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F3 E3 Shea > 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?

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
What 2 medications might shorten course of Cholestatic hepatitis? What med could be given to control the pruritis?
Shorten course: Prednisone, Ursodeoxycholic acid Pruritis: Cholestyramine
26
What are the 4 risk factors for Hep A
1. Living in endemic region- Africa, Asia, latin america 2. Close contact w/ infected person 3. MSM 4. Foodborne outbreak
27
Which Acute viral hepatitis is **_fever_** likely to occur in
HAV
28
Cholestatic and relapsing hepatitis more commonly occur with which acute viral hepatitis?
HAV
29
Which laboratory test indicates a acute HAV infection
IgM antibody to HAV (anti-HAV)
30
What does IgG anti-HAV indicate?
Positive= prior infection This indicates lifelong immunity
31
How do you treat Hep A?
supportive
32
At what age does the CDC recommend all children receive the HAV vacc?
1 year old
33
The CDC recommends giving the HAV vacc to what 6 groups of people? (these are the main ones)
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
Who should get postexposure prophylaxis for Hep A?
Persons recently exposed to active HAV that haven't been vaccinated
35
Patients are considered noninfectious with HAV until when
1 wk after onset of jaundice
36
clinical presentation of what? * **Abrupt onset** F * abd pain * **jaundice** * **hepatomegally** * jaundice * **elevation of aminotransferases** (usu. \>1000)
HAV
37
What is the test of choice for diagnosis of HAV?
IgM anti- Hep A virus serology
38
What is the key to prevention of HAV?
Personal hygiene | (can also vaccinate)
39
Where HEV highly endemic
Mexico
40
How is HEV usually spread
By **swine** or **contaminated drinking water** (consumin undercooked pork, deer meat, shellfish)
41
There is a high frequency of acute liver failure caused by HEV in which patient population
pregnant patients
42
How can you check to make sure HEV has resolved?
* ALT/AST returns to normal * IgM anti-HEV no longer detectable * IgG anti-HEV was detectable * HEV RNA undetectable
43
The following causes concern for what in a patient with HEV? * Persistent increase in AST/ALT * Persistent HEV RNA in serum/stool \>6mo
progression to chronic infection
44
What are the 2 components of treatment for **_chronic_** HEV?
1. Reduce immunosuppresive meds if pt on them 2. Ribavirin or pegylated interferon alpha for \> 3mo
45
How do you prevent HEV? (3)
1. Good sanitation 2. Avoid unpurified H2O in endmeic areas 3. Avoid raw pork and venison \*no vaccine for HEV\*
46
Which 3 viral hepatitis strains are blood borne
HBV, HDV, HCV

F3 E3 Shea (24 decks)

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