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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
Q

What is jaundice caused by in adults and infant/children?

A

obstruction, intrahepatic cholestasis or hetapcellular injury

Older adults: stones or tumor

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26
Q

What is jaundice caused by in newborns?

A

indirect or unconjugated hyperbilirubinemia (physiologic jaundice)

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27
Q

What is jaundice caused by in infants/children?

A

hepatitis

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28
Q

When does physiologic jaundice normally occur? Why does it occur?

A

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

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29
Q

What is pathologic jaundice?

A

Any jaundice that isn’t physiologic, has a pathologic underlying cause

Bilirubin is 17+ in full term infant

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30
Q

When is jaundice painful?

A

when there is an obstruction

Can be caused by gallstones, surgery and fever

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31
Q

When is jaundice painless?

A

in hepatitis, alcoholism,

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32
Q

What does dark urine and pale stools indicate?

A

conjugated bilirubinemia

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33
Q

What are the signs of liver disease in adults ?

A

jaundice

bruising

spider angiomas

gynecomastia

testicular atrophy

palmer erythema

may/may not have ascites

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34
Q

What are the signs of liver disease in infants?

A

general appearance, skin eyes

35
Q

How are infants with jaundice treated?

A

Breastfeeding

Phototherapy- maybe

OR- treat underlying cause of elevated bilirubin

If at risk for Kernicterus- give exchange transfusion

36
Q

When should an infant with jaundice be referred to a specialist?

A

if obstruction is suspected, cholestasis, hepatic failure or symptoms >3months

37
Q

What is cirrhosis?

A

Irreversible stage of chronic liver injury

38
Q

How is cirrhosis treated?

A

Prevention is best treatment

Address the cause of the cirrhosis

39
Q

What are complications of cirrhosis?

A

ascites, peripheral edema, encephalopathy, infection, bleeding, renal dysfunction, electrolyte imbalances

40
Q

What is the clinical presentation of cirrhosis?

A

fatigue

easily bruising

abdominal swelling

ankel edema

41
Q

How will chronic liver failure present?

A

palmar erythema, spider angiomata, parotid hypertrophy, loss of pubic/axillary hair, clubbing, gynecomastia

42
Q

How will portal hypertension present?

A

splenomegaly, abdominal distension-shifting dullness, prominent abdominal venous pattern

43
Q

How to prevent liver damage from alcohol?

A

abstinence, nutrition, supplements

44
Q

How to prevent liver damage from an autoimmune disorder?

A

meds like ursodiol (dissolves gallstones), colchicine (anti-inflammatory), methotrexate (immunosuppresent) may cause more damage

45
Q

What is primary sclerosing cholangitis?

A

Fibrosing inflammation in bile duct leading to cirrhosis

46
Q

What is hemochromatosis?

A

iron overload

47
Q

How to treat chronic Hep C, genotype 1?

A

Most common genotype: Need all 3 antiviral meds for 6-12 months

Olysio (simeprevir)

ribavirin

interferon (INF-alpha A or B)

48
Q

How to treat chronic Hep C genotypes 2 and 3?

A

Solvadi and Ribavirin (both antivirals) for 6-12 months

49
Q

How to treat chronic Hep C genotype 4?

A

Solvadi, Rivavirin and interferon (INF-alpha A or B) for 6-12 months

50
Q

How to treat chronic Hep B?

A

antivirals

51
Q

How is hep A transmitted?

A

fecal-oral route and IV drugs

found in stool 15-45 days before symptomatic

52
Q

What does Hep A Ab IgM mean?

A

Hep A Ab IgM- miserable

They have the active virus

53
Q

What does Hep A Ab IgG mean?

A

IgG- gone

They had a past infection or immunity

54
Q

Is hep A remain in the body after infection has passed?

A

No- not dormant

55
Q

How is Hep B transmitted?

A

Through unprotected sex, usually with another infection like gonorrhea or chlamydia.

Through IV drug use

56
Q

Who should be screened for Hep B?

A

Everyone! Even if they have the vaccine

57
Q

What body fluid has the highest concentration of HBV?

A

blood, serum and wounds

58
Q

What body fluid has a medium concentration of HBV?

A

semen, vaginal fluid and saliva

59
Q

What body fluid has the lowest concentration of HBV?

A

urine, feces, sweat, tears and breast milk

60
Q

How does your age of infection effect the likelihood of developing chronic Hep B?

A

Chronic Hep B increases the younger you are

If you are an adult, you are much less likely to develop chronic hep B.

61
Q

What is HBsAg?

A

Hep B surface antigen

Actively replicating Hep B

62
Q

What is Anti-HBs?

A

Hep B surface antibody

Immunity achieved: Had Hep B vaccine or recovered from a Hep B infection

63
Q

What is Anti-HBc IgM?

A

Hep B core antigen, IgM (miserable)

Active Actue infection

64
Q

What is Anti-HBc

A

Hep B core antigen

Had infection in the past or currently have it

Will not have positv HBc with vaccine

65
Q

What is Anti-HBe and HBeAg?

A

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
Q

What does this mean:

ABsAg- neg

anti-HBc- neg

anti-HBs- neg

A

susceptible to Hep B

No past infection and no vaccine

Need to vaccinate

67
Q

What does this mean:

ABsAg- neg

anti-HBc- pos

anti-HBs- pos

A

Had infection in the past and cleared it

68
Q

What does this mean:

ABsAg- neg

anti-HBc- neg

anti-HBs- pos

A

Has immunity due to vaccine

69
Q

What needs to be checked for patients at risk of hep B?

A

HepBcAb and HepBsAb

c- would check if they have or had it

s- would check if it was actively replicating

70
Q

What should happen if a patient has positive HepB?

A

get ultrasound and refer to GI/hepatologist

71
Q

What should be done if HepBcAb and HepBDNA are negative?

A

check for the wild type AntiHBe and HBeAg

72
Q

What is HBV DNA?

A

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
Q

How is Hep C transmitted?

A

Blood transmission through the RNA virus

small enveloped and single stranded

High risk: blood transfusion before 1992 and IV drug users

74
Q

Can mothers give their baby’s Hep C?

A

occurs infrequently

Need high Hep C RNA levels at delivery

75
Q

When does the acute phase of Hep C occur?

A

Within the first 6 months of being infected

60-70% are asymptomatic
30-40$ are symptomatic

76
Q

What are the symptoms of Hep C?

A

decreased appetite

fatigue

abdominal pain

jaundice

itching

flu-like symptoms

77
Q

Does hep C need to be treated or is it self-limiting?

A

15-25% of people clear the virus without treatment and don’t develop a chronic infection

Unsure why this happens

78
Q

When does Hep C show up on blood tests?

A

PCR- 1-3 weeks after infection

Antibodies- within 3-15 weeks of infection

79
Q

How is chronic Hep C defined?

A

Having Hep C for 6+ months

Usually they are asymptomatic

80
Q

How is the rate of progression shown in Hep C?

A

Liver biopsy

33% progress to Stage 4 cirrhosis within 20-30 years

81
Q

What factors make Hep C progression worse?

A

increasing age

Male gender

EtOH consumption

HIV co-infection

Fatty liver

82
Q

What does a positive Hep C Ab mean?

A

Having Hep C

83
Q

What should be done after receiving a positive Hep C Ab?

A

Check: Hep C genotype and Hep C RNA QN

84
Q

What referrals should be made with positive Hep C?

A

Check: full liver functioning with albumin, PT/INR

Referral to GI/Hepatologist

Diagnosis & Mgmt 1 (7 decks)

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