Liver Cirrhosis, Hepatitis, Pancreatitis Flashcards by Anna Michaela Gatchalian

only organ that can regenerate once damaged

Liver

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Chronic and irreversible liver disease due to exposure to hepatotoxic substances leading to inflammation and abnormal collagen formation/secretion

Cirrhosis

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Portal triad

bile duct (BD)
portal vein (PV)
hepatic artery (HA)

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Flapping tremor

Asterixis

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an abnormal connection between the portal vascular system and systemic circulation

Portosystemic shunt

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Enlargement of spleen due to back flow of blood

Congestive splenomegaly

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increased estrogen can cause ________, _________, _________

Gynecomastia, spider angiomata, palmar erythema

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Accumulation of fluid in peritoneal cavity

Ascites

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Hypoalbuminemia may lead to

Edema

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Unconjugated bilirubin will result to

Jaundice

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once the liver is damaged, the production of clotting factors will be affected, leading to

Bleeding

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Removing excess fluid in the abdomen

Paracentesis

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Mainstay primary prophylaxis for variceal bleeding

Beta adrenergic blockers

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NONSELECTIVE B-Blocker should be used

propranolol or nadolol

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Decrease splanchnic arterial blood flow with a subsequent decrease in portal inflow

Somatostatin and Octreotide

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TIPS

Transjugular intrahepatic portosystemic shunt

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decrease water retention with ascites

Furosemide and Spironolactone

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Bacterial Peritonitis

Broad-Spectrum antibiotics

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This can cause fulminant hepatitis (cirrhosis).

Hepatitis E

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HAV family

Picornaviridae (RNA)

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Not sexually transmitted

HEPATITIS A

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ONLY HEPATITIS THAT CAN BE CURED

HEPATITIS A

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does not cause chronic hepatitis

HEPATITIS A

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Has the largest potential among hepatitis virus to cause epidemic

HEPATITIS A

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Most common transmission of HAV

fecal-oral route

Spread by ingestion of contaminated water and food

HEPATITIS A

Yellowing of eyes in jaundice

Icteric sclera

Joint pain

Arthralgia

Uncommon sequelae of acute infection

RELAPSING

Smokers lose their taste of tobacco

PRODROME

Dark urine

ICTERIC PHASE

decrease in bile flow due to impaired secretion by hepatocytes

Cholestasis

may shorten the period of cholestasis

Corticosteroids and Ursodeoxycholic acid

DOC for gallstones

Ursodeoxycholic acid

used for pre- and post exposure prophylaxis, and offers passive immunity

Immunoglobulin

Vaccines for HAV

Havrix and Vaqta

Mean incubation period of HAV

2 - 4 weeks

Commonly transmitted via body fluids such as blood, semen and vaginal secretion

HBV

HBV family

Hepadnaviridae

Can produce fulminant hepatitis with massive liver necrosis

HBV

Asymptomatic carrier

HBV

__________ transmission is the primary mechanism for HBV infection

Sexual

_________ was the most prevalent identifiable risk factor for HBV

International travel

surface antigen of the DNA virus

HBsAg

core antigen (no envelope*)

HBcAg

secreted by the precore

HBeAg

Extracellular form of HBcAg

HBeAg

HBV enters a 4- to 10-week incubation period

Initial or acute phase

Marks a decrease in HBV DNA levels with ongoing secretion of HBeAg.

immunoactive phase

HBeAg is replaced by Anti-HBeAg

Seroconversion phase

most prominent surface antigen and is detectable at the onset of clinical symptoms

HBsAg

High levels of antibodies are detectable during acute infections.

IgManti-HBcAg

If there is an infection and if it is proliferating, there should be _______

HBcAg

Patients who respond to vaccines will have ______ only.

anti-HBsAg

HBV vaccines

Recombivax HB and Engerix-B

combination vaccine for HAV and HBV in adults

Twinrix

HBV vaccine used for children

Comvax and Pediarix

T/F: HBV infections are not curable

First-line therapy options for HBV

○ interferon (IFN)-α2b ○ Lamivudine–also used for HIV, pregnant women ○ Telbivudine ○ Adefovir ○ Entecavir ○ Pegylated IFN-α2a

most common blood-borne pathogen

HCV

approximately five times as common as HIV

HCV

caused by an RNA virus from the flaviviridae

HCV

single largest risk factor for HCV infection is

injection drug use

Vast majority of cases are chronic hepatitis.

HCV

detected 1-2 weeks of exposure

HCV

No vaccine

HCV

inhibiting key viral enzyme, NS3/4A serine protease

BOSEPREVIR

Must be administered together with PGN-INF alpha and ribavirin

BOSEPREVIR

Inhibits HCV NS3/4A protease needed for proteolytic cleavage

TELAPREVIR

Specifically intended for patients with compensated liver disease such as cirrhosis

TELAPREVIR

DOCfor thrombocytopenia

Eltrombopag

Stimulates bone marrow platelet production to provide stable platelet counts toallow therapy with interferons

Eltrombopag

Antiviral nucleoside analogue

Ribavirin

Not effective when given alone

Ribavirin

Mean incubation period of HBV

1-4 months

Digests proteins

Trypsin & Chymotrypsin

Digests Carbohydrates

Amylase

helps indigestion

exocrine function

regulates blood sugar such as insulin and glucagon

endocrine function

inflammatory disorder of the pancreas characterized by upper abdominal pain and pancreatic enzyme elevations

Acute pancreatitis

progressive disease characterized by long-standing pancreatic inflammation

Chronic pancreatitis

account for most cases in the United States

Gallstones and alcohol abuse

used in cancer chemotherapy, particularly breast cancer

Tamoxifen

type of platinum compound that is also used as an anticancer

Oxaliplatin

SIRS

systemic inflammatory response syndrome

increased intestinal permeability and translocation of colonic bacteria

Pancreatic infection

I GET SMASHED

● Idiopathic ● Gallstones ● Ethanol ● Trauma ● Steroids ● Mumps ● Autoimmune ● Scorpion sting ● Hyperlipidemia / Hypercalcemia ● Endoscopic Retrograde Cholangiopancreatography (ERCP) ● Drugs

ERCP

Endoscopic Retrograde Cholangiopancreatography

lactated Ringer’s at an initial rate of

5 to 10mL/kg/hour

crystalloids at a rate of

250 to 500 mL/hour

_______ analgesics are used to control abdominal pain

Parenteral opioid

considered in patients with necrosis who deteriorate or fail to improve within 7 to 10 days

Empiric antimicrobial therapy

Imipenem-Cilastatin: now replaced by

Meropenem

Imipenem should not be given alone because it would cause

seizure

accounts for about two-thirds of cases in Western society

Chronic ethanol consumption

Excessive fat in stool

steatorrhea

a late manifestation commonly associated with pancreatic calcification

Pancreatic diabetes

Nitrogenous substance in the stool

Azotorrhea

recommended for patients who cannot consume adequate calories, have continued weight loss, experience complications, or require surgery

Enteral nutrition via a feeding tube

Pain management should begin with weak opioid analgesics

tramadol, codeine

Administration of _____________ prior to meals may decrease postprandial pain

short-acting analgesics

should be considered for patients with steatorrhea who are unable to gain weight

Supplementation withmedium-chain triglycerides

Adjuvant agents should be added if patients have inadequate relief from opioids alone.

Pregabalin (75 mg twice daily initially; maximum 300 mg twice daily)

The enzyme dose required to minimize malabsorption is ___________ units of lipase administered with each meal.

30,000 to 50,000

The dose may be increased to a maximum of ______ units per meal.

90,000