Liver Dz

Question 1

Define Acute liver failure

Answer 1

1. Onset of liver injury
2. Hepatic encephalopathy
3. Coagulopathy (INR > 1.5)

*in patients with no prior h/o liver disease

Question 2

What is the MCC of Acute liver failure?

Answer 2

Acetaminophen OD

Question 3

What are the early stages of AMS (encephalopathy) in acute liver failure?

Answer 3

Personality change

Reversal of sleep pattern

Question 4

Other si/sx’s of acute liver failure?

Answer 4

1. Cerebral Edema
2. Coagulopathy
3. Multiple Organ Failure
4. Ascites and anasarca
5. Jaundice

Question 5

Lab findings in acute liver failure

Answer 5

1. Severe coagulopathy: increased PT/INR
2. CBC: leukocytosis
3. BMP: hyponatremia, hypokalemia, hypoglycemia
4. LFTs: marked elevation of bilirubin, ALT, AST

Question 6

Acute liver failure treatment

Answer 6

Hospitalization – transfer to a liver transplant center

Question 7

MCC of acute hepatitis?

Answer 7

Viral

Question 8

MCC of chronic hepatitis?

Answer 8

Viral

Question 9

Hepatitis A&E transmission

Answer 9

Fecal-oral

Do not cause chronic infection

Question 10

Hepatitis B, C, & D transmission

Answer 10

transmitted parenterally or via mucous membrane contact

can progress to chronic infection

Question 11

What is important history to obtain in Hep B, C, D?

Answer 11

1. IV drug use
2. tattoos
3. Infected mother
4. Blood transfusion

Question 12

Acute Viral Hepatitis prodromal sx’s

Answer 12

1. GI sxs: malaise, anorexia, N/V

2. Flu-like sxs: pharyngitis, cough, coryza, photophobia, headache, and myalgias

Question 13

What is abrupt onset of acute viral hepatitis is most c/w?

Answer 13

HAV & HEV

Question 14

What is insidious onset of acute viral hepatitis is most c/w?

Answer 14

HBV
HCV
HDV

Question 15

List the sx’s that develop after the prodromal sx’s in acute viral hepatitis?

Answer 15

Jaundice: Dark urine and pruritis

Question 16

Physical exam findings in acute viral hepatitis?

Answer 16

1 .Hepatomegaly

2. Liver tenderness
3. Splenomegaly
4. posterior cervical LAD: 15-20% of patients

Question 17

Define cholestatic hepatitis

Answer 17

Bile plugs in hepatocytes and bilirubin staining hepatocytes

MCly HAV

Question 18

cholestatic hepatitis si/sx’s

Answer 18

1. Severe jaundice for several months
2. Prominent pruritis
3. Persistent anorexia and diarrhea

Question 19

cholestatic hepatitis prognosis

Answer 19

Excellent

Question 20

Cholestatic hepatitis lab findings

Answer 20

1. Bilirubin ≥20 mg/dL
2. Elevation of alkaline phosphatase
3. Initial elevation of ALT/AST may decrease despite persistent cholestasis

Question 21

Cholestatic hepatitis treatment

Answer 21

Prednisone + Ursodeoxycholic Acid

Question 22

Pruritis treatment in cholestatic hepatitis

Answer 22

Cholestyramine

Question 23

Relapsing hepatitis si/sx’s

Answer 23

1. Sxs recur weeks – months after improvement/apparent recovery
2. Arthritis
3. Vasculitis
4. Cryoglobulinemia

Question 24

Relapsing hepatitis lab findings

Answer 24

1. Elevation of ALT, AST

2. Bilirubin recurs after normalization

Question 25

Relapsing hepatitis tx

Answer 25

1. Outpatient management unless severe dehydration requires hospitalization
2. Adequate caloric and fluid intake
3. Avoid EtOH