Rubin's 20: Liver & Biliary

Question 1

Is Hep A ever chronic?

Answer 1

No

Question 2

Hep A virus phylogeny:

Answer 2

SS RNA nonenveloped

Question 3

Incubation period Heb A:

Answer 3

3-4 wks Prodrome is low grade temp, nausea, anorexia, fatigue, mylagia, malaise

Question 4

LFTs in Hep A

Answer 4

ALT>AST before jaundice (then 500-600s) ALT is more liver specific

Question 5

Steroids have what role in Hep A tx?

Answer 5

None

Question 6

Virus type Heb B

Answer 6

DS DNA enveloped

Question 7

Most common transmission Heb B

Answer 7

Perinatal (vagina) NOT placenta

Question 8

Heb B serum markers:

Answer 8

Hep B surface ag Hep Be ag - responsible for virus replication Core - Hep Bc-ag and back Once HepB ag, immune

Question 9

How do you tell if someone has had Hep B in the past?

Answer 9

Hep B CORE antiody - not part of vaccine series

Question 10

Labs Hep B:

Answer 10

ALT>AST, in the thousands; Bili high

Question 11

Chronic Hep B is a major risk factor for hepatocellular carcinoma in what cultural group?

Answer 11

Asians

Question 12

Tx Chronic Hep B?

Answer 12

Antivirals ie epivir, tenofovir, adefovir, entecovir 1 per day for a year

Question 13

Protect babies from Hep B vertical infection by:

Answer 13

immune globulin administration within 12 hours of being born

Question 14

Tea-colored urine suggests?

Answer 14

Icteric phase Hep B infection

Question 15

85% of patients with Hep C become…

Answer 15

chronic

Question 16

Hep C is Sexual?

Answer 16

Not really, Hep B is sexually transmitted Hep C is blood (tattoos, IV drug use)

Question 17

T/F: Most acute infections of Hep C go unnoticed.

Answer 17

True, 80% subclinical

Question 18

Incubation Hep C:

Answer 18

60 days

Question 19

Must test what to dx Hep C?

Answer 19

Hep C Ab; can’t tell from AST/ALT because it’s normal

Question 20

Old tx Hep C?

Answer 20

Peg INF and ribavarin

Question 21

New tx Hep c?

Answer 21

Sofosbuvir (genotype 1 and 2 - 12 weeks); simeprevir

Question 22

Hep C what kind of virus?

Answer 22

RNA virus enveloped 6 main genotypes

Question 23

Hep D what kind of virus?

Answer 23

ss RNA (defective RNA virus) expresses core antigen named HDAg (delta antigen) co-infection OR superinfection with Hep B

Question 24

Labs Hep D?

Answer 24

HD-Ag HD-sAg

Question 25

Transmission Hep E?

Answer 25

Fecal-oral

Question 26

25% chance of WHAT in pregnant women with acute Hep E?

Answer 26

Death

Question 27

Hep E - what kind of virus?

Answer 27

nonenveloped ssRNA

Question 28

High lipase is most specific for:

Answer 28

Pancreatitis (moreso than amylase)

Question 29

Metronidazole causes what rxn with alcohol?

Answer 29

Disulfiram-like rxn

Question 30

Dx: High serum bilirubin, unconjugated; Mild jaundice Symptoms resolve with corticosteroids

Answer 30

Autoimmune hemolytic anemia Antibody-mediated erythrocyte destruction. Intravascular hemolysis leads to increased serum levels of unconjugated bilirubin which exceed the capacity of hepatocytes to conjugate it.

Question 31

Why do some newborns develop jaundice?

Answer 31

Liver is still developing, cannot conjugate bilirubin fast enough

Question 32

Dx: Necrotizing arteritis of medium-sized vessels that lead to pseudoaneurysm formation, renal thrombosis, inflammation and hemorrhage; A possible complication of chronic HBV infection due to circulating immune complexes

Answer 32

Polyarteritis nodosa

Question 33

Primary biliary cirrhosis features what positive antibody test?

Answer 33

Anti-mitochondrial antibody

Question 34

Infection with the liver fluke Clonorchis sinensis predisposes to what kind of cancer?

Answer 34

Cholangiocarcinoma