Specific Causes of Cirrhosis part 2

Question 1

Chronic Hepatitis B and C . are Asoc with this following diseases (2)

Answer 1

polyarteritis nodosa.

cancer development

Question 2

what’s
hep B surface antigen.
for

Answer 2

Hep B has surface antigen positive for longer than 6 months as a matter of definition.

Question 3

what’s
Hepatitis B DNA
level by PCR
for

Answer 3

best way to determine viral replication activity

Question 4

Hepatitis C test

Answer 4

PCR RNA viral load is the most accurate way of determining disease activity

Question 5

what’s
biopsy for
in viral hepatitis?

Answer 5

determines the degree
of inflammation and fibrosis.
can help you understand the
urgency for treatment if fibrosis is
present or worsening.

Question 6

chronic hepatitis B Tx

Answer 6

any ONE of the following agents:
Adefovir
Lamivudine
Telbivudine
Entecavir
Tenofovir (especially in pregnancy)
Interferon

LA TETIta
only ONE

Question 7

Chronic Hepatitis C Tx

Answer 7

Sofosbuvir-velpatasvir (for all genotypes) Epclusa
Sofosbuvir-ledipasvir (for genotype 1)
Sofosbuvir-daclatasvir
Elbasvir-grazoprevir
Ombitasvir-paritaprevir-dasabuvir-ritonavir
MavyretTM (GLE/PIB)

“protease inhibitors”
“direct acting antagonist”

but. …. Only acute hepatitis C is treated. wtf
amboss: both acute and chronic are treated

Question 8

Chronic Hepatitis C after Tx, when to do follow up?

Answer 8

12 and 24 weeks after therapy.

12 weeks, more than 95% of patients will achieve a cure

Question 9

HpC. What predicts the response to therapy?

Answer 9

Genotype.

Question 10

hpC What tells if there has been a response?

Answer 10

PCR-RNA viral load.

Question 11

hpC What tells the extent of liver damage?

Answer 11

Liver biopsy, but rarely needed.

Question 12

What is the most common wrong answer? (maybe among the prognostic factors)

Answer 12

Liver function tests (AST/ALT).

Question 13

Adverse Effects of

Interferon

Answer 13

Arthralgias, thrombocytopenia, depression, leukopenia

Question 14

Ribavirin se

Answer 14

Anemia

Question 15

Adefovir se

Answer 15

Renal dysfunction

Question 16

Lamivudine se

Answer 16

None

Question 17

Wilson Disease Patho

Answer 17

decrease in ceruloplasmin > decreased copper excretion> builds up
in liver, kidney, red blood cells, and the nervous system

Question 18

Wilson Disease cx fx

Answer 18

cirrhosis +hepatic insufficiency,+

***Neurological symptoms: psychosis, tremor, dysarthria, ataxia, or seizures, delusions!
**Coombs negative hemolytic anemia
Renal tubular acidosis or nephrolithiasis

Question 19

delirum vs psychosis

Answer 19

delirium can have asterixis/tremor.
psychosis not
delirium delusions are transient + disorganized.
psychosis delusions are systematized.

Delirium= liver failure
Psychosis= wilson disease

Question 20

Wilson Disease best initial test

Answer 20

slit-lamp examination for Kayser- Fleischer rings

Question 21

Wilson Disease lab

Answer 21

Ceruloplasmin is usually

low. THO IT’S THE MOST COMMON WRONG ANSWER. Cupper on serum is WRONG TOO

Question 22

Wilson Disease best diagnostic test

Answer 22

Liver biopsy is more sensitive and specific and will detect abnormally
increased hepatic copper.

Question 23

Wilson Disease most accurate diagnostic test

Answer 23

abnormally increased amount of copper excretion into the urine after giving penicillamine.

Question 24

Wilson Disease tx

Answer 24

Penicillamine (chelate)
Additional
therapies are:
Zinc (interferes with intestinal copper absorption)
trientine: an alternate chelating .

Use the last in if Penicillin allergy

Question 25

Autoimmune Hepatitis typical presentation

Answer 25

Look for young women with signs of liver inflammation with a positive ANA.

Question 26

Autoimmune Hepatitis More specific tests

Answer 26

liver-kidney microsomal antibodies high gamma globulin (IgG), anti-smooth muscle antibodies, and anti-liver/kidney microsomal antibodies.

Question 27

Autoimmune Hepatitis THO the most accurate test is

Answer 27

liver biopsy

Question 28

Autoimmune Hepatitis tx

Answer 28

prednisone and or azathioprine.

Question 29

Nonalcoholic Fatty Liver Disease (NAFLD) kinds

Answer 29

``` Nonalcoholic fatty liver (NAFL) Nonalcoholic steatohepatitis (NASH) ```

Question 30

Nonalcoholic fatty liver (NAFL)

Answer 30

is relatively benign and is not associated | with fibrosis or malignant potential

Question 31

``` Nonalcoholic steatohepatitis (NASH) is associated with _____ and _____ of the hepatic tissue, and the potential to progress to _____. NASH is potentially ______. ```

Answer 31

is associated with inflammation and fibrosis and the potential to progress to cirrhosis. NASH is potentially premalignant.

Question 32

Nonalcoholic Fatty Liver Disease (NAFLD) is an extremely common cause of

Answer 32

mildly abnormal liver function tests

Question 33

Nonalcoholic Fatty Liver Disease (NAFLD) most accurate test

Answer 33

biopsy: hows the microvesicular fatty deposits | you would find in alcoholic liver disease, but without the history of alcohol use

Question 34

NAFLD associated with:

Answer 34

Obesity Diabetes Hyperlipidemia Corticosteroid use

Question 35

NAFLD Management

Answer 35

correcting the underlying causes previously described. There is no specific drug therapy to reverse it.

Question 36

MELD score predicts

Answer 36

survival in cirrhosis and alcoholic hepatitis

Question 37

MELD score uses:

Answer 37

Age Creatinine and the need for dialysis Bilirubin and INR

Question 38

MELD score is critical in prioritizing who

Answer 38

gets a donor liver first.

Question 39

High MELD =

Answer 39

Death sooner

Question 40

Benign Liver Lesions are (3)

Answer 40

Focal nodular hyperplasia Hemangiomas hepatic adenoma

Question 41

Focal nodular hyperplasia (FNH) is caused by a ________ growth around an ______.

Answer 41

hyperplastic hepatocellular abnormal blood vessel.

Question 42

Focal nodular hyperplasia (FNH) Dx

Answer 42

imaging shows “central | stellate scarring”

Question 43

Focal nodular hyperplasia (FNH) tx

Answer 43

not needed

Question 44

Hemangiomas dx

Answer 44

Ultrasound, CT, and MRI

Question 45

Hemangiomas tx

Answer 45

Lesions <5 cm get no treatment

Question 46

which of the bening lesions can be malignant

Answer 46

only smal potential for Hepatic adenoma

Question 47

Hepatic adenoma Grows with ___. and during | ____it may grow and even ___. Adenomas can cause ___.

Answer 47

estrogen pregnancy rupture pain

Question 48

Hepatic adenoma dx

Answer 48

bipsy

Question 49

RNA Hep viruses

Answer 49

HepA | HepC.

Question 50

which kinds of hepatitis have vaccine?

Answer 50

hepA | hepB

Question 51

HepA IgM and IgG meaning

Answer 51

igM +=active infection | IgG +=inmune, cuz this hep is only acute

Question 52

DNA hep viruses

Answer 52

HepB | HepD

Question 53

HepE epidemiology

Answer 53

3rd world, pregnant woman with hepatitis

Question 54

HepC serology + rna. What results can u get from this? Ab+ HCV RNA +.=? Ab+/- ARN + = Ab+ ARN - =

Answer 54

Ab+ HCV RNA +. most cronic patients have this Ab+/- ARN + = acute state Ab- ARN + = treated

Question 55

``` HepB serology what indicates all of these? SurfaceAg= Antigen of infectivity= Antibody IgM to the surface antigen= AB IgG to the surface antigen= AB to the core= ```

Answer 55

SurfaceAg= currently on blood= infected Antigen of infectivity= you are infectious Antibody IgM to the surface antigen= early infection AB IgG to the surface antigen= immunity AB to the core= immunity adquired by exposure