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Gastroenterology > Specific Causes of Cirrhosis part 2 > Flashcards

Specific Causes of Cirrhosis part 2 Flashcards

1
Q

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

A

polyarteritis nodosa.

cancer development

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2
Q

what’s
hep B surface antigen.
for

A

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

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3
Q

what’s
Hepatitis B DNA
level by PCR
for

A

best way to determine viral replication activity

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4
Q

Hepatitis C test

A

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

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5
Q

what’s
biopsy for
in viral hepatitis?

A 
determines the degree
of inflammation and fibrosis.
can help you understand the
urgency for treatment if fibrosis is
present or worsening.
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6
Q

chronic hepatitis B Tx

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

LA TETIta
only ONE

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7
Q

Chronic Hepatitis C Tx

A

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

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8
Q

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

A

12 and 24 weeks after therapy.

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

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9
Q

HpC. What predicts the response to therapy?

A

Genotype.

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10
Q

hpC What tells if there has been a response?

A

PCR-RNA viral load.

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11
Q

hpC What tells the extent of liver damage?

A

Liver biopsy, but rarely needed.

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12
Q

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

A

Liver function tests (AST/ALT).

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13
Q

Adverse Effects of

Interferon

A

Arthralgias, thrombocytopenia, depression, leukopenia

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14
Q

Ribavirin se

A

Anemia

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15
Q

Adefovir se

A

Renal dysfunction

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16
Q

Lamivudine se

A

None

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17
Q

Wilson Disease Patho

A

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

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18
Q

Wilson Disease cx fx

A

cirrhosis +hepatic insufficiency,+

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

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19
Q

delirum vs psychosis

A

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

Delirium= liver failure
Psychosis= wilson disease
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20
Q

Wilson Disease best initial test

A

slit-lamp examination for Kayser- Fleischer rings

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21
Q

Wilson Disease lab

A

Ceruloplasmin is usually

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

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22
Q

Wilson Disease best diagnostic test

A

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

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23
Q

Wilson Disease most accurate diagnostic test

A

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

24
Q

Wilson Disease tx

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

Use the last in if Penicillin allergy

25
Q

Autoimmune Hepatitis typical presentation

A

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

26
Q

Autoimmune Hepatitis More specific tests

A

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

27
Q

Autoimmune Hepatitis THO the most accurate test is

A

liver biopsy

28
Q

Autoimmune Hepatitis tx

A

prednisone and or azathioprine.

29
Q

Nonalcoholic Fatty Liver Disease (NAFLD) kinds

A 
Nonalcoholic fatty liver (NAFL)
Nonalcoholic steatohepatitis (NASH)
30
Q

Nonalcoholic fatty liver (NAFL)

A

is relatively benign and is not associated

with fibrosis or malignant potential

31
Q 
Nonalcoholic steatohepatitis (NASH) is associated with \_\_\_\_\_ and \_\_\_\_\_ of the hepatic tissue, and the potential to progress to \_\_\_\_\_. 
NASH is potentially \_\_\_\_\_\_.
A

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

32
Q

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

A

mildly abnormal liver function tests

33
Q

Nonalcoholic Fatty Liver Disease (NAFLD) most accurate test

A

biopsy: hows the microvesicular fatty deposits

you would find in alcoholic liver disease, but without the history of alcohol use

34
Q

NAFLD associated with:

A

Obesity
Diabetes
Hyperlipidemia
Corticosteroid use

35
Q

NAFLD Management

A

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

36
Q

MELD score predicts

A

survival in cirrhosis and alcoholic hepatitis

37
Q

MELD score uses:

A

Age
Creatinine and the need for dialysis
Bilirubin and INR

38
Q

MELD score is critical in prioritizing who

A

gets a donor liver first.

39
Q

High MELD =

A

Death sooner

40
Q

Benign Liver Lesions are (3)

A

Focal nodular hyperplasia
Hemangiomas
hepatic adenoma

41
Q

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

A

hyperplastic hepatocellular

abnormal blood vessel.

42
Q

Focal nodular hyperplasia (FNH) Dx

A

imaging shows “central

stellate scarring”

43
Q

Focal nodular hyperplasia (FNH) tx

A

not needed

44
Q

Hemangiomas dx

A

Ultrasound, CT, and MRI

45
Q

Hemangiomas tx

A

Lesions <5 cm get no treatment

46
Q

which of the bening lesions can be malignant

A

only smal potential for Hepatic adenoma

47
Q

Hepatic adenoma Grows with ___. and during

____it may grow and even ___. Adenomas can cause ___.

A

estrogen

pregnancy

rupture

pain

48
Q

Hepatic adenoma dx

A

bipsy

49
Q

RNA Hep viruses

A

HepA

HepC.

50
Q

which kinds of hepatitis have vaccine?

A

hepA

hepB

51
Q

HepA IgM and IgG meaning

A

igM +=active infection

IgG +=inmune, cuz this hep is only acute

52
Q

DNA hep viruses

A

HepB

HepD

53
Q

HepE epidemiology

A

3rd world, pregnant woman with hepatitis

54
Q

HepC serology + rna. What results can u get from this?

Ab+ HCV RNA +.=?
Ab+/- ARN + =
Ab+ ARN - =

A

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

55
Q 
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=
A

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

Gastroenterology (23 decks)

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