Liver 2

Question 1

HEP A

Answer 1

Transmission: Fecal-oral, parental (IVD), sexual

Acute onset of fever

Usually mild severity

Does NOT lead to chronic hepatitis

Usually affects children and adults

Hand hygiene, Hep A vaccine

Question 2

HEP B

Answer 2

Transmission: parental or sexual

Insidious onset

-very long incubation

Severe disease, may be prolonged course or develop into chronic (10%)

Any age group affected

HBV vaccine and safe sex + hygiene

-all kids get vaccine

Question 3

HEP C

Answer 3

Transmission: parental or sexual

Insidious onset

Mild to severe symptoms

Can develop into chronic hepatitis (80%)

Any age is affected

Screening blood, hygiene, NO vaccine

Leads to: hepatocellular carcinoma, liver transplant

-New treatment is developing and becoming more widely available

Question 4

Hepatitis A vaccine

Answer 4

-2 doses 6 months apart

Recommendations:

-All children starting at 12 months

-Special “high risk” populations
(food handlers, hospital workers)

Question 5

Hepatitis B vaccine

Answer 5

-3 doses at least 4 months apart

Recommendations:

-All infants beginning as newborns

Question 6

2 Major classes of HEP B drugs

Answer 6

1. Interferons

2. Nucleoside analogs

Question 7

Treatment for B is only for

Answer 7

HIGH-RISK patients:

• Elevated AST levels
• Hepatic inflammation
• Advanced fibrosis

Question 8

Disadvantages of Hep B treatment

Answer 8

• Prolonged therapy
• Costs and adverse effects (interactions)
• High relapse

Question 9

Hep C is treated with

Answer 9

Direct-acting antiviral therapy and interferon-based regiments

-Some require treatment along with a nucleoside analogue medication as well

Question 10

How much Tylenol can Hep C people take?

Answer 10

<2g/day

Question 11

Common causes of cirrhosis

Answer 11

1. Hepatitis B + C
2. Excessive Alcohol Intake
3. Idiopathic
4. NASH + NAFLD (Non-alcoholic fatty liver disease)

Question 12

Cirrhosis

Answer 12

Irreversible, inflammatory, fibrotic liver disease

Structural changes from injury (alcohol/virus) and fibrosis

Chaotic fibrosis leads to obstructive biliary channels and blood flow Jaundice + Portal hypertension

Regeneration is disrupted by hypoxia, necrosis, atrophy, and liver failure

Question 13

Most common type of cirrhosis

Answer 13

Alcoholic cirrhosis most common type but still accounts for only 25% of all cirrhosis

Question 14

3 stages of alcoholic liver disease

Answer 14

1. Alcoholic fatty liver
2. Alcoholic steatohepatitis
3. Alcoholic cirrhosis

Question 15

1. Alcoholic fatty liver

Answer 15

-mildest, asymptomatic

reversible

Question 16

2. Alcoholic steatohepatitis

Answer 16

• precursor to cirrhosis
• inflammation (infiltration of WBC), degeneration of hepatocytes
• Symptoms apparent

(Irreversible)

Question 17

3. Alcoholic cirrhosis

Answer 17

-fibrosis and scarring alter liver structure

Irreversible

Question 18

Cirrhosis: pathogenesis

Answer 18

1. Liver cells destroyed
2. Cells try to regenerate
3. Disorganized process
4. Abnormal growth
5. Poor blood flow and scar tissue
6. Hypoxia
7. Liver failure

Question 19

Cirrhosis: Early Manifestations

Answer 19

GI Disturbances

• N/V
• Anorexia
• Flatulence
• Change in bowel habits

Fever, Weight loss

Palpable Liver

Question 20

Cirrhosis Late Manifestations: Endocrine

Answer 20

Females:

• Anovulation
• Amenorrhea

Male:

• Hypogonadism
• Impotence
• Infertility

Question 21

Cirrhosis Late Manifestations:

Answer 21

Jaundice 
Peripheral edema
Decreased albumin & PT
Ascites
Skin lesions
Hematologic Problems
-anemia + bleeding
Endocrine problems
Esophageal + anorectal varices
Encephalopathy

Question 22

Causes of Portal Vein Hypertension

Answer 22

-Systemic hypertension, vascular underfilling, stimulation of vasoactive (RAAS system), plasma volume expansion, increased CO&raquo_space;> ASCITES

Question 23

Complications of Portal Hypertension

Answer 23

Asymptomatic until complications:

-Variceal hemorrhage, ascites, peritonitis, hepatorenal syndrome, cardiomyopathy

Question 24

What leads to varices + ascites?

Answer 24

Resistant portal blood flow (portal hypertension)

Question 25

Primary factor of encephalopathy diagnosis

Answer 25

LOC + correlate with LIVER labs (ammonia)

Question 26

Acute Liver Failure: Fulminant liver failure: Most common cause

Answer 26

Acetaminophen OD

use acetylcysteine

Question 27

Acute Liver Failure (Fulminant Liver Failure): pathology

Answer 27

edematous hepatocytes and patchy areas of necrosis and inflammatory cells infiltrate and disrupt liver tissue

Question 28

Acute Liver Failure (Fulminant Liver Failure): When and how can it occur?

Answer 28

Can occur 6-8 weeks after viral hepatitis or metabolic liver disease

-5 days to 8 weeks after acetaminophen OD

Question 29

Lactulose

Answer 29

Class: hyperosmotic Laxitive

MOA: reduces blood ammonia levels by converting ammonia to ammonium

Given PO or enema/rectal

Can be given to titrate by number of stools or by ammonia levels

-Not just given for high ammonia levels though, MUST have signs/symptoms of encephalopathy

Make sure that patient is NOT hypokalemic

Question 30

Rifaximin

Answer 30

Second line if lactulose isn’t working

MOA: inhibits bacterial RNA synthesis by binding to bacterial DNA (initially used as an antibiotic for GI infections)

Can sometimes be given as preventative, depends on HCP

PO

SE: peripheral edema, nausea, ascites, dizziness, fatigue, pruritis, skin rash, abdominal pain, anemia

Has been associated with an increased risk of C. diff