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liver Flashcards

1
Q

intial (synthetic dysfunction): decreased albumin, Inc PT/INR, inc bilirubin

portal HTN: thrombocytopenia, varices, ascities

*DEFINITIVE: biopsy to show bridging fibrosis and nodular regeneration

anemia. mild elevations of AST and alkaline phosphatase

A

dx in cirrhosis

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2
Q

.fatigue, malaise, anorexia, nausea, tea colored urine and vague abdominal discomfort

A

common complaints with hep

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3
Q

cavernous hemangioma, hepatocelluar adenoma,

infantile hemangioe-endothelioma

A

benign liver neoplasms

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4
Q

autoimmune disease that presents with jaundice and pruritis in middle aged women

tx

A

primary biliary cirrhosis

Tx: urosodeoxycholic acid to slow progression of disease, cholestyramine for pruritis,

liver transplant

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5
Q

.menstrual changes(amenorrhea), impotence, loss of libido, gynecomastia, N/V, anorexia, fatigue, weakness, fatigue, weight loss, abd pain, hepatomegaly

A

sx of early cirrhosis

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6
Q

fever, chills, worsening ascites, abd pain

may lead to diarrhea and renal failure

> 250 PMNs/mL in ascitic fluid

A

presentation of spontaneous bacterial peritonitis

think cirrhosis

tx: antibiotics

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7
Q

HCV

% become chronic

sexually transmitted

acute liver failure

A

80%

less likely to be sexually transmitted

rarely leads to acute liver failure

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8
Q

common etiology of cirrhosis

A

chronic hep C. alcohol. nonfatty liver disease

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9
Q

presentation of spontaneous bacterial peritonitis

4 initial symptoms and what 2 sx may follow

think what other diagnosis

labs

tx

A

fever, chills, worsening ascites, abd pain

may lead to diarrhea and renal failure

think cirrhosis

> 250 PMNs/mL in ascitic fluid

tx: antibiotics

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10
Q

all HIV positive pts with chronic hep B should be treated with what medications

A

with therapies that cover both infections

Tenofovir with either emtricitabine or lamivudine will cover the hep B and additional antiretroviral meds will cover the HIV infection

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11
Q

HBeAg

A

hep B envelope antigen indicates active infection that is highly contagious

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12
Q

hep B and C presentation

who should be screened for hep C

A

asymptomatic to fulminant

people born between 1945-1965

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13
Q

alpha fetoprotein elevated in what

A

cirrhosis, hep C, hepatic carcinoma

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14
Q

which hepatitis may exist in a carrier state or a chronic infection

A

hep B

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15
Q

describe hepatitis D

seen when and with what

acute phase hep B along with hep D

risk of cirrhosis/cancer

tx

A

seen only with hep B. assoc with a more severe course

acute phase of hep B is not made worse by hep D infection

risk of cirrhosis/cancer is increased with a hep D infection in the chronic state

tx: peginterferon

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16
Q

what shows hep A has resolved

A

HAV IgG

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17
Q

late stage cirrhosis symptoms

A

ascites, pleural effusion, peripheral edema, ecchymosis, esophageal varices, hepatic encephalography

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18
Q

sx: jaundice, pruritis, fat solulable vitamin def(A, D, E, K)
dx: inc alk phos/bilirubin/cholesterol

+ antimitochondrial antibody

A

primary biliary cirrhosis

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19
Q

what does HBsAg indicate

A

ongoing infection of any duration

found throughout the clinical illness

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20
Q

Tenofovir with either emtricitabine or lamivudine

A

give to all HIV positive pts with chronic hep B infection

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21
Q

.wilson disease

hemochromatosis

A

copper accumulation in body/ liver is the initial site of copper accumlation.

an cause chronic hepatitis

hemochromatosis

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22
Q

hep A

duration of sx

4 sx

2 PE

4 labs

how long is recovery

vacc available?

A

2-3 wks

prodrome of anorexia, N/V, malaise

fever

hepatomegaly, jaundice

nml or low WBC, elev bilirubin/AST/ALT

recovery 9 weeks

vaccination available

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23
Q

explain thrombocytopenia in cirrhosis

A

secondary to hypersplenism, sequestration of platelets in the liver, and decreased thrombopoietin production

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24
Q

what indicates a lower viral titer; hepatitis

A

anti-HBe

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25
Q

viral DNA load in chronic liver infection

what tends to occur with a reduction in viral DNA

A

it will be greater then 10:5 copies

HBeAg seroconversion

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26
Q

how often does pts with chronic hep progress to serious liver disease

A

20-30%. occurs most often with alcohol is involved or it pt is co-infected with hep B or HIV

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27
Q

most common cause of acute viral hepatitis worldwide

A

HAV

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28
Q

Immunoglobulin M antibody can be detected with what

A

onset of hep A(15-40 day incubation period)

disappears after several months

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29
Q

what indicates “immunity by past infection or vaccination”

A

anti-HBs

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30
Q

what indicates active infection that is highly contagious; hepatitis

A

HBeAg

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31
Q

anti-HBe

A

indicates a lower viral titer

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32
Q

what are liver abscesses generally caused by

occurs when

sx

tx

A

entamoeba histolytica or the coliform bacteria

can occur after travel or secondary to an intra-abdominal infection and presents with fever and abd pain

tx: antibiotics and percutaneous drainage or surgical excision

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33
Q

.primary hepatocellular carcinoma assoc with what 3 diseases

A

hep B, hep C, aflatoxin B1 exposure(various foods)

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34
Q

increased alk phos and bilirubin

A

cholestasis

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35
Q

common drugs that cause acute hepatitis

A

alcohol

acetaminophen

INH

methyldopa

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36
Q

which hepatitis is self limiting

A

hep A and E

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37
Q

.what may be elevated in hepatic carcinoma

imaging

avoid what

A

alpha fetoprotein

contrast enhanced CT or MRI. Liver bx

no needle bx until the tumor is resectable for fear of seeding

38
Q

cirrhosis tx

A

no alcohol

salt restriction, bed rest

spirolactone 100mg daily

maybe liver transplant

39
Q

.acute and chronic hepatitis

ALT and AST

bili

alk phos

A

acute: all markedly elevated
chronic: ALT and AST mildly elevated or nml/low >3-6 mnth

40
Q

.dx in cirrhosis

labs first off

portal HTN (3)

definitive dx

CBC, Liver enzymes

A

intial (synthetic dysfunction): decreased albumin, Inc PT/INR, inc bilirubin

portal HTN: thrombocytopenia, varices, ascities

*DEFINITIVE: biopsy to show bridging fibrosis and nodular regeneration

anemia. mild elevations of AST and alkaline phosphatase

41
Q

whats the 1st and 2nd common cause of acute hepatitis

A

viral is 1st then toxins(alcohol)

42
Q

.hep virus with extremely high transmission rate

A

HBV

43
Q

presents with unconjugated hyperbilirubinemia but have nml CBC, blood smear, and LFTs

hereditary?

tx

A

gilbert syndrome

autosomal recessive of bilirubin

benign, no tx

44
Q

.high mortality rate in pregnant women

may become chronic in immunocompromised pts

A

HEV

45
Q

.which hepatitis is seen with HIV

A

hep C are more frequent then hep B

30% of HIV pts found to have hep C as well and together the progression of cirrhosis is increased

46
Q

.pts with hep C should be vaccinated against what

A

hep A and hep B

47
Q

bilirubin levels in hep

A

over 3 indicates scleral iterus if not frank jaundice

48
Q

.alpha fetoprotein elevated

no needle bx until the tumor is resectable for fear of seeding

A

hepatic carcinoma

49
Q

hep B incubation period

duration of sx

increases risk for what

6 sx

2 PE

how long is recovery

vacc available?

A

incubation: 6 wks to 6 months / 2-3 weeks for sx

increases risk for cirrhosis and hepatocellular carcinoma

prodrome of anorexia, N/V, malaise

arthralgia, diarrhea, fever

hepatomegaly, jaundice

self limiting- sx resolve in 2-3 weeks/ full recovery is 16 weeks

vacc avail for infants. antiviral therapy an option

50
Q

anti-HBs

A

immunity by past infection or vaccination

or has recovered from an HBV infection

51
Q

tx for acute bleeding/coagulopathy in cirrhosis

A

FFP

not vitamin K

52
Q

HBcAb

A

antibody to HBcAg;

IgM positive during the window period.

IgG HBcAb is an indicator of prior or current infection

53
Q

.gold standard for hepatitis

A

liver biopsy

54
Q

.sequelae of chronic hepatitis

A

cirrhosis

portal HTN

liver failure

hepatocellular carcinoma

55
Q

.common complaints with hep

A

fatigue, malaise, anorexia, nausea, tea colored urine and vague abdominal discomfort

56
Q

hep A and E from what

A

fecal-oral contamination

57
Q

anti-HBc

A

hep B core antibody present between the disappearance of HBsAg and the appearance of anti-HBs,

indicating acute hepatitis

58
Q

.what suggest alcohol hepatitis

A

AST/ALT ratio > 2

youre toASTed

59
Q

jaundice occurs with what bilirubin level

A

over 2.5

60
Q

increased AST and ALT

A

hepatocellular injury

61
Q

.sx for cirrhosis

A

ascites, gynecomastia, weakness, fatigue, and wt loss common. N/V and anorexia usually present

62
Q

what antibody is present between the disappearance of HBsAg and the appearance of anti-HBs, indicating acute hepatitis

A

anti-HBc

63
Q

.cirrhosis related to what

A

45% due to alcohol

remainder due to hep B and hep C with congenital disorders

64
Q

.chronic hepatitis results from what 2 things

A

viral(hep B,C,D) or inheritied disorders(wilsons disease, alpha one antitrypsin deficiency)

65
Q

.presentation of hepatocelluar carcinoma

A

many asymptomatic.

RUQ tenderness, abdominal distention,

chronic liver d/s(jaundice, easy bruising, coagulopathy)

liver enlargement

66
Q

what is the goal of therapy for hepatitis C

A

reduction of viral RNA to undetectable at 6 months post therapy

67
Q

.very elevated AFP

abn LFTs

A

hepatocellular carcinoma dx

do u/s or CT to find mass

Bx if needed

68
Q

what indicates hepatocellular damage in hepatitis

A

aminotransferase elevations

69
Q

what indicates an ongoing infection of any duration; hepatitis

A

HBsAg

70
Q

what does HAV IgG mean

A

hep A has resolved

71
Q

asterixis(flapping of hand), tremor, dysarthria, delirium, coma,…

A

hepatic encephalopathy

72
Q

hepatocellular carcinoma dx

A

do u/s or CT to find mass

very elevated AFP

abn LFTs

Bx if needed

73
Q

fulminent liver disease

A

INR > 1.5

hepatic encephalopathy

can be from HAV or HBV

74
Q

hep C describe virus appearance

3 sx

1 PE

7 labs

how long is recovery

meds for tx

A

single stranded RNA virus

prodrome anorexia, N/V, malaise

jaundice

elev bil/alk phos/ALT/AST

HCV antibody, PCR for HCV RNA

self limiting and recovery is 3-6 months

interferon alpha, pegylated interferon, ribavirin

75
Q

toxic hepatitis tx

prognosis

A

acetylchysteine

good prognosis is pt survives the acute episode

76
Q

.which hepatitis is generally detected by its antibody

A

hep C or D

hep C generally indicates ongoing infection

as it does for hep D if hep B infection is ongoing

77
Q

carbon tetrachloride, halothane, phenytoin, INH, ETOH, tylenol

A

causes toxic hepatitis

78
Q

.what is aflatoxin B1 exposure

A

produced by aspergillus found in contaminated vegetation and food

think primary hepatocellular carcinoma

79
Q

.more sensitive: ALT or AST

A

ALT

80
Q

.labs of cholestasis

A

increased ALK-phos with increased GGT

Increased bilirubin > ALT/AST

81
Q

.indicator of early severe liver injury/prognosis

A

PT better than albumin

82
Q

.albumin

A

useful marked of overall liver protein synthesis

83
Q

.alcohol hepatitis labs

A

AST double ALT. alcohol causes mitochondrial injury. AST found in mitochondria. increases with injury.

84
Q

.labs with viral/toxic/inflammatory liver processes

A

ALT > AST

85
Q

.autoimmune hepatitis labs

A

increased ALT>1000, + ANA, +smooth muscle antibodies, increased IgG. responds to corticosteroids, azathioprine

86
Q

.budd chiari syndrome def

s/s

dx testing

A

hepatic vein obstruction leading to decreased liver drainage

ascites, hepatomegaly, RUQ pain

do u/s initially. venography gold standard

87
Q

.asterixis

A

flapping tremor with wrist extension

hepatic encephalopathy with cirrhosis

88
Q

.sx of hepatic encephalopathy

tx

A

confusion, lethargy(increased ammonia levels to brain), asterixis

lactulose or rifaximin

89
Q

.what is spontaneous bacterial peritonitis

organism

A

infection of ascites WITHOUT perf of bowel

complication of cirrhosis

common is e coli

90
Q

.Non alcoholic fatty liver and
non alcoholic steatohepatitis

difference

A

NASH associated with fibrosis and potential to progress to cirrhosis. it is also premalignant.

91
Q

.liver bx: microvesicular fatty deposits

A

nonalcohol fatty liver disease

92
Q

.kayser fleischer rings

A

brown or green pigmented rings in cornea

wilsons ds

GI (14 decks)

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