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MJ- F3E3: GI > Liver 1 > Flashcards

Liver 1 Flashcards

1
Q

S/S of what?

  • AMS (encephalopathy)- personality, change, reversal of sleep pattern, lethargy, coma
  • Cerebral edema
  • Coagulopathy
  • Jaundice
  • Multiple organ failure
  • Ascites and anasarca
  • Shrinking liver
A

Acute liver failure

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2
Q

In acute liver failure, encephalopathy develops within ____ to ____ weeks of onset of liver injury?

What about in subacute liver failure?

A

Acute= 1-4 wks

Subacute= 12-24wks

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3
Q

What is seen on the following labs in Acute liver failure?

PT/INR?

CBC?

BMP? (3)

LFTs? (3)

A
  • Increased PT/INR- severe coagulopathy
  • CBC: Leukocytosis
  • BMP: Hyponatremia, Hypokalemia, hypoglycemia
  • LFTs: Marked elevation of bilirubin, ALT, AST
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4
Q

What are the 4 components of treatment for acute liver failure?

A
  1. hospitalization
  2. Continuous monitoring and supportive care
  3. Await spontaneous resolution
  4. If recovery unlikely–> liver transplant
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5
Q

What is the MCC of acute hepatitis?

Second MCC?

A

MC- Viral

2nd MC- toxins (drugs, alcohol)

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6
Q

What is the MCC of chronic hepatitis

A

Viral

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7
Q

How is Hepatitis A&E transmitted

A

Fecal-oral

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8
Q

Do Hepatitis A or E cause chronic infection? Where is Hepatitis E most common?

A

A: doesn’t cause chronic infection

E: can progress to chronic infection rarely. MC in Mexico

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9
Q

How are Hepatitis B, C and D transmitted

A

parenterally or via mucous membrane contact

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10
Q

Can Hepatitis B, C and D cause chronic infection

A

yes

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11
Q

What 4 things are commonly in the history of patients with Hep B, C and D?

A
  • IV drug use
  • tattoos
  • infected mother
  • blood transfusion
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12
Q

Which of the viral hepatitis (A-E) are self limited

A

HAV and HEV

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13
Q

Cholestatic hepatitis is MCly associated with which hepatitis

A

HAV

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14
Q

Pathophys of what condition?

  • Cell-mediated immune mechanisms–> hepatocyte injury (degeneration and apoptosis)
  • CD8 and CD4 T cell responses
  • Production of cytokines in the liver and systemically
A

Acute viral hepatitis

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15
Q

What are the prodromal sxs seen in acute viral hepatitis?

A

GI sxs: malaise, anorexia, N/V

Flu-like sxs

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16
Q

Which acute viral hepatitis has abrupt sx onset? Which ones have insidious onset?

A

Abrupt= HAV and HEV

Insidious= HBV, HCV, HDV

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17
Q

What would you see in acute viral hepatitis after prodromal sxs subside? (3)

A

Jaundice

dark urine

pruritis

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18
Q

What might be see on physical exam in a patient with acute viral hepatitis?

A

mild enlargement/tenderness of the liver

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19
Q

Acute viral hepatitis:

S/S of cholestatic hepatitis

A
  1. severe jaundice for several months
  2. Pruritis
20
Q

What is the prognosis for complete recovery from cholestatic hepatitis?

A

excellent

21
Q

Arthritis, vasculits and cryoglobulinema may be seen in which acute viral hepatitis

A

Relapsing hepatitis

22
Q

Which condition has the following laboratory findings?

  • ALT & AST >500
  • normal-mild leukopenia
  • alk phos, PT/INR: normal to mild elevation
A

Acute viral hepatitis

23
Q

What laboratory findings might you see in cholestatic disease

A

Bilirubin >20

Alk phos elevated

24
Q

What is the tx for acute viral hepatitis? (4)

What else could you do in HCV and HBV?

A
  1. outpatient management- unless dehydration then admit
  2. Adequate caloric and fluid intake
  3. Avoid EtOH
  4. rest
  5. HCV- oral antivirals if no resolution in 3 months
  6. HBV- tenofovir or entecavir (only if severe)
25
Q

What 2 medications might shorten course of Cholestatic hepatitis? What med could be given to control the pruritis?

A

Shorten course: Prednisone, Ursodeoxycholic acid

Pruritis: Cholestyramine

26
Q

What are the 4 risk factors for Hep A

A
  1. Living in endemic region- Africa, Asia, latin america
  2. Close contact w/ infected person
  3. MSM
  4. Foodborne outbreak
27
Q

Which Acute viral hepatitis is fever likely to occur in

A

HAV

28
Q

Cholestatic and relapsing hepatitis more commonly occur with which acute viral hepatitis?

A

HAV

29
Q

Which laboratory test indicates a acute HAV infection

A

IgM antibody to HAV (anti-HAV)

30
Q

What does IgG anti-HAV indicate?

A

Positive= prior infection

This indicates lifelong immunity

31
Q

How do you treat Hep A?

A

supportive

32
Q

At what age does the CDC recommend all children receive the HAV vacc?

A

1 year old

33
Q

The CDC recommends giving the HAV vacc to what 6 groups of people? (these are the main ones)

A
  1. Kids at 1y/o
  2. Ppl traveling to high risk countries
  3. MSM
  4. IVDU
  5. Ppl w/ occupational risk
  6. Chronic liver disease
34
Q

Who should get postexposure prophylaxis for Hep A?

A

Persons recently exposed to active HAV that haven’t been vaccinated

35
Q

When are patients with HAV considered noninfectious

A

1 wk after onset of jaundice

36
Q

clinical presentation of what?

  • Abrupt onset F
  • abd pain
  • jaundice
  • hepatomegally
  • jaundice
  • elevation of aminotransferases (usu. >1000)
A

HAV

37
Q

What is the test of choice for diagnosis of HAV?

A

IgM anti- Hep A virus serology

38
Q

What is the key to prevention of HAV?

A

Personal hygiene

(can also vaccinate)

39
Q

Where HEV highly endemic

A

Mexico

40
Q

How is HEV usually spread

A

By swine or contaminated drinking water

(consumin undercooked pork, deer meat, shellfish)

41
Q

There is a high frequency of acute liver failure caused by HEV in which patient population

A

pregnant patients

42
Q

How can you check to make sure HEV has resolved?

A
  • ALT/AST returns to normal
  • IgM anti-HEV no longer detectable
  • IgG anti-HEV was detectable
  • HEV RNA undetectable
43
Q

The following causes concern for what in a patient with HEV?

  • Persistent increase in AST/ALT
  • Persistent HEV RNA in serum/stool >6mo
A

progression to chronic infection

44
Q

What are the 2 components of treatment for chronic HEV?

A
  1. Reduce immunosuppresive meds if pt on them
  2. Ribavirin or pegylated interferon alpha for > 3mo
45
Q

How do you prevent HEV? (3)

A
  1. Good sanitation
  2. Avoid unpurified H2O in endmeic areas
  3. Avoid raw pork and venison

*no vaccine for HEV*

46
Q

Which 3 viral hepatitis strains are blood borne

A

HBV, HDV, HCV

MJ- F3E3: GI (9 decks)

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