liver Flashcards
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
dx in cirrhosis
.fatigue, malaise, anorexia, nausea, tea colored urine and vague abdominal discomfort
common complaints with hep
cavernous hemangioma, hepatocelluar adenoma,
infantile hemangioe-endothelioma
benign liver neoplasms
autoimmune disease that presents with jaundice and pruritis in middle aged women
tx
primary biliary cirrhosis
Tx: urosodeoxycholic acid to slow progression of disease, cholestyramine for pruritis,
liver transplant
.menstrual changes(amenorrhea), impotence, loss of libido, gynecomastia, N/V, anorexia, fatigue, weakness, fatigue, weight loss, abd pain, hepatomegaly
sx of early cirrhosis
fever, chills, worsening ascites, abd pain
may lead to diarrhea and renal failure
> 250 PMNs/mL in ascitic fluid
presentation of spontaneous bacterial peritonitis
think cirrhosis
tx: antibiotics
HCV
% become chronic
sexually transmitted
acute liver failure
80%
less likely to be sexually transmitted
rarely leads to acute liver failure
common etiology of cirrhosis
chronic hep C. alcohol. nonfatty liver disease
presentation of spontaneous bacterial peritonitis
4 initial symptoms and what 2 sx may follow
think what other diagnosis
labs
tx
fever, chills, worsening ascites, abd pain
may lead to diarrhea and renal failure
think cirrhosis
> 250 PMNs/mL in ascitic fluid
tx: antibiotics
all HIV positive pts with chronic hep B should be treated with what medications
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
HBeAg
hep B envelope antigen indicates active infection that is highly contagious
hep B and C presentation
who should be screened for hep C
asymptomatic to fulminant
people born between 1945-1965
alpha fetoprotein elevated in what
cirrhosis, hep C, hepatic carcinoma
which hepatitis may exist in a carrier state or a chronic infection
hep B
describe hepatitis D
seen when and with what
acute phase hep B along with hep D
risk of cirrhosis/cancer
tx
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
what shows hep A has resolved
HAV IgG
late stage cirrhosis symptoms
ascites, pleural effusion, peripheral edema, ecchymosis, esophageal varices, hepatic encephalography
sx: jaundice, pruritis, fat solulable vitamin def(A, D, E, K)
dx: inc alk phos/bilirubin/cholesterol
+ antimitochondrial antibody
primary biliary cirrhosis
what does HBsAg indicate
ongoing infection of any duration
found throughout the clinical illness
Tenofovir with either emtricitabine or lamivudine
give to all HIV positive pts with chronic hep B infection
.wilson disease
hemochromatosis
copper accumulation in body/ liver is the initial site of copper accumlation.
an cause chronic hepatitis
hemochromatosis
hep A
duration of sx
4 sx
2 PE
4 labs
how long is recovery
vacc available?
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
explain thrombocytopenia in cirrhosis
secondary to hypersplenism, sequestration of platelets in the liver, and decreased thrombopoietin production
what indicates a lower viral titer; hepatitis
anti-HBe
viral DNA load in chronic liver infection
what tends to occur with a reduction in viral DNA
it will be greater then 10:5 copies
HBeAg seroconversion
how often does pts with chronic hep progress to serious liver disease
20-30%. occurs most often with alcohol is involved or it pt is co-infected with hep B or HIV
most common cause of acute viral hepatitis worldwide
HAV
Immunoglobulin M antibody can be detected with what
onset of hep A(15-40 day incubation period)
disappears after several months
what indicates “immunity by past infection or vaccination”
anti-HBs
what indicates active infection that is highly contagious; hepatitis
HBeAg
anti-HBe
indicates a lower viral titer
what are liver abscesses generally caused by
occurs when
sx
tx
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
.primary hepatocellular carcinoma assoc with what 3 diseases
hep B, hep C, aflatoxin B1 exposure(various foods)
increased alk phos and bilirubin
cholestasis
common drugs that cause acute hepatitis
alcohol
acetaminophen
INH
methyldopa
which hepatitis is self limiting
hep A and E
.what may be elevated in hepatic carcinoma
imaging
avoid what
alpha fetoprotein
contrast enhanced CT or MRI. Liver bx
no needle bx until the tumor is resectable for fear of seeding
cirrhosis tx
no alcohol
salt restriction, bed rest
spirolactone 100mg daily
maybe liver transplant
.acute and chronic hepatitis
ALT and AST
bili
alk phos
acute: all markedly elevated
chronic: ALT and AST mildly elevated or nml/low >3-6 mnth
.dx in cirrhosis
labs first off
portal HTN (3)
definitive dx
CBC, Liver enzymes
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
whats the 1st and 2nd common cause of acute hepatitis
viral is 1st then toxins(alcohol)
.hep virus with extremely high transmission rate
HBV
presents with unconjugated hyperbilirubinemia but have nml CBC, blood smear, and LFTs
hereditary?
tx
gilbert syndrome
autosomal recessive of bilirubin
benign, no tx
.high mortality rate in pregnant women
may become chronic in immunocompromised pts
HEV
.which hepatitis is seen with HIV
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
.pts with hep C should be vaccinated against what
hep A and hep B
bilirubin levels in hep
over 3 indicates scleral iterus if not frank jaundice
.alpha fetoprotein elevated
no needle bx until the tumor is resectable for fear of seeding
hepatic carcinoma
hep B incubation period
duration of sx
increases risk for what
6 sx
2 PE
how long is recovery
vacc available?
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
anti-HBs
immunity by past infection or vaccination
or has recovered from an HBV infection
tx for acute bleeding/coagulopathy in cirrhosis
FFP
not vitamin K
HBcAb
antibody to HBcAg;
IgM positive during the window period.
IgG HBcAb is an indicator of prior or current infection
.gold standard for hepatitis
liver biopsy
.sequelae of chronic hepatitis
cirrhosis
portal HTN
liver failure
hepatocellular carcinoma
.common complaints with hep
fatigue, malaise, anorexia, nausea, tea colored urine and vague abdominal discomfort
hep A and E from what
fecal-oral contamination
anti-HBc
hep B core antibody present between the disappearance of HBsAg and the appearance of anti-HBs,
indicating acute hepatitis
.what suggest alcohol hepatitis
AST/ALT ratio > 2
youre toASTed
jaundice occurs with what bilirubin level
over 2.5
increased AST and ALT
hepatocellular injury
.sx for cirrhosis
ascites, gynecomastia, weakness, fatigue, and wt loss common. N/V and anorexia usually present
what antibody is present between the disappearance of HBsAg and the appearance of anti-HBs, indicating acute hepatitis
anti-HBc
.cirrhosis related to what
45% due to alcohol
remainder due to hep B and hep C with congenital disorders
.chronic hepatitis results from what 2 things
viral(hep B,C,D) or inheritied disorders(wilsons disease, alpha one antitrypsin deficiency)
.presentation of hepatocelluar carcinoma
many asymptomatic.
RUQ tenderness, abdominal distention,
chronic liver d/s(jaundice, easy bruising, coagulopathy)
liver enlargement
what is the goal of therapy for hepatitis C
reduction of viral RNA to undetectable at 6 months post therapy
.very elevated AFP
abn LFTs
hepatocellular carcinoma dx
do u/s or CT to find mass
Bx if needed
what indicates hepatocellular damage in hepatitis
aminotransferase elevations
what indicates an ongoing infection of any duration; hepatitis
HBsAg
what does HAV IgG mean
hep A has resolved
asterixis(flapping of hand), tremor, dysarthria, delirium, coma,…
hepatic encephalopathy
hepatocellular carcinoma dx
do u/s or CT to find mass
very elevated AFP
abn LFTs
Bx if needed
fulminent liver disease
INR > 1.5
hepatic encephalopathy
can be from HAV or HBV
hep C describe virus appearance
3 sx
1 PE
7 labs
how long is recovery
meds for tx
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
toxic hepatitis tx
prognosis
acetylchysteine
good prognosis is pt survives the acute episode
.which hepatitis is generally detected by its antibody
hep C or D
hep C generally indicates ongoing infection
as it does for hep D if hep B infection is ongoing
carbon tetrachloride, halothane, phenytoin, INH, ETOH, tylenol
causes toxic hepatitis
.what is aflatoxin B1 exposure
produced by aspergillus found in contaminated vegetation and food
think primary hepatocellular carcinoma
.more sensitive: ALT or AST
ALT
.labs of cholestasis
increased ALK-phos with increased GGT
Increased bilirubin > ALT/AST
.indicator of early severe liver injury/prognosis
PT better than albumin
.albumin
useful marked of overall liver protein synthesis
.alcohol hepatitis labs
AST double ALT. alcohol causes mitochondrial injury. AST found in mitochondria. increases with injury.
.labs with viral/toxic/inflammatory liver processes
ALT > AST
.autoimmune hepatitis labs
increased ALT>1000, + ANA, +smooth muscle antibodies, increased IgG. responds to corticosteroids, azathioprine
.budd chiari syndrome def
s/s
dx testing
hepatic vein obstruction leading to decreased liver drainage
ascites, hepatomegaly, RUQ pain
do u/s initially. venography gold standard
.asterixis
flapping tremor with wrist extension
hepatic encephalopathy with cirrhosis
.sx of hepatic encephalopathy
tx
confusion, lethargy(increased ammonia levels to brain), asterixis
lactulose or rifaximin
.what is spontaneous bacterial peritonitis
organism
infection of ascites WITHOUT perf of bowel
complication of cirrhosis
common is e coli
.Non alcoholic fatty liver and
non alcoholic steatohepatitis
difference
NASH associated with fibrosis and potential to progress to cirrhosis. it is also premalignant.
.liver bx: microvesicular fatty deposits
nonalcohol fatty liver disease
.kayser fleischer rings
brown or green pigmented rings in cornea
wilsons ds
