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monster management > liver > Flashcards

liver Flashcards

1
Q

liver fxn if BG high

A

glycogenesis: forms glycogen from excess glucose

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2
Q

liver fxn if BG low

A

glycogenolysis: breaks down glycogen into glucose

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3
Q

beta oxidation

A

breakdown of fatty acids (liver fxn)

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4
Q

hep A transmission

A

fecal-oral

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5
Q

hep B transmission

A

blood, sexual contact (semen, vaginal secretions, saliva)

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6
Q

hep C transmission

A

blood (transfusions, IVDU, multiple sex partners, piercings, tats, immunocompromised individuals, sharing personal items like razors, occupational exposures)

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7
Q

hep D transmission

A

percutaneous (increased incidence w IV drug abusers)

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8
Q

hep A & B s/s (+1 A only)

A

hepatomegaly
liver tenderness
splenomegaly ~15%
A: lymphadenopathy

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9
Q

hep C s/s

A

longterm consequences s/t inflammation- scarring- hep fibrosis- cirrhosis (30%)- hepatocellular carcinoma (3%)- end stage liver disease

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10
Q

increases Hep C viral load

A

EtOH lt 50g

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11
Q

hep A fecal excretion

A

up to 2 wks before clinically apparent illness

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12
Q

hep B onset

A

more insidious than A, can be abrupt

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13
Q

hep A illness & recovery

A

acutely ill: 2 - 3 wksfull recovery: ~9 wks

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14
Q

*hep B illness, incubation, recovery

A

acutely ill 2 - 3 weeks
*incubation 6 wks - 6 mo (avg 12 - 14 wks)
recovery 16 wks
can become chronic

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15
Q

*hep C incubation, illness

A

*incubation 6 - 7 wksfreq asx for years70% infected develop chronic disease

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16
Q

labs hep A vs B

A
  • WBC WNL
  • mild proteinuria
  • ↑ bilirubin & alk phos
  • ↑ AST & ALT (B gt A)
  • bilirubinemia (precedes jaundice)
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17
Q

Hep A specific labs x2

A

anti-HAV IgM & IgG

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18
Q
  • Hep A: IgM
A
  • dx marker
  • peaks 1st wk illness
  • disappears w/in 3-6 mo
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19
Q
  • Hep A: IgG
A
  • indicates prev exposure
  • non-infectivity & immunity
  • peaks after 1 mo, may persist yrs
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20
Q

*Hep B specific labs x6

A

HBsAg, HBcAg, HBeAg
anti-HBs
anti-HBc IgM & IgG

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21
Q

*Hep B: first evidence infection / infectivity

A

HBsAg- persists → clinical illness

  • indicates infectivity
  • if persists 6+ mo ind chronic Hep B
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22
Q

*Hep B: successful vaccination

A

anti-HBs

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23
Q

*Hep B: recovery & non-infectivity

A

anti-HBs appears then disappears

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24
Q

Hep B: anti-HBs

A

appears after virus clearance

  • successful vaccination
  • appears/disappears = anti-HBs
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25
Q

Hep B: IgM

A
  • appears shortly after HBsAg
  • helps confirm dx in pts who may have cleared HBsAg
  • may persist 3 - 6 mo
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26
Q

Hep B: IgG

A

persists indefinitely whether cured or chronic

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27
Q

Hep B: helps confirm dx in pts who may have cleared HBsAg

A

IgM anti-HBc

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28
Q

Hep C dx + sens/spec

A 
enzyme immunoassay (EIA) detects ab to JCV- low spec (false +)
- mod sens (false -)
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29
Q

Hep C confirmatory dx

A

HCV-PCR RNA (how much HCV in blood?)

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30
Q

Hep A & B tx

A 
bedrest
fluids - PO
ADMIT:
- cannot maintain hydration
- INR gt 1.6
- encephalopathy
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31
Q

when to admit Hep A or B

A

ADMIT:

  • cannot maintain hydration
  • INR gt 1.6
  • encephalopathy
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32
Q

Hep A specific tx

A
  • handwashing !!
  • immune globulin to all close personal contacts
  • avoid EtOH, strenuous exercise, hepatotoxic rx (tylenol)
  • prevention: inactivated hep A vax
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33
Q

Hep C tx

A 
based on genotype (1-6, 1-3 most common)
protocols based on "resp rate"
- peginterferon
- ribavirin
- protease inhibitors
- sovaldi
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34
Q

peginterferon

A

helps healthy cells fight HCV, strengthens immune sys
SE
- flu-like: fatigue, HA, fever, chills, n/v, arthralgias, myalgias
-worsening depression
-mood instability
- ↑ susceptibility to inf

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35
Q

worsening psych seen as SE to which HCV tx?

A

peginterferon

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36
Q

ribavirin

A 
antiviral (HCV), interferes w RNA metabolism
SE
- hemolytic anemia
- MI
- pneumonitis
- dyspnea & infiltrates
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37
Q

sofosbuvir (Sovaldi)

A

HCV polymerase inhibitor

  • 12 wk course (varies by genotype)
  • may include ribavirin & peginterferon
38
Q

no chronic form of which Hep?

A

Hep A

39
Q

only viral hep that causes fever spikes

A

Hep A

40
Q

Hep B vaccination

A
  • initial, 1 & 6 mo
  • recombinant-derived
  • lasts 15 yrs
  • booster if titers lt 10 mIU/mL~90% vax’d dev protective ab to Hep B
41
Q

single stranded RNA virus + mutates rapidly (difficult to treat)

A

Hep C

42
Q

*Hep A: infected markers

A

anti-HAV

IgM anti-HAV

43
Q

*Hep A: non-infectivity, immunity

A

IgG anti-HAV

44
Q

*Hep B: infected

A

HBSAg

HBEAg

45
Q

*Hep B: confirmatory dx

A

IgM anti-HBC

46
Q

*Hep B: non-infectivity, immunity

A

anti-HBSAg

47
Q

*Hep C specific labs

A

ab to HCV

HCV RNA assay

48
Q

chronic hepatitis

A

B, C, D

  • inflammatory response gt 3 to 6 mo
  • ↑ ALT & AST
  • inflammation of portal sys + lobules (mild, mod, severe)
  • fibrosis (mild, mod, severe) or cirrhosis
49
Q

chronic Hep B s/s

A
  • cirrhosis (40-50% die w/in 5 yrs)
  • liver failure
  • hepatocellular carcinoma
50
Q

chronic Hep B tx

A

interferon (recombinant human interferon alfa-2b) {Intron A} Lamivudine (Epivir) nucleotide analogs: suppress HB DNA for 1 yr

51
Q

chronic Hep C s/s + risks

A
  • 20% cirrhosis after 20 yrs
  • hepatocellular carcinoma
    risks:
  • gt 50g EtOH qd
  • acquire HBC @ 40+
  • immunosuppressed
52
Q

chronic Hep C tx

A
  • peginterferon, ribavirin, PI (protocols based on resp rate)
  • Sovaldi
53
Q

chronic Hep D s/s + dx

A

superimposed on B

  • dx: ab to Hep D ag (anti-HDV)
  • rapid dev cirrhosis
  • ↑↑↑ mortality
54
Q

alcoholic hepatitis

A
  • REVERSIBLE *
    acute or chronic inflammation → necrosis of parenchyma
    most common cause of cirrhosis (Hep C #2)
55
Q

red flag EtOH levels (possible alcoholic hepatitis)

A

4 oz whiskey15 oz wine4x 12 oz beer (cans)50g/day 10+ years

56
Q

alcoholic hepatitis: risk factors

A
  • 50g/day 10+ years- female (↓ gastric mucosal EtOH dehydrogenase level)

↑ duration (10-15yrs) + ↑ consumption = ↑ probability AH & cirrhosis

57
Q

alcoholic hepatitis: s/s

A
  • h/o N/V
  • hepatomegaly, splenomegaly
  • jaundice, ascites
  • abd pain/tenderness
  • fever, encephalopathy
58
Q

alcoholic hepatitis: labs

A
  • CBC: macrocytic anemia, leukocytosis (left shift), thrombocytopenia
  • PT ↑ & INR
  • AST ↑ gt ALT↑
  • ↑ alk phos, bilirubin
  • ↓ albumin folic acid deficiency
59
Q

alcoholic hepatitis: tx

A
  • nutritional support: proteins & CHO to offset catabolism, prev hypogly
  • vit supplement (Banana Bag): folic acid, thiamine (B1)
  • MUST GIVE GLUCOSE + THIAMINE or → Wernicke-Korsakoff Syndrome *
60
Q

alkaline phosphatase

A

protein found in all body tissues, higher in liver, bile ducts, bone.

61
Q
  • Wernicke-Korsakoff Syndrome *
A

encephalopathy w/ ataxia, confusion, amnesia, confabulation, & impaired learning in alcoholic hepatitis, glucose given without thiamine (B1) can result in this

62
Q

liver cirrhosis leads to what anemia?

A

macrocytic anemia

63
Q

spider nevi s/s of?

A

cirrhosis

64
Q

palmar erythema s/s of?

A

cirrhosis

65
Q

Dupuytren’s contractures

A

flexion 4/5 digits indicating cirrhosis

66
Q

notable late s/s of cirrhosis

A

pleural effusions, encephalopathy

+ jaundice, ascites, peripheral edema, ecchymotic lesions, asterixis

67
Q

cirrhosis lab findings

A

macrocytic anemia
↓ WBC s/t hypersplenism thrombocytopenia
prolonged PT, ↑ INR↑ of AST, alk phos, bilirubin↓ albumin

68
Q

ascites r/t cirrhosis: pathophys

A

portal htn: → ↑ hydrostatic pressure (liver enlarged, pushes fluid out of vessels → 3rd spacing)
hypoalbuminemia → ↓oncotic pressure

69
Q

ascites r/t cirrhosis: tx

A

restrict Na+ (400-800mg/day)
diuretics: Spironolactone, Furosemide large
-vol paracentesis (4-6L)
TIPS (Transjugular intrahepatic Portosystemic Shunt)

70
Q

TIPS (Transjugular intrahepatic Portosystemic Shunt)

A

stent btw branch of hepatic vein & portal vein introduced via IJ
takes blood from liver to IVC

71
Q

complications of cirrhosis

A 
ascites
spontaneous bacterial peritonitis
hepatorenal syndrome
encephalopathy
portal hypertension
72
Q

spontaneous bacterial peritonitis r/t cirrhosis: risk + s/s + tx

A

risk: h/o variceal bleeding & PPI uses/s: abd pain, ↑ ascites, fever, progressive encephalopathy
tx: cefotaxime (3rd gen cephalosporin) + IV albumin

73
Q

hepatorenal syndrome r/t cirrhosis + dx

A

renal failure s/t ESLD
dx: azotemia, in abs of shock or sig proteinuria, in ESLD where renal fxn doesn’t improve w infusion of 1.5L NS → r/o other causes of renal failure including pre-renal azotemia

74
Q

hepatorenal syndrome labs

A
  • azotemia
  • urine vol lt 500mL/day
  • urine Na lt 10mEq/L
  • urine osm gt plasma osm
  • urine RBC gt 50
  • serum Na lt 130mEq/L
75
Q

hepatorenal syndrome type 1 pathophys

A

rapid progression - doubling creatinine to gt 2.5mg/dL in 2 wks

76
Q

hepatorenal syndrome type 2 pathophys

A

slower progression - more chronic (presents as diuretic-resistant ascites)

77
Q

presents as diuretic-resistant ascites

A

type 2 hepatorenal syndrome

78
Q

is type 1 or 2 hepatorenal syndrome faster?

A

type 1 progression more rapid

79
Q

hepatorenal syndrome tx

A

liver transplantation

80
Q

encephalopathy r/t liver: pathophys

A

cerebral edema: poss etiologies inc breakdown of BBB -or- Na+ accumulation s/t inhibition of Na-K ATPase
leads to acute ↑ ICP → ↓ CPP, cerebral blood flow, loss of autoregulation

81
Q

encephalopathy stages

A

I - euphoria, depression, mild confusion, slowed mentation, slurred speech, sleep disturbances
II - drowsiness, inappropriate behavior, tremors
III - sleeps but arousable, confused, incoherent speech, abn EEG, tremors
IV - Unarousable, Abn EEG

82
Q

encephalopathy mgmt

A

mannitol (hold if serum osm gt 320)↓ ammonia levels:

  • lactulose (hold if ileus)
  • neomycin (monitor for oto or nephrotoxicity)
83
Q

portal hypertension r/t cirrhosis

A

progression of liver failure: pressure back up → ascites & varices (esophageal, gastric, duodenal, rectal)
*pre-disposed to a GI bleed ( coagulopathy + likely to bleed + pressure prob d/t vol back up)

84
Q

portal hypertension tx

A

sclerotherapy
TIPS
balloon tamponade

85
Q

sclerotherapy

A

tx for portal hypertension: cauterize vessels

86
Q

fulminant hepatitis + s/s

A 
viral hepatitis → sudden or severe liver disease
- massive hepatocellular necrosis
s/s (shocky & losing volume)
- jaundice
- hepatomegaly
- ↑ AST & ALT
- ↓ H&H
- prolonged PT
- encephalopathy
87
Q

fulminant hepatitis tx

A

SUPPORTIVE

  • maintain perfusion (fluids, inotropes)
  • vent support
  • monitor f&e, maintain normal glucose
  • monitor ammonia: tx w lactulose or neomycin
  • consider transplantation
88
Q

Non-Alcoholic Steatohepatitis (NASH)

A

“silent liver disease”

resembles alcoholic liver dz in individuals who do not drink

89
Q

NASH clinical findings + dx

A

↑ ALT & AST
initially pts asx
- liver bx diagnostic
- fatty liver, inflammation, damage to liver cells

90
Q

NASH dz progression

A

asx → fatigue, weight loss, weakness

adv disease → liver failure, cirrhosis

91
Q

NASH tx

A

initially lifestyle → IBW, balanced diet, avoid unnecessary meds, avoid ETOH, ↑ physical activity
liver failure = only tx is transplantation

monster management (29 decks)

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