Non-viral Liver Disease

Question 1

Describe the 4 stages of NAFLD

Answer 1

I: fatty liver (steatosis)
II: fatty liver + inflammation (NASH)
III: NASH + septal fibrosis
IV: cirrhosis

Question 2

Treatment for NASH

Answer 2

Exercise, weight loss, Vit. E

Question 3

Bronze diabetics

Answer 3

Hemochromatosis

Question 4

Why does alcohol cause worse symptoms with Hemochromatosis?

Answer 4

EtOH increases iron absorption in the duodenum

Question 5

How is genetic serological screening performed to diagnose hemochromatosis?

Answer 5

Testing for HFE gene mutations: 282Y and H63D

Diagnosis confirmed with:
-two of the 282Y genes
or
-one 282Y and one H63D genes

Question 6

What iron saturation indicates hemochromatosis?

Answer 6

> 60% men

>50% women

Question 7

Treatment for Hemochromatosis.

Answer 7

Phlebotomy

desfuroximine for those who can’t tolerate phlebotomy

Question 8

Musculoskeletal symptom of hemochromatosis.

Answer 8

Calcium pyrophosphate accumulation in joints causing arthralgia

Question 9

What are the 3 types of Chronic autoimmune hepatitis?

Answer 9

1. ANA, anti-SMA, p-anc
2. Anti-ilver-kidney microsomal Abs
3. Soluble liver Ag w/ associated HCV

Question 10

Treatment for autoimmune hepatitis (3 drugs)

Answer 10

Prednisone

6-mercaptopurine or azothioprine

Question 11

Pathology of Alpha-1-Antitrypsin deficiency.

Answer 11

Lack of A1AT leads to an accumulation of A1AT protein which inhibits neutrophil elastase. Neutrophils use this to remove debris and pathogens and if it is inhibited, these materials accumulate in lungs and liver.

Question 12

How is A1AT def. diagnosed on biopsy?

Answer 12

Presence of: PAS(+) diastase-resistant globules

Question 13

Treatment for A1AT def.

Answer 13

Liver transplant

stop smoking if lungs are affected

Question 14

What is the main rule when dealing with liver disease in pregnancy?

Answer 14

Deliver the baby ASAP

Question 15

During pregnancy, what normal changes occur with the proteins:
albumin, TBG, anti-thrombin III, transferrin, haptoglobin, Ceruloplasmin, fibrinogen, and CSBG?

Answer 15

Increase: albumin, anti-thrombin III, haptoglobin

Decrease: ceruloplasmin, fibrinogen, TBG, CSBG, transferrin

Question 16

Why does alkaline phosphatase (ALP) rise during pregnancy?

Answer 16

The placenta generates this protein

also rises with bone growth in children and blockage in the liver

Question 17

Two findings on PE that are normal in pregnancy that would otherwise indicate liver disease.

Answer 17

1. Spider angioma

2. Palmar Erythema

Question 18

How should babies that present with HBV sAg(+) be treated?

Answer 18

Hep B immunoglobulin + HBV vaccine at birth

Question 19

Which 2 drugs are safest to give in pregnancy for Hep B infection?

Answer 19

Lamivudine: RT inhibitor
Tenofovir: serine protease inhibitor

(ribavirin and INF-a are Teratogenic)

Question 20

Cause and treatment of Intrahepatic Cholestasis of Pregnancy.

Answer 20

Cause: unknown but may be related to a reaction to increased estrogen levels in the body. (bilirubin may be 100x normal)

Treatment: best treatment is deliver, resolves the situation

Question 21

Common condition that arises from Acute fatty liver of pregnancy.

Answer 21

Disseminated Intravascular Coagulation (DIC)

-hypercoagulability

Question 22

Diagnosis and Treatment of Acute fatty liver of pregnancy.

Answer 22

Dx: Microvesicular fat in Zone 3 on biopsy
Tx: delivery

Question 23

What is HELLP syndrome?

Answer 23

Hemolysis, Elevated Liver enzymes, Low Platelets

Question 24

Treatment for HELLP syndrome.

Answer 24

Treat the hypertension, monitor the platelets, fetus, and transaminases
Deliver ASAP

Question 25

Presentation and treatment for Hepatic Hemorrhage and Rupture during pregnancy.

Answer 25

RUQ pain, chest pain, peritonitis. usually occurs with pre/Eclampsia

Treatment: hemodynamic support, laparotomy

Question 26

Treatment of hyperemesis gravidarum.

Answer 26

Treat the vomiting, water and electrolyte replacement.