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Hepatitis _
CMI-Fall 2011
| Question | Answer |
|---|---|
| What defines acute hepatitis? | -Sx < 6mo -Self-repair, resolution of sx, no permanet damage |
| What defines chronic hepatis? | -Sx>6mo -Risk of progression to fibrosis and cirrhosis,which adds risk of liver CA |
| What is fulminant hepatitis? | -A severe, potentially fatal form of acute hep. -Signs of liver failure w/in 4-8wks of onset sx |
| Explain blood supply to and from liver: | -75% of blood supply to liver via hepatic portal vein, 25% via hepatic artery -Blood exits liver via hepatic vein |
| The liver breaks down toxic products, what is the pathway of breakdown for a certain toxic byproduct of muscle breakdown? | Ammonia>Urea>Elimination |
| What is the liver's role in drug conversion? | Fat-soluble to water-soluble |
| Which 2 important hormones that are synthesized from cholesterol are regulated by the liver? | Estrogens and Androgens (If liver dz>estrogen build-up>Gynecomastia in men) |
| What are some symptoms suggestive of acute hepatitis? | -"Flu-like" initially,fever,dark urine -RUQ pain, jaundice, pruritis? |
| Which liver enzymes should you test? | ALT,AST,Alk Phos,GGT |
| What is a NL aminotransferase value? | <40 |
| W/acute hepatitis, aminotransferase will be elevated to? | >1,000 |
| If aminotranferase >5,000..think? | -Acetaminophen -Ischemic -Unusual virus |
| If ALT>AST, what is the hepatitis from, usually? | Drugs, ischemia, viruses |
| If AST>ALT, what is the hep from, usually? | Alcohol |
| When do you see Hep D? | Only seen in HBV infected pts |
| Routes of transmission of HAV? | -Oral -Fecal-Oral -Person to person |
| HAV IgG + indicates? | Lifelong immunity (either from past infection or vaccination) |
| HBV route of transmission? | -Vertical (mom to kid), kid to kid -Sex, needles, transfusion -Shared toothbrush, razor, nailclippers w/ HBV+ person |
| If HebB core AB +? | Pt HAS been exposed to virus |
| If HepB surface ag +? | Infection (Acute or chronic-active or passive) |
| IgM anti-HBc? | Marker of recent infection |
| IgG anti-HBc? | Lifelong marker/past chronic infection -Does not indicate immunity and is not induced by vaccine |
| HBsAG present w/ IgM anti-HBc? | Acute infection (>6 mo=chronic) |
| HepBeAg? | Appears shortly before sxs |
| Neg HBcAb? | No exposure |
| Neg HBsAg? | No infection |
| Neg HBsAb? | No immunity |
| Pos HBcAg? | Exposed |
| Pos HBsAg? | Infection |
| Pos HBsAb? | Immunity |
| Interpret: Neg HBcAb, Neg HBsAg, Neg HBsAb? | Never exposed, never infected, not immune. *VACCINATE! |
| Interpret: +HBcAb, -HBsAg, +HBsAb? | Old infection |
| Interpret: Core ABNeg, HBsAg Neg, +HBsAb? | Not exposed, no infection, immune *Had a vaccination :) |
| +HBeAg? | HIGH INFECTIOUS STATE (replicating the virus) |
| Anti HCV negative? | No infection = educate pt |
| Anti HCV positive | Acute, Chronic, Previous; confirm results w/ RIBA |
| If qualitative RNA is + for HCV? | Marker of active infection |
| Quantitative RNA for HCV? | Viral load; numerical answer |
| Genotype of HCV? | Type 1-6; Type 1 = 70% of US infex -Type 1 = least responsive to RX tx |
| 1/2 of the liver transplants in US are d/t? | Chronic HBV or HCV |
| What is chronic HBV the CHIEF cause of? | Hepatocellular CA, Cirrhosis |
| Stage 4 of fibrosis in chronic hepatitis means? | Cirrhosis |
| What are some steps to take to prevent Viral Hep B? | -VACCINATE!! -HBIG (Hep B immunoglobulin) for exposed individuals -Testing for surface ag in all pregnant women (to determine if risk to baby) |
| HAV is inactivated and w/o preservatives, who can it be given to? and where is it given? | >/=12 mo -Rec for children @ age 1, age 2-18 living in communities w/ high dz prev -Men who have sex w/men -Chronic liver dz -IM deltoid |
| When is Hep B vaccine usually administered? | -0,1,6 mo's |
| Who is HBvacc rec for? | -All US <19 y.o. -Health care workers w/ possibility of blood exposure -Unvacc ppl w/MSM, IVDU, STD, multiple sexual partners |
| What kind of "special" vaccine has been approved for travelers? | -Accelerated combo HAV/HBV vaccine at days 0,7,21 -Booster @ 1 yr |
| What are some of the main causative agents in drug-induced liver injury? | -Abx -CNS drugs -MSK drugs -GI drugs |
| What is the MC cause of fulminant hepatic failure? | Acetaminophen poisoning (>10g; alcohol and malnut enhance risk) |
| Autoimmune hepatitis is overwhelmingly more common in? | Females (70-80% of cases) |
| Lab results in autoimmune hep? | -^AST, ALT, bilirubin -NORMAL Alk Phos and GGT -IgG>2x ULN (not seen in pts w/high alcohol/drug hx) |
| Tx for autoimmune hep? | Prednisone (systemic steroids) |
| What is hereditary hemochromatosis? | -Inherited d/o of iron metab -Gene HFE -MC single gene inherited d/o in US *IRON OVERLOAD = LIVER INFLAMM |
| What is the earliest and most sensitive test for hereditary hemochromatosis? | Transferrin saturation |
| What is the form that iron is stored in, in the body? | Serum ferritin |
| Gold std for dxing HH? | Bx: hepatic iron index |
| What dz involves copper overload? | Wilson's dz |
| Clinical features of wilson's dz? | -Dz of the young 12-23 y.o. (rare after 40) -copper deposition (Kaysar-Fleischer rings) **CONSIDER IN ANY YOUNG PERSON W/LIVER DZ** |
| What is the inherited d/o that can cause lung and liver damage? | a-1 antitrypsin defic (damages lung tissue and defective proteins accum in liver) |
| DX of a-1 antitrypsin defic? | Genotype testing: MM=NL ZZ=assoc w/cirrhosis MZ=assoc w/lung or liver dz |
| What is the MC metabolic indication for liver transplant with excellent outcomes? | a-l antitrypsin deficiency (bc diff't genotype, so can get rid of dz!) |
Created by:
ferrier.kath
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