Liver Flashcards
The next test after elevated ALP
abdominal Ultrasound
the best marker for previous exposure to HBV.
anti-HBc IgG
It correlates with the quantity of intact virus and, therefore, with infectivity and liver inflammation
HBeAg
the first marker detectable in the serum in hepatitis B
the antigen HBsAg
What is the”window”period for Hepatitis B infection?
HBsAg becomes undetectable, there is a period of Weeks to months before the anti-HBs antibody becomes delectable. This is called the “window,” and you must perform an unti-HBc IgM during this period to confirm acute hepatitis
Polyarteritis nodosa is associated with which hepatitis virus?
Hepatitis B is strongly associated with polyarteritis nodosa
Can pregnnt patients use HBV vaccine?
yes it is safe for pregnant patients
The likelihood of developing chronic HBV
is inversely related to age
a woman with breast cancer who also has an inactive carrier state with hepatitis B is to be started on chemotherapy. What other drug is given?
Lamivudine is given with her chemotherapy to blunt viral replication
a newborn of a mother with hepatitis B
Give a newborn of a mother with hepatitis B HBIG and hepatitis B vaccination. There is a 5-10% transplacental transmission of HBV.
If an asymptomatic patient has HBsAg in the serum, what does it mean?and what should we do?
either the patient is a carrier or the patient has early hepatitis B -so initial action is only to follow closely (once the patient is infected; neither vaccine nor HBIG helps).
Close contacts to a patient with acute HBV infection should be given
should be given hepatitis B immune globulin (HBIG) followed by a complete course of HBV vaccinations. Pregnant women are treated the same.
Treatment of hepatitis B:
Pegylated interferon alpha (IFN-a) weekly injections x 4 months.
Oral lamivudine x 12 months
How to use HAV vaccine?
It is for use in patients 2 years or older, and given as 2 doses, 6 months apart.
Indications for use of HAV vaccine:
- high-risk behavior
- children > 2 years old in communities with high rates
- chronic liver disease pa
- travel in high-risk countries
- HAV vaccine is also given to all patients with hepatitis C; if these patients get hepatitis A. it can be fulminant.
With which hepatitis infection mixed cryoglobulinemia strongly associated? How does it present?
Hepatitis C
Mixed cryoglobulinemia presents as a small vessel (leukocytoclastic) vasculitis with a rash consisting of “palpable purpura” or “crops of purple papules.”
Treatment of hepatitis C:
pegylated INF-a and
• oral ribavirin.
diagnosis of of hepatitis C:
- Within 2-4 months after an episode of hepatitis C, recheck for loss of HCV-RNA
- In a person positive for anti-HCV, check for active virus with HCV-RNA
How Meaure response to treatment in Hepatitis C?
Measure response to treatment by following HCV-RNA: if no response at 12 weeks, discontinue therapy. For those who respond, if the HCV is genotype 1, treat for 1year; if it is genotype 2 or 3, treat for 6 months.
With acute hepatitis in a traveler and negative standard serology (Hep A. B), think of
Hepatitis E
Hepatitis E is associated with which risk factor?
Unlike hepatitis A. hepatitis E carries a very high risk for fulminant hepatitis in the 3rd trimester of pregnancy
Autoantibodies in Autoimmune Chronic Hepatitis
affected patients often have a positive ANA, anti-dsDNA. smooth muscle antibody (SMA), ANCA, and anti-actin.The SMA test is
the most specific of the autoantibody tests for type 1
Diagnosis of Autoimmune Chronic Hepatitis
Other forms of hepatitis must be excluded. and the following autoantibody tests are done: ANA, SMA, ANCA. You can also do antimitochondrial antibody
Treatment of Autoimmune Chronic Hepatitis
prednisone +/- azathioprine
Drug-related chronic hepatitis
methyldopa, nitrofurantoin. acetaminophen. trazodone, phenytoin. and methotrexate, INH, and oral contraceptives.
positive test in Drug-related chronic hepatitis
the patients are often ANA+.Hypergamaglobulinemia is also often present. Best treatment is to stop the drug.
is the most common cause of fulminant hepatitis in the U.S?
Acetaminophen toxicity
If suspected, draw acetaminophen blood levels; early treatment consists of using n-acetyl cysteine (Mucomyst”)
HCC-associated parancoplastic syndromes
Hypercalcemia and high hematocrit levels are indications of HCC-associated parancoplastic syndromes and are clues to the diagnosis. Consider hepatocellular cancer in any cirrhotic who decompensates without an obvious reason
which treatment in chronic hepatitis C reduces the risk of HCC?
IFN-a
What disease is most probable in a patient with tender hepatomegaly, a RUQ bruit,bloody ascites,a high alkaline phosphatase, and a very elevated alpha fetoprotein level?
HCC
For patients with cirrhosis from either HBV or HCV, do hepatoma surveillance
with abdominal ultrasound and alphafetoprotein (AFP) levels every 6 months
which test become abnormal first after acquiring hepatitis B infection?
Surface antigen
which test is the most direct correlate with amount , or quantitiy of active viral replication? (B)
e-antigen
Which test indicates that a patient is no longer a risk for transmitting infection to another person?(B)
No surface antigen found
which test is the best indication of the need for treatment with antiviral medications in chronic disease?(B)
e-antigen
which indicator is the best that a pregnant woman will transmit infection to her child?
e-antigen or DNA polymerase
