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Foundations III > Liver > Flashcards

Liver Flashcards

1
Q

Most common cause of acute liver failure

A

Acetaminophen overdose

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2
Q

Acute liver failure signs and symptoms

A
  • Ascites
  • Coagulopathy
    -Jaundice
  • ## Encephalopathy/altered mental status (1-4 weeks after jaundice)
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3
Q

Acute liver failure labs

A
  • ALT and AST, bilirubin elevated
  • INR elevated
  • Leukocytosis (high WBCs)
  • Hyponatremia, hypokalemia, hypoglycemia
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4
Q

Acute liver failure: TX

A

hospitalize, may need transplant

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5
Q

Hepatitis: acute and chronic

A

Viral is most common cause of both

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6
Q

Which hepatitis viruses are transmitted fecal oral

A

A and E

  • self limited
  • abrupt onset
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7
Q

How are hepatitis B, C, D transmitted?

A
  • IV drug use
  • tattoos
  • infected mother
  • blood transfusion
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8
Q

Which hepatitis virus most commonly causes cholestatic hepatitis?

A

hepatitis A

  • prominent jaundice and itching
  • elevation in bilirubin, ALK phos
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9
Q

Which hepatitis virus is the most common cause of relapsing hepatitis?

A

hepatitis A

  • symptoms recur in weeks/months
  • may see arthritis, vasculitis, excess protein in the blood
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10
Q

Acute viral hepatitis: physical exam

A
  • mild hepatomegaly with tenderness
  • mild splenomegaly
  • posterior cervical lymphadenopathy
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11
Q

Acute Viral hepatitis (self-limited disease and relapsing hepatitis) treatment

A

outpatient (unless super dehydrated)

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12
Q

Cholestatic hepatitis: tx

A
  1. Prednisone
  2. Ursodeoxycholic acid
  3. Cholestyramine (for itching, binds to cholesterol)
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13
Q

Hep A: signs/sx

A
  • fever (uncommon in other viral hepatitis)**

- icteric phase: jaundice peaks at 2 weeks

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14
Q

How long does IgM antibody to HAV stay elevated?

A

3-6 months

IgM is test of choice***

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15
Q

How long does IgG anti-HAV stay elevated?

A

lifelong

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16
Q

Which hepatitis viruses have vaccines?

A

Hep A

Hep B

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17
Q

When should the Hep A vaccine be given?

A
  • at 1 year old
  • MSM
  • IV drug user
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18
Q

Post exposure Hep A prophylaxis?

A

Vaccine for 1 -40 years

Immunoglobulin for <1 yr, >40 yr, or immunocompromised

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19
Q

In whom is hepatitis E often more severe and fulminant?

A

pregnant lady

acute liver failure esp if in 3rd trimester

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20
Q

Hepatitis E

A
  • longer incubation than Hep A**

- Spread by swine/undercooked meat

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21
Q

Hepatitis E: labs

A
  • IgM first
  • IgG second
  • HEV RNA test confirms and quantifies HEV presence*** (stool or serum)
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22
Q

Hepatitis E: prevention

A
  • no vaccine

- no immunoglobulin

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23
Q

Viral differences

A

Hep A and E: non-enveloped, not affected by bile/detergents

Hep B, C, D: enveloped, disrupted by bile/detergents

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24
Q

Hep B: general

A
  • DNA virus
  • transmission via percutaneous and permucosal routes
  • sexually transmitted
  • May result in chronically infected state–>esp infants, kids
  • Adults more likely to get asymptomatic/self-limited disease
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25
Q

What does HBeAg tell you?

A

marker of active infection

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26
Q

What does antibody to HBsAg tell you?

A

immunity to the surface antigen

27
Q

If the patient has anti-HBs and anti-HBc what does that tell you?

A

Prior HBV infection

28
Q

What labs would indicate chronic Hepatitis B infection?

A

HBsAg for >6 months

29
Q

If patient has Hep B infection, is young, non-cirrhotic, low HBV DNA level what is the treatment?

A

Peginterferon alfa-2a
(SQ injections for 48 weeks)
-greater chance of seroconversion

Nucleoside analogues (ex. entecavir, tenofovir)

  • inhibit HBV replication, don’t eradicate HBV
  • Oral medication
30
Q

Hep B: passive immunization (ex. newborns of HBsAg moms)

A
  1. Immunoglobulin (HBIG)
    - give postexposure prophylaxis to casual sexual partners
  2. HBV vaccine series
    - 2 shots, 6 months apart
31
Q

Who should be screened for Hepatitis C?

A
  • high risk

- Born between 1945-1965 [BABY BOOMERS]

32
Q

Most common Hepatitis C genotype in US?

A

genotype 1

note: genotype 3 is hardest to treat

33
Q

Hepatitis C: etiology/risk factors

A
  • transmitted MC between IV drug users**
  • Blood transfusion before 1992
  • HIV (less likely to clear virus)
34
Q

Hepatitis C: clinical presentation

A
  • usually asymptomatic
  • young women more likely to clear the virus (blacks less likely to clear)
  • majority will develop chronic infection
35
Q

Which lab is needed to diagnose acute Hep C infection?

A

HCV RNA test***

-if present >6 months =chronic infection

36
Q

Hep B vs. Hep C in kids

A

Hep B - kids more likely to become chronic

Hep C - kids more likely to resolve spontaneously

37
Q

In a patient with chronic Hep C, how do you tell if there is active infection?

A

+ screening test by EIA (antibodies against the virus)

38
Q

If your patient has hepatitis C, what other things are important to do?

A
  • screen for HIV

- vaccinate for Hep B, and Hep A

39
Q

What determines the treatment regimen for hep C?

A

genotype

40
Q

What are the new Hep C drugs?

A

Direct-acting antivirals
-NS3-4 protease inhibitors (ex. Simeprevir)

-NS5B polymerase inhibitors (ex. Sofosbuvir)

41
Q

What is the main offender for drug-induced liver injury?

A
  • antibioticss (esp. Augmentin, Sulfonamides)***
  • Acetaminophen
  • Antituberulous Agents (Isoniazid and Rifampin)
42
Q

What does Maddrey’s discrimination function help you determine?

A

mortality during current hospitalization for alcoholic hepatitis

Tx: methylprednisolone and pentoxifylline help

43
Q

Non alcoholic fatty liver disease, and nonalcoholic steatohepatitis: general

A
  • asymptomatic, maybe RUQ pain
  • elevated ALT
  • <4 alcoholic drinks a day
44
Q

Autoimmune hepatitis: general

A

-young to middle aged women
-high serum gamma-globulin level
+ANA
+smooth muscle antibody

45
Q

Autoimmune hepatitis: Tx

A

Tx: Prednisone 30mg (taper over month) +/- azathioprine

46
Q

Autoimmune hepatitis: prognosis/follow up

A

hepatologist every 3-6 months due to high relapse rate

47
Q

Wilson disease

A
  • impaired biliary copper excretion
  • Autosomal recessive
  • decreased serum ceruloplasmin
  • Kayser-Fleicher rings
48
Q

Wilson disease: tx

A

D-penicillamine

49
Q

Which organs are affected by Alpha-1 antitrypsin deficiency

A

Lung and Liver

50
Q

Primary Sclerosing Cholangitis

A

-Men 20-40
-Ulcerative colitis
-cholangiocarcinoma
+ P-ANCA
-Elevated: Alk Phos, Bilirubin

51
Q

Primary Biliary Cirrhosis

A

-middle aged women
-fatigue and pruritis**
-xanthelasma/xanthoma
+Anti-mitochondrial antibody**

52
Q

Primary Biliary Cirrhosis: Tx

A
  1. Urodeoxycholic acid*

2. Cholestyramine (bile acid resin)

53
Q

Primary Sclerosing Cholangitis: Dx

A

ERCP with stenting

-Ursodiol (reduces secretion of cholesterol)

Definitive –>most will need transplant

54
Q

ESLD hepatic encephalopathy

A
  • hepatocellular dysfunction leads to increased serum ammonia levels
  • Neuropsychiatric abnormalities (grade1: short attention span, grade2: personality change, grade3: confusion disorientation, grade4: coma
55
Q

ESLD: Tx for high ammonia in the blood

A

Lactulose and/or Rifaximin`

56
Q

What happens to albumin in end-stage liver disease?

A

decreases

  • more difficulty maintaining osmotic pressure of blood
  • less carrying ability for small hydrophobic molecules
57
Q

End Stage Liver disease: Sodium

A
  • Chronically low - fluid overload
  • Indirect marker of portal hypertension
  • hyponatremia - risk of cerebral edema and neurologic changes
58
Q

Model of End-Stage Liver Disease (MELD)

A

determines transplant eligibility

> 15 MELD score is where 3 month survival starts dropping = consider for transplant

59
Q

What are strong predictors of 3 month mortality

A
  1. Total Bilirubin
  2. INR
  3. Cr
  4. Na+
60
Q

Hepatocellular Carcinoma (HCC)

A

MC risk factor = cirrhosis
Image every 6 months = alternating CT/MRI

Serum cancer marker = Alpha feto-protein

61
Q

Cholangiocarcinoma: etiology

A
  • cancer from bile duct epithelium
  • Klatskin tumor –> if near bifurcation of the ducts
  • MOST are adenocarcinomas

-Males, between ages 50-70

62
Q

Cholangiocarcinoma: history and exam

A
  • Painless jaundice
  • pruritus
  • fever, jaundice, RUQ pain (Charcots)
  • palpable gallbladder
  • hepatomegaly
  • dark urine
  • pale stools
63
Q

Contraindications for liver transplant

A
  • active EtOH or drug abusee
  • HCC outside the liver
  • Metastatic bile duct cancer
  • Non-hepatic malignancy
  • Severe cardiopulmonary disease
  • Comorbidities (BMI>35)
  • Psych/social issues

Foundations III (34 decks)

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