata, parotid hypertrophy, loss of pubic/axillary hair, clubbing, gynecomastia
42
How will portal hypertension present?
splenomegaly, abdominal distension-shifting dullness, prominent abdominal venous pattern
43
How to prevent liver damage from alcohol?
abstinence, nutrition, supplements
44
How to prevent liver damage from an autoimmune disorder?
meds like ursodiol (dissolves gallstones), colchicine (anti-inflammatory), methotrexate (immunosuppresent) may cause more damage
45
What is primary sclerosing cholangitis?
Fibrosing inflammation in bile duct leading to cirrhosis
46
What is hemochromatosis?
iron overload
47
How to treat chronic Hep C, genotype 1?
Most common genotype: Need all 3 antiviral meds for 6-12 months Olysio (simeprevir) ribavirin interferon (INF-alpha A or B)
48
How to treat chronic Hep C genotypes 2 and 3?
Solvadi and Ribavirin (both antivirals) for 6-12 months
49
How to treat chronic Hep C genotype 4?
Solvadi, Rivavirin and interferon (INF-alpha A or B) for 6-12 months
50
How to treat chronic Hep B?
antivirals
51
How is hep A transmitted?
fecal-oral route and IV drugs found in stool 15-45 days before symptomatic
52
What does Hep A Ab IgM mean?
Hep A Ab IgM- miserable They have the active virus
53
What does Hep A Ab IgG mean?
IgG- gone They had a past infection or immunity
54
Is hep A remain in the body after infection has passed?
No- not dormant
55
How is Hep B transmitted?
Through unprotected sex, usually with another infection like gonorrhea or chlamydia. Through IV drug use
56
Who should be screened for Hep B?
Everyone! Even if they have the vaccine
57
What body fluid has the highest concentration of HBV?
blood, serum and wounds
58
What body fluid has a medium concentration of HBV?
semen, vaginal fluid and saliva
59
What body fluid has the lowest concentration of HBV?
urine, feces, sweat, tears and breast milk
60
How does your age of infection effect the likelihood of developing chronic Hep B?
Chronic Hep B increases the younger you are If you are an adult, you are much less likely to develop chronic hep B.
61
What is HBsAg?
Hep B surface antigen Actively replicating Hep B
62
What is Anti-HBs?
Hep B surface antibody Immunity achieved: Had Hep B vaccine or recovered from a Hep B infection
63
What is Anti-HBc IgM?
Hep B core antigen, IgM (miserable) Active Actue infection
64
What is Anti-HBc
Hep B core antigen Had infection in the past or currently have it Will not have positv HBc with vaccine
65
What is Anti-HBe and HBeAg?
Anti-HBe is the wild type Hep B Antibody HBeAg is the wild type Hep B antigen Can lead to seroconversion: If antigen is negative and antibody is positive, it could be that the immune system is controlling the virus
66
What does this mean: ABsAg- neg anti-HBc- neg anti-HBs- neg
susceptible to Hep B No past infection and no vaccine Need to vaccinate
67
What does this mean: ABsAg- neg anti-HBc- pos anti-HBs- pos
Had infection in the past and cleared it
68
What does this mean: ABsAg- neg anti-HBc- neg anti-HBs- pos
Has immunity due to vaccine
69
What needs to be checked for patients at risk of hep B?
HepBcAb and HepBsAb c- would check if they have or had it s- would check if it was actively replicating
70
What should happen if a patient has positive HepB?
get ultrasound and refer to GI/hepatologist
71
What should be done if HepBcAb and HepBDNA are negative?
check for the wild type AntiHBe and HBeAg
72
What is HBV DNA?
Used to track the progression of treatment. Measures the amount of Hep B DNA circulating in the blood. DNA disappears after the inflection has cleared.
73
How is Hep C transmitted?
Blood transmission through the RNA virus small enveloped and single stranded High risk: blood transfusion before 1992 and IV drug users
74
Can mothers give their baby's Hep C?
occurs infrequently Need high Hep C RNA levels at delivery
75
When does the acute phase of Hep C occur?
Within the first 6 months of being infected 60-70% are asymptomatic 30-40$ are symptomatic
76
What are the symptoms of Hep C?
decreased appetite fatigue abdominal pain jaundice itching flu-like symptoms
77
Does hep C need to be treated or is it self-limiting?
15-25% of people clear the virus without treatment and don't develop a chronic infection Unsure why this happens
78
When does Hep C show up on blood tests?
PCR- 1-3 weeks after infection Antibodies- within 3-15 weeks of infection
79
How is chronic Hep C defined?
Having Hep C for 6+ months Usually they are asymptomatic
80
How is the rate of progression shown in Hep C?
Liver biopsy 33% progress to Stage 4 cirrhosis within 20-30 years
81
What factors make Hep C progression worse?
increasing age Male gender EtOH consumption HIV co-infection Fatty liver
82
What does a positive Hep C Ab mean?
Having Hep C
83
What should be done after receiving a positive Hep C Ab?
Check: Hep C genotype and Hep C RNA QN
84
What referrals should be made with positive Hep C?
Check: full liver functioning with albumin, PT/INR Referral to GI/Hepatologist

Diagnosis & Mgmt 1 (7 decks)

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