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GI Week 4 > Lecture 39: Acute and Chronic Hepatitis > Flashcards

Lecture 39: Acute and Chronic Hepatitis Flashcards

1
Q

What are the types of hepatic biochemical tests?

A

LFTs don’t test function, they test inflammation

  1. ALT and AST
  2. Alkaline Phosphatase
  3. Bilirubin
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2
Q

When you have a really high AST and ALT level (10,000), what should be your first thought?

A

Acetaminophen until proven otherwise

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3
Q

How does alcoholic hepatitis present?

A

AST:ALT is 3:1 or 2:1 (scotch and tonic)

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4
Q

How does Fatty liver disease present with LFT?

A

ALT > AST (which is different than alcoholic hepatitis and cirrhosis)

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5
Q

How does Cirrhosis present with LFT?

A

AST > ALT

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6
Q

What is the only hepatitis that presents with higher ALT than AST?

A

Steatosis or steatohepatitis

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7
Q

What happens when you have elevated alkaline phosphatase?

A

You have to think of cholestasis

Could also be bone, placenta, liver and kidneys

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8
Q

Which presents with higher alkaline phosphatase, intra or extrahepatic cholestasis?

A

Intrahepatic cholestasis (ie bile duct in kidney is obstructed) because blockage of bile duct will induce hepatocytes to die

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9
Q

What are examples of intrahepatic cholestasis?

A
  1. Drug induced
  2. PBC
  3. Hepatic granulomas due to sarcoidosis
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10
Q

What are examples of extraheptic cholestasis?

A
  1. Bile duct obstruction due to stones
  2. cancer
  3. biliary tract disease like PSC
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11
Q

Are cholestasis and hyperbilirubinemmia synonymous?

A

NO
Cholestasis can be seen without jaundice
Example = cholestasis of pregnancy = no bilirubin elevation necessary

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12
Q

Where do you see the highest amount of bilirubin?

A

Hepatocellular disease (some cases of intrahepatic cholestasis)

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13
Q

What is the significance of a non-enveloped virus?

A

Non-enveloped = enterically transmitted

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14
Q

What is the significance of an enveloped virus?

A

They are blood borne

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15
Q

Which hepatitis viruses are non-enveloped?

A
  1. HAV
  2. HEV
    Always acute
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16
Q

Which hepatitis viruses are enveloped?

A
  1. HBV
  2. HCV
  3. HDV
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17
Q

What is the natural history of HAV?

A

99% recover after acute episode

1% have fulminant hepatitis and died

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18
Q

What is the serologic course of HAV?

A

Starts with a shitload of ALT (because you are breaking down liver)
Then you have a shitload of IgM

19
Q

What are the vaccines you can take for HAV?

A
  1. Havrix

2. VAQTA

20
Q

What are the key components of the HBV genome? Significance?

A
  1. PreS1
  2. PreS2
  3. S
    Significance is that HBV vaccines contain these portions of the HBV genome to induce immunity
21
Q

What is the significance of the e antigen in the HBV genotype?

A

Has implications for disease severity?
We classify HBV as “e” positive or “e” negative…secreted when COR protein is active
HeAg+ HBV individuals have actively replicating HBVirus

22
Q

How do you differentiate acute from chronic HBV?

A

IgM anti-HBC
If you have positive IgM, it is acute
If no IgM, it is chronic
Only if associated with surface antigen (the “s” antigen)

23
Q

What are the two routes of HBV transmission?

A
  1. Horizontal transmission (infected person to recipient)

2. vertical transmission (mother to infant)

24
Q

What is an important difference between HCV and HBV?

A

Hepatocellular carcinoma in HBV does NOT have to present with cirrhosis
HCV patients must have cirrhosis to present with HCC

25
Q

What are the HBV vaccines?

A
  1. Engerix-B

2. Recombivax HB

26
Q

What are the types of genotypes in HBV?

A

A through J … A = North America while J = Japan

G = US

27
Q

What is the significance of HeAg+ HBV patients having kids?

A

A mother who is “e” antigen positive is MORE LIKELY to pass HBV, whereas a mother who is not actively replicating has 30% less risk

28
Q

What HBV patients need to be treated?

A
  1. HBeAg+ individual

2. HBeAg (-) individuals who have a PRECORE MUTATION (so still replicating despite not producing “e” antigens)

29
Q

What are the types of genotypes in HCV?

A

1a, 1b, up till 5c

30
Q

How many of those with HCV are undiagnosed?

A

76%…how the fuck could they know this??

31
Q

What is ESLD?

A

End-stage liver disease

32
Q

What is SVR in the context of HCV? Significance?

A

Sustained virologic response

Achieving an SVR should be considered equivalent to a cure for chronic HCV infection

33
Q

What % of HCV individuals develop chronic disease?

A

85%

34
Q

What % of CHRONIC HCV individuals develop cirrhosis?

A

20%

35
Q

What are the extrahepatic manifestations of HCV?

A
  1. hematologic (aplastic anemia)
  2. dermatologic (vasculitis)
  3. Renal (glomerulonephritis)
  4. Endocrine (Diabetes mellitus)
  5. Ocular (corneal ulcer, uveitis)
  6. Vascular (necrotizing vasculitis and polyarteritis nodosa)
  7. neuromuscular weakness
  8. CREST syndrome for autoimmune
36
Q

What are the treatments for HCV?

A
  1. PEGylated interferons
  2. Ribavirin
  3. DAA (direct acting antivirals) agents
37
Q

What is difference between fatty liver and steatohepatitis?

A

Fatty liver = just fat (no cirrhosis)
Steatohepatitis = cirrhosis, fat + inflammation
In the context of non-alcoholic fatty liver disease

38
Q

What are the characteristics of INTRINSIC Drug induced liver injury (DILI)?

A
  1. predictable
  2. dose-related
  3. similar in animal
  4. high incidence
  5. short latency
  6. cholestatic or directly destructive or indirect/metabolic
  7. mortality high
39
Q

What are the characteristics of IDIOSYNCRATIC DILI?

A

Unpredictable
No dose-relateed
Not seen in animals
rare

40
Q

What is Hy’s Law?

A

Hepatocellular injury and jaundice together = 10% mortality

41
Q

What is the term for cholesterol deposits?

A

Xanthomas

42
Q

What is sicca syndrome?

A

Sjogren’s syndrome (autoimmune cells destroy and attack exocrine glands)

43
Q

If a patient has PBC, what is one potential sequelae?

A

Sicca syndrome

GI Week 4 (12 decks)

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