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Hepatitis _

CMI-Fall 2011

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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