Foundations III > Liver > Flashcards

Liver Flashcards

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1
Q

Most common cause of acute liver failure

A

Acetaminophen overdose

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2
Q

Acute liver failure signs and symptoms

A
  • Ascites
  • Coagulopathy
    -Jaundice
  • ## Encephalopathy/altered mental status (1-4 weeks after jaundice)
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3
Q

Acute liver failure labs

A
  • ALT and AST, bilirubin elevated
  • INR elevated
  • Leukocytosis (high WBCs)
  • Hyponatremia, hypokalemia, hypoglycemia
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4
Q

Acute liver failure: TX

A

hospitalize, may need transplant

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5
Q

Hepatitis: acute and chronic

A

Viral is most common cause of both

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6
Q

Which hepatitis viruses are transmitted fecal oral

A

A and E

  • self limited
  • abrupt onset
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7
Q

How are hepatitis B, C, D transmitted?

A
  • IV drug use
  • tattoos
  • infected mother
  • blood transfusion
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8
Q

Which hepatitis virus most commonly causes cholestatic hepatitis?

A

hepatitis A

  • prominent jaundice and itching
  • elevation in bilirubin, ALK phos
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9
Q

Which hepatitis virus is the most common cause of relapsing hepatitis?

A

hepatitis A

  • symptoms recur in weeks/months
  • may see arthritis, vasculitis, excess protein in the blood
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10
Q

Acute viral hepatitis: physical exam

A
  • mild hepatomegaly with tenderness
  • mild splenomegaly
  • posterior cervical lymphadenopathy
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11
Q

Acute Viral hepatitis (self-limited disease and relapsing hepatitis) treatment

A

outpatient (unless super dehydrated)

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12
Q

Cholestatic hepatitis: tx

A
  1. Prednisone
  2. Ursodeoxycholic acid
  3. Cholestyramine (for itching, binds to cholesterol)
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13
Q

Hep A: signs/sx

A
  • fever (uncommon in other viral hepatitis)**

- icteric phase: jaundice peaks at 2 weeks

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14
Q

How long does IgM antibody to HAV stay elevated?

A

3-6 months

IgM is test of choice***

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15
Q

How long does IgG anti-HAV stay elevated?

A

lifelong

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16
Q

Which hepatitis viruses have vaccines?

A

Hep A

Hep B

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17
Q

When should the Hep A vaccine be given?

A
  • at 1 year old
  • MSM
  • IV drug user
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18
Q

Post exposure Hep A prophylaxis?

A

Vaccine for 1 -40 years

Immunoglobulin for <1 yr, >40 yr, or immunocompromised

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19
Q

In whom is hepatitis E often more severe and fulminant?

A

pregnant lady

acute liver failure esp if in 3rd trimester

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20
Q

Hepatitis E

A
  • longer incubation than Hep A**

- Spread by swine/undercooked meat

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21
Q

Hepatitis E: labs

A
  • IgM first
  • IgG second
  • HEV RNA test confirms and quantifies HEV presence*** (stool or serum)
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22
Q

Hepatitis E: prevention

A
  • no vaccine

- no immunoglobulin

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23
Q

Viral differences

A

Hep A and E: non-enveloped, not affected by bile/detergents

Hep B, C, D: enveloped, disrupted by bile/detergents

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24
Q

Hep B: general

A
  • DNA virus
  • transmission via percutaneous and permucosal routes
  • sexually transmitted
  • May result in chronically infected state–>esp infants, kids
  • Adults more likely to get asymptomatic/self-limited disease
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25
What does HBeAg tell you?
marker of active infection
26
What does antibody to HBsAg tell you?
immunity to the surface antigen
27
If the patient has anti-HBs and anti-HBc what does that tell you?
Prior HBV infection
28
What labs would indicate chronic Hepatitis B infection?
HBsAg for >6 months
29
If patient has Hep B infection, is young, non-cirrhotic, low HBV DNA level what is the treatment?
Peginterferon alfa-2a (SQ injections for 48 weeks) -greater chance of seroconversion Nucleoside analogues (ex. entecavir, tenofovir) - inhibit HBV replication, don't eradicate HBV - Oral medication
30
Hep B: passive immunization (ex. newborns of HBsAg moms)
1. Immunoglobulin (HBIG) - give postexposure prophylaxis to casual sexual partners 2. HBV vaccine series - 2 shots, 6 months apart
31
Who should be screened for Hepatitis C?
- high risk | - Born between 1945-1965 [BABY BOOMERS]
32
Most common Hepatitis C genotype in US?
genotype 1 note: genotype 3 is hardest to treat
33
Hepatitis C: etiology/risk factors
- transmitted MC between IV drug users** - Blood transfusion before 1992 - HIV (less likely to clear virus)
34
Hepatitis C: clinical presentation
- usually asymptomatic - young women more likely to clear the virus (blacks less likely to clear) - majority will develop chronic infection
35
Which lab is needed to diagnose acute Hep C infection?
HCV RNA test*** -if present >6 months =chronic infection
36
Hep B vs. Hep C in kids
Hep B - kids more likely to become chronic Hep C - kids more likely to resolve spontaneously
37
In a patient with chronic Hep C, how do you tell if there is active infection?
+ screening test by EIA (antibodies against the virus)
38
If your patient has hepatitis C, what other things are important to do?
- screen for HIV | - vaccinate for Hep B, and Hep A
39
What determines the treatment regimen for hep C?
genotype
40
What are the new Hep C drugs?
Direct-acting antivirals -NS3-4 protease inhibitors (ex. Simeprevir) -NS5B polymerase inhibitors (ex. Sofosbuvir)
41
What is the main offender for drug-induced liver injury?
- antibioticss (esp. Augmentin, Sulfonamides)*** - Acetaminophen - Antituberulous Agents (Isoniazid and Rifampin)
42
What does Maddrey's discrimination function help you determine?
mortality during current hospitalization for alcoholic hepatitis Tx: methylprednisolone and pentoxifylline help
43
Non alcoholic fatty liver disease, and nonalcoholic steatohepatitis: general
- asymptomatic, maybe RUQ pain - elevated ALT - <4 alcoholic drinks a day
44
Autoimmune hepatitis: general
-young to middle aged women -high serum gamma-globulin level +ANA +smooth muscle antibody
45
Autoimmune hepatitis: Tx
Tx: Prednisone 30mg (taper over month) +/- azathioprine
46
Autoimmune hepatitis: prognosis/follow up
hepatologist every 3-6 months due to high relapse rate
47
Wilson disease
- impaired biliary copper excretion - Autosomal recessive - decreased serum ceruloplasmin - Kayser-Fleicher rings
48
Wilson disease: tx
D-penicillamine
49
Which organs are affected by Alpha-1 antitrypsin deficiency
Lung and Liver
50
Primary Sclerosing Cholangitis
-Men 20-40 -Ulcerative colitis -cholangiocarcinoma + P-ANCA -Elevated: Alk Phos, Bilirubin
51
Primary Biliary Cirrhosis
-middle aged women -fatigue and pruritis** -xanthelasma/xanthoma +Anti-mitochondrial antibody****
52
Primary Biliary Cirrhosis: Tx
1. Urodeoxycholic acid* | 2. Cholestyramine (bile acid resin)
53
Primary Sclerosing Cholangitis: Dx
ERCP with stenting -Ursodiol (reduces secretion of cholesterol) Definitive -->most will need transplant
54
ESLD hepatic encephalopathy
- hepatocellular dysfunction leads to increased serum ammonia levels - Neuropsychiatric abnormalities (grade1: short attention span, grade2: personality change, grade3: confusion disorientation, grade4: coma
55
ESLD: Tx for high ammonia in the blood
Lactulose and/or Rifaximin`
56
What happens to albumin in end-stage liver disease?
decreases - more difficulty maintaining osmotic pressure of blood - less carrying ability for small hydrophobic molecules
57
End Stage Liver disease: Sodium
- Chronically low - fluid overload - Indirect marker of portal hypertension - hyponatremia - risk of cerebral edema and neurologic changes
58
Model of End-Stage Liver Disease (MELD)
determines transplant eligibility >15 MELD score is where 3 month survival starts dropping = consider for transplant
59
What are strong predictors of 3 month mortality
1. Total Bilirubin 2. INR 3. Cr 4. Na+
60
Hepatocellular Carcinoma (HCC)
MC risk factor = cirrhosis Image every 6 months = alternating CT/MRI Serum cancer marker = Alpha feto-protein
61
Cholangiocarcinoma: etiology
- cancer from bile duct epithelium - Klatskin tumor --> if near bifurcation of the ducts - MOST are adenocarcinomas -Males, between ages 50-70
62
Cholangiocarcinoma: history and exam
- Painless jaundice - pruritus - fever, jaundice, RUQ pain (Charcots) - palpable gallbladder - hepatomegaly - dark urine - pale stools
63
Contraindications for liver transplant
- active EtOH or drug abusee - HCC outside the liver - Metastatic bile duct cancer - Non-hepatic malignancy - Severe cardiopulmonary disease - Comorbidities (BMI>35) - Psych/social issues
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