Liver Flashcards
Hepatitis B diagnosis
HBsAG > 6 months
elevated ALT and HBV DNA > 2000 IU
Hepatitis B treatment
tenofovir or entecavir
Hepatitis C diagnosis
anti-HCV positive and detectable HCV RNA
Hepatitis C treatment
direct-acting antivirals (sofosbuvir/velpatasvir) for 8-12 weeks
Wilson’s disease diagnosis
low ceruloplasmin (<20)
high urine copper
Urine copper in Wilson’s
> 100 ug/24 hr
Treatment for Wilson’s w/ chelation therapy
penicillamine 250 mg BID
maintenance w/ zinc 50 mg TID
Hemochromatosis diagnosis
genetic testing for HFE mutation
Transferrin and ferritin (men & women) for hemochromatosis
transferrin saturation > 45%
ferritin > 300 in men
ferritin > 200 in women
Hemochromatosis treatment w/ phlebotomy
remove 500 mL weekly until ferritin < 50
Vitamins, supplements, substances to avoid with hemochromatosis (3)
alcohol
iron
vitamin C
Autoimmune hepatitis diagnosis
positive ANA, SMA, or anti-LKM1- confirmed w/ liver biopsy
Additional labs elevated w/ autoimmune hepatitis
IgG
AST/ALT > 2x ULN
Autoimmune hepatitis treatment
prednisone 40 mg/day
+/- azathioprine 50-100 mg/day
AST/ALT ratio for NAFLD
< 1
Acute liver failure diagnosis (3)
evidence of hepatic encephalopathy
INR > 1.5
acute LFT elevation
Urine sodium in HRS
low, < 10 mEq/L
Transferin saturation in hereditary hemochromatosis
high, > 45%
Leading cause of liver transplant in the United States
chronic hepatitis C
Hepatitis types that can increase the risk of hepatocellular carcinoma (2)
hepatitis B
hepatitis C
Medication classes for hepatitis B treatment (2)
nucleoside/nucleotide analogs
interferon therapy
Medication class for hepatitis C treatment
direct-acting antivirals
Milan criteria
1) tumor size - single </= 5cm, up to three </= 3cm
2) no extrahepatic spread
3) no vascular invasion
Tenofovir dose (chronic hepatitis B)
300 mg daily
Entecavir dose (chronic hepatitis B)
0.5 mg qday (treatment naive), 1 mg qday (lamivudine-resistant)
Sofosbuvir dose (chronic hepatitis C)
400 mg qday
Lactulose dose (hepatic encephalopathy)
15-30 g 3-4 times/day
HAV transmission (3)
fecal-oral
contaminated food/water
person-to-person
HBV transmission (3)
blood
sexual contact
mother-to-child
HCV transmission (3)
blood
shared needles
contaminated blood products
HDV transmission (3)
blood
sexual contact
mother-to-child
HEV transmission (2)
fecal-oral
contaminated water
Hepatitis D diagnosis (2)
anti-HDV antibodies
HBV DNA
Hepatitis E diagnosis (2)
anti-HEV IgM
PCR for HEV DNA
Type of hepatitis that requires HBV coinfection
hepatitis D
Weight loss target w/ hepatic steatosis
5-10% of body weight
HCV diagnosis (2, 1 is confirmatory)
anti-HCV antibodies and HCV RNA PCR to confirm
Medication (and dose) indicated for NASH
pioglitazone 15-45 mg daily
Drug class to treat hepatitis C
direct-acting antivirals
MELD score where albumin is indicated in SBP
> 18
SAAG >/= 1.1
portal HTN
SAAG < 1.1
malignancy
Ceruloplasmin for Wilson’s diagnosis
< 20
Urine copper for Wilson’s diagnosis
> 100
Wilson’s chelation therapy
penicillamine 250 mg QID
Wilson’s maintenance therapy
zinc acetate 50 mg TID
Wilson’s inheritance pattern
autosomal recessive
Hereditary hemochromatosis inheritance pattern
autosomal recessive
Who to screen if hereditary hemochromatosis diagnosis
first-degree relatives
Who to screen if Wilson’s disease diagnosis
siblings
Antibody associated w/ autoimmune hepatitis
anti-smooth muscle
Anti-smooth muscle association
autoimmune hepatitis
Hepatitis D treatment
interferon alfa
Hepatitis C treatment
sofosbuvir 400 mg daily + ledipasvir 90 mg daily
