Liver Disease Cases

Question 1

AST/ALT 500-3000 indicates

Answer 1

acute hepatitis

Question 2

AST/ALT <500-3000 indicates

Answer 2

chronic hepatitis

Question 3

AST/ALT >5-10000 indicates

Answer 3

acetominophen toxicity, shock liver

Question 4

AST>ALT ratio of 2-3:1 or greater indicates

Answer 4

alcohol hepatitis

Question 5

AST>ALT ratio 1-2:1 indicates

Answer 5

cirrhosis

Question 6

ALT>AST indicates

Answer 6

fatty liver disease

Question 7

AST and ALT elevation indicates

Answer 7

liver disease, celiac, hypothyroidism, muscle damage

Question 8

Sources of Alk Phos

Answer 8

bone, placenta, liver, kidney

Question 9

T/F biliary obstruction has higher elevation in alk phos than intrahepatic cholestasis

Answer 9

F

Question 10

Examples of intrahepatic cholestasis

Answer 10

drug induced, pbc, hepatic granulomas/sarcoid

Question 11

Examples of extrahepatic cholestasis

Answer 11

bile duct obstruction due to stones, cancer, psc

Question 12

Sources of indirect bilirubin

Answer 12

hemolysis or resorption of hematomas

Question 13

Are cholestasis and hyperbilirubinemia synonymous?

Answer 13

no –> cholestasis of pregnancy has no bilirubin elevation necessarily

Question 14

Is there higher bilirubin in intrahepatic disease/hepatocellular disease or in extrahepatic cholestasis?

Answer 14

intrahepatic cholestasis or hepatocellular disease

Question 15

Which hepatitis virus is dna?

Answer 15

hbv

Question 16

Which hepatitis viruses are enterically transmitted?

Answer 16

HAV, HEV

Question 17

Diagnostic marker for acute HepA

Answer 17

IgM

Question 18

Immunity marker for HepA

Answer 18

total antibody + and IgM - (suggests it’s all IgG)

Question 19

Prevention of HepA

Answer 19

Ig prophylaxis or vaccine

Question 20

E protein

Answer 20

precore mutation in HBV that prevents secretion of E protein –> some people are e+/-

Question 21

T/F The younger you are the more likely you have a subclinical HBV infection

Answer 21

T –> allows it to persist in the population

Question 22

What is immune tolerance in HBV?

Answer 22

you have lots of viral particles but no impact on the liver –> normal histology, markers –> early transmission/perinatal (but Eantigen+)

Question 23

Risk of cirrhosis in HepC

Answer 23

20% in 20 years

Question 24

Leading risk factor for liver cancer in US

Answer 24

HepC cirrhosis

Question 25

Difference between liver cancer in HepB and HepC

Answer 25

in HepC it is seen only with cirrhosis

Question 26

Disadvantages to HepC ELISA

Answer 26

delay between infection and detection (window period), immunosuppressed patients may not make detectable response, false positive

Question 27

Does a -HepC antibody test rule out infection?

Answer 27

No –> only viral RNA test is definitive

Question 28

R > 5 and ALT >2x uln indicates

Answer 28

hepatocellular DILI (R = ALT/uln/ALKP/uln)

Question 29

RULN indicates

Answer 29

cholestatic DILI

Question 30

2<5 indicates

Answer 30

mixed cholestatic and hepatocellular DILI

Question 31

Hys law

Answer 31

if ALT >3X and Tbili>2X, likelihood of death is about 10%

Question 32

Xanthomas suggest hepatocellular/cholestatic disease

Answer 32

cholestatic

Question 33

PSC vs PBC demographic

Answer 33

PSC = young men, PSC = older women