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Liver Dz Flashcards

1
Q

liver damage Pathophysiology:

A

chronic injury damages liver lobules (collapse + lose function), causes formation of fibrous septa and hepatocyte regeneration w/nodule formation

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2
Q

Tests of Hepatic Synthesis:

A

Serum Albumin (14-21 days)

PT/PTT (hours) - better for acute

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3
Q

Tests of Hepatic Cellular Damage:

A

AST/SGOT/aspartate

ALT/SGPT/alanine

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4
Q

hepatocellular injury panel pattern

A

Increased ALT/AST +/- Bilirubin

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5
Q

cholestatic injury panel pattern

A

Increased Alk Phos +/- Bilirubin:

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6
Q

causes of hepatocellular injury (5)

A

Viral hepatitis

Drug/alcohol induced

Fatty Liver dz

Autoimmune

Metabolic causes (hemochromatosis, Wilson’s dz)

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7
Q

causes of cholestatic injury (6)

A 
Drugs/Medications
Liver Congestion
PSC
PBC
Sarcoidosis 
Infiltrative Liver dz
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8
Q

in-depth way to study liver fibrosis

A

liver biopsy

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9
Q

disadvantages of liver biopsy

A

Invasive

Complications (serious bleeding)

Susceptible to sampling error

Common that pts who need bx would have contraindications (INR >1.5, thrombocytopenia <50k)

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10
Q

non invasive liver studies

A

Used to stage fibrosis in chronic liver disease, used to determine if advanced fibrosis is present

Determines liver stiffness (elasticity and viscosity) via MRI or U/S

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11
Q

advantages of non invasive liver evals

A

non invasive

allows you to determine if fibrosis is present

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12
Q

ddx of jaundice

A

ESRD

Addison’s

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13
Q

causes of Unconjugated Hyperbilirubinemia

A

(BEFORE liver)
1.Over production of bilirubin

2.Decreased Hepatic uptake/conjugation

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14
Q

over production of bilirubin MC caused by + labs

A

hemolysis

INCREASED LDH, DECREASED HAPTOGLOBIN, INCREASED BILIRUBIN

unconjugated hyper

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15
Q

causes of decreased hepatic uptake/conjugation

A

drugs
hepatocellular disease
Gilbert’s syndrome

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16
Q

drugs that cause decreased hepatic uptake/conjugation

A

rifampin
radiocontrast agents
chloramphenicol

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17
Q

gilbert’s syndrome

A

genetic defect, male predominance

recurrent episodes of jaundice, worsened by over exertion/febrile illness

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18
Q

lab results of gilbert’s syndrome

A

elevated unconjugated bilirubin but normal AST/ALT and no hemolysis

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19
Q

conjugated hyperbilirubinemia causes

A
  1. impaired excretion

2. extra-hepatic billiard obstruction

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20
Q

causes of impaired bilirubin excretion (4)

A

hepatocellular disease
hepatitis
drug or pregnancy induced cholestasis
sepsis

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21
Q

causes of extra hepatic biliary obstruction

A

gallstones
tumors
biliary structures

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22
Q

what do we use to determine severity of liver disease?

A

child Pugh

MELD

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23
Q

child Pugh measures

A

measures encephalopathy, ascites, serum bilirubin, albumin PTT

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24
Q

MELD measures

A

bilirubin, CR, INR

score >25 = increased mortality

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25
Hepatitis phases
1. prodromal phase 2. icteric phase 3. convalescent phase
26
prodromal phase time length
abrupt in HAV insidious in HBV or HCV
27
s.s of prodromal phase
Pain GI symptoms (anorexia, nausea) Skin (pruritus) Fever Systemic (fatigue, weakness) URI symptoms (flu like) Myalgia
28
pain of hepatitis
(RUQ pain, severe to mild, radiate to back of epigastrium)
29
icteric phase
5-10 days after prodrome jaundice + worsening of prodromal symptoms
30
convalescent phase
gradual return of appetite, disappearance of jaundice abdominal pain and fatigue
31
3 main signs of hepatitis
hepatomegaly liver tenderness (RUQ) jaundice
32
lab values of hepatitis
Normal-Low WBC Mild proteinuria and hyperbilirubinemia Striking AST/ALT elevations, elevated bilirubin and alk phos
33
hepatitis DDX:
other infectious disease, drug induced liver dz, ischemic hepatitis, autoimmune hepatitis, metastatic CA of liver
34
hepatitis General Tx:
small meals IV hydration avoidance of strenuous exertion, EtOH and hepatotoxic agents
35
Chronic Viral Hepatitis:
inflammation of the liver for 3-6 months persistently elevated transaminases gradually progressive damage
36
toxins to AVOID in chronic hepatitis
NSAIDs, Alcohol, herbal medicine
37
hepatitis A transmission
fecal oral, spread is facilitated by crowding and poor sanitation * contaminated water or food (undercooked shellfish)
38
HAV incubation
30 days excreted in feces for 2 weeks before clinical illness is apparent
39
symptoms HAV
Illness is more severe in adults (children are typically asymptomatic) SPIKING FEVERS Fulminant hepatitis is rare, no carrier state and no chronic hepatitis A
40
HAV Testing
Anti-HAV IgG and IgM Abs -IgM persists for 3-6 months only, IgG persists for decades
41
Prevention HAV
immun globulin w/in 30 days vaccination
42
HBV transmission
Infected blood or blood products, sexual contact or vertical transmission Present in semen, saliva, vaginal fluid
43
HBV high risk
IV drug users health care workers blood transfusions (esp. older pts)
44
infants and HBV spreading
vertical (@ or before birth) No prevention benefit via C-Section, started vax series
45
HBV incubation
insidious onset (6 weeks-6 months)
46
Chronic Hep B risk if you have HBV
Age at time of infection, inversely related to likelihood of developing chronic HBV Persists in 5% of immunocompetent adults and more immunocompromised pts
47
HBV testing
HBsAg - first serum marker for acute infection HBeAg present for life of patient
48
Chronic HBV
detectable HBV Ig in serum for 3 months
49
chronic HBV tx candidates
Decompensated, compensated cirrhosis High viral load and sustained ALT > 2x ULN Prior immunosuppressive therapy Prior to tx of HCV co-infection Hepatocellular carcinoma
50
tx of HBV
pegylated interferon SQ injection seroconversion still common in 30-40% of patients
51
Pts with HBV that gets serial ultrasounds to screen for HCC:
Asian men > 40 Asian women >50 Pts with HBV and cirrhosis African and North American Blacks Pts with family history of HCC
52
Hep D infection
Only causes infection in presence of HBsAg present
53
Hep D Prognosis:
Worse short-term prognosis if superinfection bc it is development of fulminant hepatitis Chronic HDV has 3x higher risk of hepatocellular CA than chronic Hep B alone
54
Hep C associated conditions
``` Glomerulonephritis autoimmune thyroiditis monoclonal gammopathies pulmonary fibrosis T2DM ```
55
Transmission of HCV
MC due to drug use Infected blood, contaminated medical equipment Transmitted via tattooing, sharing razors and acupuncture, common HIB co-infections
56
clinical course of Acute Hep C
mild or asymptomatic w/waxing and waning ALT levels 70-85% of acute HCV in immunocompetent pts will become chronic, higher rate in immunocompromised No immunity provided by antibodies
57
chronic hep C (how many people and definition)
70-85% of acute HCV in immunocompetent pts become chronic Detectable levels of HCV RNA in blood > 6 months after acute infection
58
who gets chronic HCV tx
All patients with chronic HCV who are able to adhere to treatment protocol should be offered tx
59
tx HCV goal
SVR: negative PCR test for HCV RNA 3 months after conclusion of therapy
60
hep E
- Waterborne hepatitis, rare in US | - High mortality rate in pregnant women, worsening of chronic liver disease
61
mechanisms drugs cause liver injury
Directly hepatotoxic Idiosyncratic reactions Non-inflammatory cholestatic reactions Inflammatory cholestatic reactions Acute or chronic hepatitis
62
how does estrogen cause liver damage?
non inflammatory cholestatic rxn neoplasm
63
how does augmentin cause liver damage?
Inflammatory cholestatic reactions
64
how do glucocorticoids cause liver damage?
fatty liver
65
how does methotrexate cause liver damage?
fibrosis and cirrhosis

GI2 (6 decks)

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