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Gastroenterology > Liver > Flashcards

Liver Flashcards

1
Q

Criteria for liver transplant in paracetamol overdose

A

INR>3 at 48hrs, oliguria/cr>300, persistent acidosis

hypotension,hypoglycemia, thrombocytopenia,encephalopathy

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2
Q

Target antigen in AI hepatitis type 2

A

Cyp450 2D6 , associated with anti LKM in young adults

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3
Q

Strongest contraindication for use of interferon in treatment of viral hepatitis

A

Decompensated cirrhosis

Other- significant psychiatric illness, alcohol, low Hb, solid organ transplant

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4
Q

Diagnostic triad for PBC

A

Cholestatic LFT, positive AMA, histologic findings

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5
Q

Antibody predictive of poor clinical and biochemical response to therapy in AIH

A

anti-LKM

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6
Q

Indications for treatment in Hep B

A

Cirrhotics(even if if Hbe Ag positive or negative)
Hbe Ag+, Non cirrhotic- Rx if persistent DNA>20,000,ALT>2ULN
HbeAg -, non cirrhotic - Rx if DNA>2000, ALT>2ULN
[Normal ALT-25 females, 35- males]

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7
Q

Medication used to induce seroconversion

A

Interferon s/c weekly for 48weeks (30% chance of eAg seroconversion, 5-10% chance of sAg seroconversion)
Viral suppression - entecavir, tenofovir -life long

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8
Q

Rare s/e of tenofovir

A

Fanconi’s syndrome

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9
Q

Management of latent HBV with core Ab positive for chemo/ritux

A

Treat with entecavir/lamivudine to start before chemo/ritux and continue for 12-18months post chemo

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10
Q

Screening for HCC in HBV

A

Africans >20yrs, First degree relative with HCC, Asian men>50, women >40, A+TS >50, Cirrhotics

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11
Q

Risk of transmission for HBV in pregancy

A

Hbs ag positive, Hbe positive, Viral load above 1x105
Rx -commence in 3rd trimester tenofovir/ lamivudine
Cease 6 weeks post partum
Baby -HBIG, vaccination

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12
Q

Hepatitis C genotype common in Australia

A

1 and 3

Synergistic effect with alcohol

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13
Q

Hepatitis C extrahepatic manifestations

A

Autoantibodies 40-60%, T2DM, Mixed cryoglobulinemia, Membranoproliferative GN, lichen planus, porphyria cutanea tarda, lymphoma/splenic lymphoma

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14
Q

MOA and SE of Sorafenib for HCC

A

TK inhibitor, anti -VEGF, anti-angiogenesis

S/e- palmar plantar erythrodysesthesia(hand-foot syndrome), fatigue, rash

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15
Q

Optimal treatment regimen for Hep C

A

PEG-INF2alpha daily s/c for 4 weeks, then 3 times per week for 20 weeks

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16
Q

Management of HBV in pregnancy

A

Mild disease, low viremia -Rx commence when pregnant
Mild disease, high viremia-Rx in last trimester with tenofovir-can be ceased post partum
Mod liver disease, no cirrhosis -Rx before pregnancy,if responds -can stop treatment before pregnancy
Advanced liver disease-Rx before, during and post delivery

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17
Q

Most common side effect of ribavirin treatment in Hep C

A

Hemolytic anemia

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18
Q

Hepatitis B genotype with worst prognosis

A

Genotype C

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19
Q

Strongest predictor of development of cirrhosis and HCC in patients with hepatitis B

A

High circulating levels of HBV DNA

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20
Q

Which of the following features does not affect natural history of progression of Hepatitis C

A

Genotype

21
Q

Absolute contraindication for liver transplantation

A

Alcohol use(should be abstinent for 6 months)
Cardiopulmonary disease that cannot be corrected
Extrahepatic malignancy within 5 yrs

22
Q

Primary biliary cirrhosis features

A 
Women >45yrs
AMA positive in 95% cases
Immune attack on small bile ducts only
Ursodeoxycholic acid slows progression
Transplantation for end stage liver disease -Bn>100
23
Q

Primary sclerosing cholangitis

A

Sclerosis of large bile ducts
Strongly associated with UC
Complicated by cholangiocarcinoma in 10%
Ursodeoxycholic acid not useful

24
Q

Predictors of poor outcome in paracetamol overdose

A 
INR>3at 48hr or 4.5 at any time
Oliguria or creatinine >200
Persistent acidosis with pH<7.3 or lactate>3
SBP<80 despite resuscitation
Hypoglycemia
Severe thrombocytopenia
Any degree of encephalopathy
25
Q

Most common long term complication of liver transplantation

A

Metabolic syndrome

26
Q

Causes of raised AST: ALT ratio

A

Alcoholic liver disease, NASH,
Hep C with cirrhosis
Cirrhosis from viral hepatitis
Wilsons disease

27
Q

Genotype of Hep C that predicts poor response to treatment

A

Genotype 3
Genotype 1a more difficult to treat than 1b
Negative predictive factors in studies:
Male gender, weight>75,non CC IL28B genotype, cirrhosis, HCV RNA>800000

28
Q

Mx of treatment naïve Hep C genotype 3 without cirrhosis

A

8wks fixed dose combination of glecaprevir and pibrentasvir

HCV genotype 2 -sobosfuvir and ribavirin for 12 weeks

29
Q

Autoantibodies in AIH

A

ANA, anti-LKM, AMA

30
Q

What defines chronicity in Hepatitis B

A

Hbs Ag persisting >6months

31
Q

MC sideeffect of Ribavirin treatment

A

Haemolytic anemia

32
Q

Conditions least likely to cause HCC

A

AIH, PBC, Wilsons

33
Q

Risk factors for bleeding in esophagial varices

A 
Varix size
Child class
Endoscope -cherry red spot, redwale sign
Continued alcohol use
HVPG>12
Previous bleed -60-70%
34
Q

Criteria for liver transplantation in paracetamol poisoning

A

INR>6.5, Cr>300, Gr 3/4 encephalopathy

35
Q

Liver transplantation criteria in non paracetamol liver failure

A 
INR>6.5 or 3of 5 foll criteria
Age <11or>40
Bn>300
Jaundice to coma time>7 days
INR>3.5
Drug toxicity
36
Q

Criteria for liver transplantation in HCC

A

Single lesion less than 5cm
Upto 3 lesions, all <3cm
No evidence of gross vascular invasion
No regional node/distant mets

37
Q

Risk factors for NAFLD

A

Obesity, Type 2DM, hyperlipidemia,insulin resistence

Genetic modifiers PNPLA3

38
Q

Best diet for NAFLD patients

A

Mediterranean diet (olive oil, nuts, avocado), fish, green leafy vegetables

39
Q

Most sensitive initial screening tool for HH

A

Fasting morning transferrin saturation
Transferrin sats>45% detects almost all C282 homozygotes
Ferritin>1000 (without other causes) may indicate need for liver Bx

40
Q

Suveillance post HCC resection

A

CT 3 monthly for 1styear, 6monthly for 2nd year

Then USG 2yrly

41
Q

Factors leading to clearance of Hep C

A

Younger age,female gender,MHC genes, IL-28B

42
Q

Factors predictive of disease progression in Hep C

A

Older age, male,Histology, alcohol,obesity, high ALT,Co infection (HIV,HepB), insulin resistance

43
Q

Hep B genotype with better response to INF

A

A and B

44
Q

Hep B genotypes associated with severe liver disease

A

C and D

45
Q

HBe seroconversion rate with oral nucleotides (entecavir/tenofovir)

A

10-20% per year

46
Q

Advantages of INF Rx for HBV

A

Finite duration of therapy
Higher rate of HbeAg loss in 1 year
Higher rate of Hbs Ag loss with short duration of Rx
No resistance

47
Q

Advantages of oral nucleotides for HBV

A

Higher rates of HBV DNA suppression

48
Q

Conditions where tenofovir prefered over entecavir

A

Pregnant women

If previous Lamivudine experienced (50% chance of entecavir resistance)

Gastroenterology (8 decks)

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