Lecture 7 - Liver

Question 1

besides the hepatitis viruses, name 2 viruses that can cause hepatitis

Answer 1

CMV, EBV

Question 2

viral hepatitis:
jaundice with increased _____;
liver enzyme profile?

Answer 2

UCB and CB (mixed);

ALT > AST

Question 3

Hep A:
DNA or RNA virus?
acute, chronic, or both?
fecal oral, parenteral, or blood transmission?
acute infection serology = 
immunity serology =

Answer 3

RNA (picorna);
acute;
fecal-oral (ie shellfish);
IgM;
IgG

Question 4

Hep B:
DNA or RNA virus?
spread by the "3 B's" which are \_\_\_\_\_;
worse clinically in babies or adults?
progression to HCC?

Answer 4

DNA (hepadna);
blood, baby-making (Sex), birthing (perinatally);
babies (cause chronic infection);
yes (with or without cirrhosis)

Question 5

Hep B serology:
_____ is the antigen found on the surface. it indicates _____;
___ is the antigen associated with the core of HBV

Answer 5

HBsAg; infection;

HBcAg (not detected in blood)

Question 6

Hep B serology:

HBeAG = the ____ antigen. what does it indicate?

Answer 6

envelope;

active viral replication/high transmission risk

Question 7

Hep B serology:
what is the only positive marker during the window period?
_____ is present during the incubation period, ie before symptoms;
_____ indicates immunity, either from past infection or immunization

Answer 7

anti-HBc;
HBsAG;
anti-HbS IgG

Question 8

Hep B:

loss of ____ is called seroconversion. good or bad sign?

Answer 8

HBeAg;

good sign

Question 9

Hep B (if going to treat):
first line is entecavir or _____;
what Interferon can be used?

Answer 9

tenofovir;
Interferon Alpha (not used much tho)

Question 10

Hep C:
DNA or RNA virus?
transmitted via _____;
do most stay acute or most become chronic?

Answer 10

RNA (flavi);
blood (IV drugs mostly);
chronic

Question 11

Hep C:

lacks what enzyme? this causes what.

Answer 11

3-5’ exonuclease = antigen variation

Question 12

Hep C extrahepatic probs:
what fun skin problem can they get?
increased risk of what kind of cancer, besides HCC?
causes _____ in the kidney

Answer 12

porphyria cutanea tarda (or lichen planus);
Non Hodgkin’s Lymphoma;
membranoproliferative GN

Question 13

Hep C:
Anti-HCV indicates what?
+ HCV RNA indicates ___

Answer 13

exposure (not necessarily active or immunity);

active infection

Question 14

Hep C (treatment from FA):
_____ inhibits HCV RNA-Dependent RNA polymerase, acting as a chain terminator.
_____ is a HCV protease inhibitor

Answer 14

sofusbuvir;
simeprevir

both are pretty cheap

Question 15

Hep D:
DNA or RNA virus?
____ is HDV infection following a HBV. _____ is HDV infection concurrent with HBV infection. which is worse?

Answer 15

RNA (deltavirus);
superinfection, coinfection;
superinfection is worse

Question 16

Hep E:
DNA or RNA virus?
transmission = \_\_\_\_;
fulminant hepatitis in who?
risk of chronic infection?

Answer 16

RNA (hepevirus);
fecal-oral (esp waterborne);
pregnant women;
nope

Question 17

autoimmune hepatitis:
look for anti\_\_\_\_\_ Ab and \_\_\_\_
causes v high \_\_\_\_\_;
associated with \_\_\_\_\_ infiltrate on biopsy
usually men or women?

Answer 17

smooth muscle, ANA;
ALT;
lymphoplasmocytic;
women

associated with other auto-immune conditions

Question 18

treatment of autoimmune hepatitis:

Answer 18

prednisone and azathioprine (good response usually)

Question 19

alcoholic hepatatitis:
lab findings?
_____ on biopsy, which are what?
notable symptom?

Answer 19

AST > ALT;
mallory bodies, damaged cytokeratin fibers;
painful hepatomegaly

Question 20

acetaminophen hepatotoxicity:
overdose produces hepatic _____;
the metabolite ____ depletes _____ and forms toxic byproducts;
can occur with low doses if liver enzymes have been induced by ____

Answer 20

centrilobular necrosis;
NAPQI, glutathione;
alcohol

Question 21

acetaminophen overdose treatment:
_____ if within 4 hours;
_____ if within 72 hours;
maybe liver transplant

Answer 21

activated charcoal;

N-acetylcysteine (replenishes glutathione)

Question 22

non-alcoholic fatty liver disease:
patients are typically ____;
lab findings?
risk of progression to _____

Answer 22

obese/metabolic syndrome;
ALT > AST;
cirrhosis, HCC

Question 23

cavernous hemangionoma:
benign or malignant?
____ is contraindicated because of risk of ____

Answer 23

benign;

biopsy, bleeding

Question 24

focal nodular hyperplasia:

believed to be a hyperplastic response to a _____

Answer 24

anamalous artery

Question 25

hepatic adenoma:
related to ____ use;
bleeding risk during ____ due to ____

Answer 25

contraceptive (and steroids);

pregnancy, estrogen

Question 26

HCC:
associated with ____ with or without cirrhosis, plus all other causes of cirrhosis;
what carcinogen is high yield to know?

Answer 26

HBV;

aflatoxin from aspergillosis

Question 27

HCC:
tumor marker =
spreads via blood or lymph?
____ is curative

Answer 27

alpha-fetoprotein;
blood;
liver transplant

Question 28

primary sclerosing cholangitis and gall bladder cysts are associated with what cancer?

Answer 28

cholangiosarcoma