Liver disease note cards

Question 1

Pathophysiology of chronic viral hepatitis?

Answer 1

Inflammatory-mediated cellular damage and necrosis with late fibrosis.

Question 2

Hep viruses RNA or DNA. A,B,C,D,E

Answer 2

RNA,DNA,RNA A-b-c

Question 3

When would you see HBsAg?
Anti-HBs
Anti-HBc

Answer 3

HBsAG in early infection or recent vaccination.
Previous immunized or resolution of infection. SO you now have the antibody of the surface antigen
Antibody to HBcore means acute or chronic infection.

Question 4

Risks of Hep C?

Answer 4

Usually goes to chronic liver disease. Risk of non hodgkin lymphoma. possible carcinoma.

Question 5

If you are exposed to Hep C what do you do?

Answer 5

Can take interferon to prevent after exposure + ribavirin

Question 6

Treatment of Alcoholic liver disease? what does it cause?

Answer 6

Alcoholic steatosis. Needs Folic acid, thiamine, and zinc and cessation.

Question 7

primary biliary cirrhosis?

Answer 7

usually causes by some type of autoimmune disease which causes death of the biliary tract.
Clinical signs are xanthomas. jaundice, hyperpigmentation.

Question 8

Natural progression of liver cirrhosis?
Two factors not made in liver?
Treatment of cirrhosis?

Answer 8

portal hypertension, esophogeal varices, hyperspenism, possible ascites. Decrease in coagulation factors.
3 and 8(Vw)
get your vaccines. no alcohol. possible diuretics. Surgically a TIPS procedures. Transjugular intrahepatic shunt.

Question 9

Classification of Liver disease?

Answer 9

MELD score- Model for end-stage liver disease. goes 6-40.
Child-pugh score… Uses bilirubin, albumin, INR, .. Goes ABC. A has highest 2 year survival. C has lowest 2 year survival. C has 80% perioperative mortality.

Question 10

What tests would you want prior to surgery in a cirrhotic patient?
Any consults?

Answer 10

Coags, CBC, CMP. I would want EKG. Primary care, cardiology,.

Question 11

What medications could you give for somebody with liver disease and coagulopathy ?

Answer 11

FFP.. Some give desmopressin. and also Vitamin K prior to the procedure can help.

Question 12

Which Neuromuscular blocker could you use in a cirrhotic Class C patient?

Answer 12

Cisatracurium or atracurium or succ

Question 13

IS midazolam safe? How does liver break it down?

Answer 13

Hydroxylation. It can be but titrate. Higher circulating amounts of benzos and opioids.