Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Foundations III GI (Cholley) > Liver > Flashcards

Liver Flashcards

1
Q

What is acute liver failure?

A

Liver injury, hepatic encephalopathy, & coagulopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What causes acute liver failure?

A

Hepatocyte necrosis due to:

  • Viral hepatitis
  • Drug induced
  • Toxins
  • Metabolic
  • Vascular
  • Wilson’s disease, autoimmune, tumor, transplant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the #1 cause of acute liver failure?

A

Acetaminophen overdose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are s/s of acute liver failure?

A 
AMS 
Cerebral edema
Coagulopathy 
Organ failure
Ascites & anasarca 
Shrinking liver
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are clinical features of acute hepatic failure?

A

Coagulopathy & jaundice

Encephalopathy within 1-4 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are clinical features of subacute hepatic failure?

A

Encephalopathy within 12-24wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are lab findings w/ acute liver failure?

A

Increased PT/INR

Leukocytosis

Hyponatremia, hypokalemia, hypoglycemia

Elevated bilirubin, ALT/AST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do you treat acute liver failure?

A

Transfer to liver transplant
Await for resolution
If no recovery –> transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which type of hepatitis is transmitted fecal-orally & do not cause chronic infection?

A

A & E

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How are hep B, C, & D transmitted?

A

Parenterally or MM contact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does acute viral hepatitis look like on PE?

A

Enlargement/ tenderness of liver

Splenomegaly & posterior cervical lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are s/s of cholestatic hepatitis?

A

Severe jaundice for several month

Prominent pruritis

Persistent anorexia & diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are s/s of relapsing hepatitis?

A

Arthritis, vasculitis, cryoglobulinemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are lab findings in acute viral hepatitis?

A 
ALT/AST > 500, ALT > AST
Bilirubin: nl - 10mg
Alk phos: nl - mild elevation
Prolonged Pt/INR 
Albumin: nl - mild decrease
WBC nl - mild leukopenia
Lymphocytosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the lab findings in cholestatic hepatitis?

A

Bilirubin ≥ 20
Alk phos elevated
ALT/AST may decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the lab findings in relapsing hepatitis?

A

ALT, AST elevated

Bilirubin recurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do you treat cholestatic hepatitis?

A

Prednisone & urso

Cholestyramine for pruritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are RFs for hep A?

A

Living in endemic region
Contact w/ infected person
MSM
Foodborne outbreak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are s/s of hep A?

A

Incubation = 28 days
Preicteric phase lasts 5-7 days
Fever, jaundice, RUQ TTP
Fulminant course

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do you dx hep A?

A

IgM antibody to HAV, which is then replaced by IgG anti-HAV

Elevated ALT/AST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How do you treat hep A? What is the prognosis?

A

Supportive
85% recover within 3 mos
nearly all recover within 6mos

10-20% can have relapsing course

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How do you prevent hep A?

A

Handwashing
Disposal of wastes
Immunization
Avoid excessive APAP & Etoh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

In hep A, when can children return to school?

A

1 week after the onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When should you give someone postexposure prophylaxis for hep A?

A

If recently exposed & not vaccinated

Give ASAP/within 2 wks

12mos-40yo –> HAV vaccine

< 12mos or > 40, immunocompromised, liver disease –> immune globulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
In hep A, transmission usually precedes sx by...
2 weeks!
26
What are RFs for hep E?
Mexico, Cuba, Asia, Africa, Middle East Consumption of undercooked pork, deer meat, shellfish Contaminated water = MC
27
What are clinical features of hep E?
Abrupt onset of prodromal sx Acute liver failure occurs in pregnant
28
How do you dx Hep E?
IgM anti-HEV detectable for at least 6wks, then replaced by IgG anti-HEV (detectable for 12-20 mos) HEV RNA confirms & quantifies
29
How do you prevent hep E?
Good sanitation Avoid unpurified H2O, boil & chlorinate Avoid raw pork & venison
30
What are general characteristics of HAV & HEV?
Nonenveloped viruses Linear RNA molecules Survive when exposed to bile Shed in feces
31
What are general characteristics of HBV, HDV, & HCV?
Enveloped Disrupted by bile/detergents A/w chronic liver disease
32
What are high prevalence areas w/ Hep B?
West Africa & South Sudan
33
What does the outer envelope of hep B contain?
HBsAg
34
What does the inner envelope of hep B contain?
HBcAg (structural protein): induces response against HBV HBeAg (non-structural): marker for active replication DNA polymerase: reverse-transcriptase
35
What are strong RFs for Hep B?
``` Perinatal exposure Multiple sex partners MSM Injection drug use Asian, European, African FHx of HBV or liver disease FHx of HCC Contact w/ HBV ```
36
What are weak RFs for Hep B?
``` Male Hx of STDs HIV, Hep C Blood transfusion HCW Hx of incarceration Hemodialysis ```
37
What are s/s of hep B?
Insidious onset of prodromal sx Serum sickness-like syndrome in 10%: F/C, malaise, maculopapular or urticarial rash, N/V, arthralgia/arthritis
38
What are s/s of hep B in those that are chronically infected?
Asx s/s of chronic liver disease: - cirrhosis - HCC - failure
39
What are all the lab findings for hep B?
See page 149 in PANCE book
40
How do you treat hep B?
Acute --> self-limiting Fulminant --> transplant Chronic --> anti-viral (only if ALT elevated, which indicated active inflammation)
41
What are 1st line pharmocological options for chronic hep B?
Peginterferon alpha-2a SQ x 48wks Nucleoside analogues PO QD (may be indefinitely): Entecavir & tenofovir
42
How do you prevent hep B?
Active immunization: - Hep B vaccine Passive immunization: - Hep B immune globulin (used for postexposure prophylaxis)
43
When should you suspect HDV?
Fulminant HBV Relapsing HBV Progressive chronic HBV
44
How do you treat HDV?
High dose interferon alpha & PEG IFN
45
Who should be screened for hep C?
High risk All people born btwn 1945-1965, all baby boomers
46
Hep C has how many genotypes & subtypes?
6 genotypes & > 50 subtypes 75% in US are genotype 1
47
What causes hep C?
MC = IVDU Sex activity, perinatally, accidental blood contact
48
What are strong RFs for hep C?
IVDU Blood transfusion HIV 10% have no known RF.
49
How does hep C present?
Asx 30% have prodromal sx & jaundice
50
How do you dx hep C?
Hepatitis C antibody (anti-HCV) HCV RNA needed to dx acute infection
51
Which genotype of hep C has more frequent spontaneous resolution vs less frequent?
More frequent = genotype CC Less frequent = genotype CT & TT
52
What are characteristics of chronic Hep C?
HCV RNA in blood ≥ 6 months Presents w/: chronic liver disease cirrhosis HCC
53
What factors influence progression of chronic hep C liver disease?
``` Older age Male Concurrent chronic HBV HIV Alcohol ```
54
How do you screen for chronic HCV?
EIA (detects antibodies)
55
How do you use qualitative vs quantitative studies?
Qualitative: confirms viremia, low limits of detection Quantitative: give wide dynamic range of viral loads, best way to confirm response to tx
56
How do you treat HCV?
1st test for genotype, bc this determines the regimen - PEGIFN weekly (no longer considered SOC) - Ribavirin - Oral antivirals = 1st line
57
What are examples of direct acting antivirals (DAAs) used for the tx of HCV?
NS3-4 protease inhibitors: genotype 1 & 4 ("previr") NS5B polymerase inhibitors: all genotypes ("buvir") NS5A replication complex inhibitors: ("asvir")
58
What is RVR?
Rapid viral response HCV RNA undetectable by week 4 of tx
59
What is EOT?
End of treatment HSV RNA undetectable at the end of tx
60
What is SVR?
Sustained virologic response Undetectable HCV RNA at 12 weeks after tx
61
What is nonresponse?
Failure to attain undetectable HCV RNA at any point
62
What is relapse?
EOT response followed by return of HCV RNA after completion of tx
63
What are major offenders of drug-induced liver injury (DILI)/ toxic hepatitis?
``` Antimicrobials (MC) CNS agents Immunomodulators Analgesics Lipid-lowering ```
64
How does drug-induced liver injury (DILI)/ toxic hepatitis present?
Ranges from subclinical LFT elevation to acute liver failure Liver injury may develop in days or within several wks of ingestion Labs may reveal hepatoxic injury, cholestatic, or mixed
65
How does acetaminophen overdose present?
30mins-24 hrs: GI sx 2 days after: R abd pain & oliguria, elevated LFTs & prolonged PT/INR 3-5 days: hepatic necosis w/ elevated aminotransferases, renal failure, & ALF 5-10 days: recovery phase
66
What determines the likelihood of death or need for transplant?
pH < 7.3 Stage 3-4 encephalopathy w/ PT/INR > 6.5 & Cr > 3.4 Factor V level ≤ 10%
67
How do you treat acetaminophen overdose?
IV N-acetylcysteine for serial doses Charcoal within 1 hr Gastric lavage within 4 hrs
68
What abnormalities are seen w/ alcoholic liver disease?
Steatosis Steatohepatitis Cirrhosis
69
What are clinical features of alcoholic liver disease?
Asx to advanced liver failure Portal HTN Fever, anorexia, nausea, RUQ pain, hepatomegaly, jaundice
70
What are the lab findings found in alcoholic liver disease?
AST elevated (but not above 300) > ALT Elevated alk phos Elevated TG, glucose K, phosphate, Mg deficient
71
How do you determine the short-term px in pts w/ worsening alcoholic hepatitis?
Maddrey's discrimination fuction (DF) DF = 4.6 x (the difference btwn the patient's & control prothrombin time) + bilirubin If DF > 32 --> pt has 50% mortality
72
What drug reduces 4wk mortality & frequency of hepatorenal syndrome in alcoholic liver disease?
Pentoxifylline
73
What is hepatic steatosis?
Accumulation of TG droplets in hepatocytes Benign
74
What is non-alcoholic steatohepatitis (NASH)?
Necroinflammatory changes on liver bx, may progress to cirrhosis
75
What are RFs for NAFLD?
``` Insulin resistance DM2 Obesity Lipid abnormalities Tamoxifen & corticosteroids ```
76
How does NAFLD present?
Usually asx May have RUQ pain, hepatomegaly
77
What labs are seen in NAFLD?
Elevated aminotransferase levels
78
What are the lab results seen in autoimmune hepatitis?
ALT elevated 8 fold AST elevated 7 fold Bilirubin elevated 2 fold Gamma-globulin elevated 1.5 fold Alk phos elevated 1.5 fold
79
What does autoimmune hepatitis look like on liver bx?
Interface hepatitis w/out bridging necrosis & no cirrhosis
80
What are features of autoimmune hepatitis?
Young - middle aged females Chronic hep w/ globulins Positive ANA &/or SM antibody Responds to corticosteroids
81
What are s/s of autoimmune hep?
Usually insidious Fatigue, jaundice, hepatomegaly May be severe/fulminant
82
How do you dx autoimmune hepatitis?
Autoantibodies (need at least 1 for dx): ANA or SM ≥ 1.4, anti-SLA, anti-LKM1 ≥ 1.4
83
How do you treat autoimmune hep?
Prednisone w/ or w/out azathioprine
84
What is the f/u like for autoimmune hep?
If remission achieved, f/u every 3-6mos due to high likelihood of relapse
85
How do you treat Wilson disease?
D-penicillamine
86
What are manifestations of hereditary hemochromatosis?
``` High serum iron or ferritin Cardiac disease DM Joint disease Infections ```
87
What gene mutation is typically found in hereditary hemochromatosis?
HFE gene
88
What is the pathogenesis behind primary biliary cirrhosis?
T cell attack on bile ducts --> bile duct loss & scarring --> cirrhosis
89
What are features/sx of primary biliary cirrhosis?
Middle aged Asx, fatigue & pruritis Jaundice, xanthelasma, xanthoma, steatorrhea
90
What are the lab findings in primary biliary cirrhosis?
Elevated alk phos + AMA Elevated IgM Increased cholesterol
91
How do you treat primary biliary cirrhosis?
Cholestyramine w/ water or juice 3 times daily for pruritis Urso (slows progression) Consider liver transplant
92
What is primary sclerosing cholangitis strongly a/w?
Cholangiocarcinoma | UC
93
What is the clinical presentation of primary sclerosing cholangitis?
M > F , 41 yo = average Jaundice & pruritis MC Fatigue, wt loss, RUQ pain Hepatomegaly, splenomegaly Hx of UC
94
What are the lab findings in PSC?
Elevated alk phos & bilirubin Mild elevation of transferases Positive p-ANCA
95
What procedures do use to dx PSC?
MRCP/ERCP Liver bx
96
How do you treat PSC?
Stent Recurrent ERCPs Urso
97
What are complications of ESLD?
- Jaundice - Palmar erythema - Spider angioma - Encephalopathy w/ asterixis - Portal HTN - Portal vein thrombosis - Ascites, muscle wasting - Spontaneous bacterial perotinitis
98
What does hepatic encephalopathy lead to?
Increased ammonia --> neuropsychiatric abnormalities
99
How do you treat hepatic encephalopathy?
Lactulose: removes ammonia from gut
100
What imaging do you use to dx portal vein thrombosis?
Doppler US, CT, MRI
101
How do you treat portal vein thrombosis?
Anticoag w/ heparin or LMWH
102
How do you treat ascites, LE edema, or pleural effusion?
1st line = diuretics (furosemide & spironolactone) 2nd = paracentesis/thoracentesis 3rd = transjugular shunt
103
How do you treat spontaneous bacterial peritonitis?
IV cefotaxime IV albumin Post infection bactrim
104
How do you assess degree of ESLD?
MELD Bilirubin + INR + Cr Mortality decreases at 15
105
What is the MC RF for HCC?
Cirrhosis
106
What imaging/lab should you perform for HCC?
CT/MRI every 6 mos AFP
107
How do you treat HCC?
Transplant Monitor via imaging Ablation & TACE
108
Klatskin tumors
Perihilar tumors involving the bifurcation of biliary ducts Intrahepatic
109
What is the MC age range for dx of cholangiocarcinoma?
50-70!!! (2/3)

Foundations III GI (Cholley) (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions