| 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!) |
