Specific Causes of Cirrhosis part 2 Flashcards
Chronic Hepatitis B and C . are Asoc with this following diseases (2)
polyarteritis nodosa.
cancer development
what’s
hep B surface antigen.
for
Hep B has surface antigen positive for longer than 6 months as a matter of definition.
what’s
Hepatitis B DNA
level by PCR
for
best way to determine viral replication activity
Hepatitis C test
PCR RNA viral load is the most accurate way of determining disease activity
what’s
biopsy for
in viral hepatitis?
determines the degree of inflammation and fibrosis. can help you understand the urgency for treatment if fibrosis is present or worsening.
chronic hepatitis B Tx
any ONE of the following agents: Adefovir Lamivudine Telbivudine Entecavir Tenofovir (especially in pregnancy) Interferon
LA TETIta
only ONE
Chronic Hepatitis C Tx
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
Chronic Hepatitis C after Tx, when to do follow up?
12 and 24 weeks after therapy.
12 weeks, more than 95% of patients will achieve a cure
HpC. What predicts the response to therapy?
Genotype.
hpC What tells if there has been a response?
PCR-RNA viral load.
hpC What tells the extent of liver damage?
Liver biopsy, but rarely needed.
What is the most common wrong answer? (maybe among the prognostic factors)
Liver function tests (AST/ALT).
Adverse Effects of
Interferon
Arthralgias, thrombocytopenia, depression, leukopenia
Ribavirin se
Anemia
Adefovir se
Renal dysfunction
Lamivudine se
None
Wilson Disease Patho
decrease in ceruloplasmin > decreased copper excretion> builds up
in liver, kidney, red blood cells, and the nervous system
Wilson Disease cx fx
cirrhosis +hepatic insufficiency,+
***Neurological symptoms: psychosis, tremor, dysarthria, ataxia, or seizures, delusions!
**Coombs negative hemolytic anemia
Renal tubular acidosis or nephrolithiasis
delirum vs psychosis
delirium can have asterixis/tremor.
psychosis not
delirium delusions are transient + disorganized.
psychosis delusions are systematized.
Delirium= liver failure Psychosis= wilson disease
Wilson Disease best initial test
slit-lamp examination for Kayser- Fleischer rings
Wilson Disease lab
Ceruloplasmin is usually
low. THO IT’S THE MOST COMMON WRONG ANSWER. Cupper on serum is WRONG TOO
Wilson Disease best diagnostic test
Liver biopsy is more sensitive and specific and will detect abnormally
increased hepatic copper.
Wilson Disease most accurate diagnostic test
abnormally increased amount of copper excretion into the urine after giving penicillamine.
Wilson Disease tx
Penicillamine (chelate) Additional therapies are: Zinc (interferes with intestinal copper absorption) trientine: an alternate chelating .
Use the last in if Penicillin allergy
Autoimmune Hepatitis typical presentation
Look for young women with signs of liver inflammation with a positive ANA.
Autoimmune Hepatitis More specific tests
liver-kidney microsomal antibodies
high gamma globulin (IgG),
anti-smooth muscle antibodies,
and anti-liver/kidney microsomal antibodies.
Autoimmune Hepatitis THO the most accurate test is
liver biopsy
Autoimmune Hepatitis tx
prednisone and or azathioprine.
Nonalcoholic Fatty Liver Disease (NAFLD) kinds
Nonalcoholic fatty liver (NAFL) Nonalcoholic steatohepatitis (NASH)
Nonalcoholic fatty liver (NAFL)
is relatively benign and is not associated
with fibrosis or malignant potential
Nonalcoholic steatohepatitis (NASH) is associated with \_\_\_\_\_ and \_\_\_\_\_ of the hepatic tissue, and the potential to progress to \_\_\_\_\_. NASH is potentially \_\_\_\_\_\_.
is associated with inflammation and fibrosis and the potential to progress to cirrhosis.
NASH is potentially premalignant.
Nonalcoholic Fatty Liver Disease (NAFLD) is an extremely common cause of
mildly abnormal liver function tests
Nonalcoholic Fatty Liver Disease (NAFLD) most accurate test
biopsy: hows the microvesicular fatty deposits
you would find in alcoholic liver disease, but without the history of alcohol use
NAFLD associated with:
Obesity
Diabetes
Hyperlipidemia
Corticosteroid use
NAFLD Management
correcting the underlying causes previously described. There is no
specific drug therapy to reverse it.
MELD score predicts
survival in cirrhosis and alcoholic hepatitis
MELD score uses:
Age
Creatinine and the need for dialysis
Bilirubin and INR
MELD score is critical in prioritizing who
gets a donor liver first.
High MELD =
Death sooner
Benign Liver Lesions are (3)
Focal nodular hyperplasia
Hemangiomas
hepatic adenoma
Focal nodular hyperplasia (FNH) is caused by a ________ growth around an ______.
hyperplastic hepatocellular
abnormal blood vessel.
Focal nodular hyperplasia (FNH) Dx
imaging shows “central
stellate scarring”
Focal nodular hyperplasia (FNH) tx
not needed
Hemangiomas dx
Ultrasound, CT, and MRI
Hemangiomas tx
Lesions <5 cm get no treatment
which of the bening lesions can be malignant
only smal potential for Hepatic adenoma
Hepatic adenoma Grows with ___. and during
____it may grow and even ___. Adenomas can cause ___.
estrogen
pregnancy
rupture
pain
Hepatic adenoma dx
bipsy
RNA Hep viruses
HepA
HepC.
which kinds of hepatitis have vaccine?
hepA
hepB
HepA IgM and IgG meaning
igM +=active infection
IgG +=inmune, cuz this hep is only acute
DNA hep viruses
HepB
HepD
HepE epidemiology
3rd world, pregnant woman with hepatitis
HepC serology + rna. What results can u get from this?
Ab+ HCV RNA +.=?
Ab+/- ARN + =
Ab+ ARN - =
Ab+ HCV RNA +.
most cronic patients have this
Ab+/- ARN + = acute state
Ab- ARN + = treated
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=
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
