Liver Disease Word Scramble
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Question | Answer |
Viral hep that can cause cirrhosis | Hep B & C |
Conjugated bili: | direct; bound to gluc acid; water soluble; caused by obstruction of outflow tract or in the liver |
Unconjugated bili: | indirect; water insoluble; caused by hemolysis |
Fulminant acute liver dz: | progress to liver fail in 14 days; no h/o liver dz; develop coagulopathy (INR >2), encephalopathy |
ALT/AST | hepatocell injury: correlates w/degree of cell death; >1000: hepatitis, shock, toxins (Tylenol) |
Abnormal AST/ALT | AST:ALT >2:1 = alcoholic hep; <500: EtOH; poss normal in cirrhosis |
Alk phos | liver, bone, intestinal tract, placenta, kidney; elevated in liver damage/obstruction; if elevated more than AST/ALT, more likely biliary disorder |
Child-Pugh score assesses: | prognosis of chronic liver dz |
Alfa fetoprotein (AFP) is used to detect: | hepatocellular ca; inflammation |
Liver dz lab w/u | Hep A, B, C; ANA; ASMA; IgG; Anti-mito Ab (primary biliary cirrhosis) |
Labs for hemochromatosis | ferritin, iron sat, HFE gene |
Hep A clinical features | Incubation 4-6 wks (average 30d); 80% jaundice pts >14 yo; fulminant course uncommon; no chronic/carrier state |
Hep B clinical features | Incubation 6 wks- 6 mos (average 60-90d); 60% fulminant dz; 15-25% premature mortality; cirrhosis (3-5%); HCC; Asians |
Hep C clinical features | Incubation 6-7 weeks; 40% jaundice; 50-70% chronic; persistent; AA men in 40s; No. 1 indication for liver transplant |
Hep C dx labs | ELISA (pos in 8-10 wks; good screen for chronic); HCV RNA; HCV genotype |
Alcoholic hepatitis | 40-60 g EtOH/day (less for women); jaundice, fever, anorexia, nausea; TBil, alb, INR; histo makes the dx; hepatomegaly, steatohepatitis; Tx supportive (severe: prednisone/pentoxifylline) |
Cirrhosis: dx | pathologic; Fibrosis, Regenerated nodules, Vascular distortion |
Cirrhosis: complications | Hepatorenal syndrome; hepatoma (hepatocellular ca); Portal HTN (pressure > 12mmHg; varices, ascites, encephalopathy, GI bleeding) |
Varices Tx | Active bleed (Hematemesis, melena, hematochezia; Hypotension, tachy): Emergent endoscopy; Octreotide (splanchnic VC to reduce portal pressure; dec collateral flow & variceal pressure); Minnesota tube: Last chance (bridge to TIPS) |
Varices prevention | screening endoscopy; endo banding (if large varices & prior bleed); beta blockers to HR<60; nitrates |
Ascites | 60% develop within 10 yrs of cirrhosis dx; US (check for fluid & portal v. thrombosis) |
Serum ascites albumin gradient | paracentesis; if gradient >1.1: portal HTN |
Spont bac peritonitis | peritoneal cell count: >500 PMN confirms dx |
Ascites mgmt | Na & fluid restriction; diuretic tx (Aldactone/Lasix); LVP & albumin replacement; TIPS for refractory ascites |
Encephalopathy tx | r/o infxn, correct lytes; lactulose; neomycin; rifaximin |
Cirrhosis & Hepatoma (HCC) | screen (US & AFP 6-12 mos); common/increasing worldwide ca; tx Partial hepatectomy, Chemoembolization, RF ablation; poss TP |
Liver TP indications | Hep C (No. 1 in US); EtOH (abstinent >6 mos); Cryptogenic/NASH; PBC, PSC; Autoimmune hep; Hep B; risk of relapse in new liver |
NASH | chronic hep or metab syn; usu Asx; liver bx; hepatocytes replaced; tx: stop offending meds; wt/glycemic ctrl |
Benign masses: dx | imaging > bx; 20% of popn |
Most common benign liver tumor | hemangioma; W>M, 20-40 (2nd most common: FNH) |
Hepatic adenoma | W>M, young, LT estrogen use; anabolic steroids |
HCC/malignant mass | usu in setting of chronic liver injury or cirrhosis; need multi-phasic imaging to dx (arterial phase hypervascularity; delayed phase wash-out) |
Hep A mgmt | IVIG within 14d post exposure |
Hepatitis virus types (RNA / DNA): | HAV: RNA virus; HAV: double-stranded DNA; HCV: single-stranded RNA; HDV: defective RNA virus (requiring assistance by HBV) |
Hepatitis: modes of transmission | HAV: fecal-oral route; HBV: blood or body fluids (sex, transfusion, IVDU / needles); HCV: blood or body fluids (50% IVDU); HEV: fecal-oral route |
Defn Chronic HBV: | Positive HBSAg >6 months |
Hep E clinical features | Incubation 35-40 days; 0.5% mortality (20% in PG); no carrier state |
Viral hepatitis causing spiking fevers: | HAV |
Acute Hep C mgmt | Acute HCV may benefit from interferon alpha or peginterferon (reduces risk of chronic hep) |
How many patients with acute HCV clear the virus spontaneously? | 20% |
Chronic Hep C mgmt | slow-release peginterferon; daily ribavirin in divided doses; protease inhibitors (boceprivir or teleprivir) |
Chronic Hep B mgmt | interferon alpha or peginterferon; possibly entecavir or tenofovir (short-term: lamivudine & telbivudine) |
Use of immune globulin: | Give to all household persons / close contacts of patient with HAV. Give HBIG within 7 days of exposure to HBV |
Cirrhosis etiology | EtOH (leading cause in US); viral hep; chronic biliary obstruction, metabolic disorders; CHF |
Cirrhosis workup | Labs: CBC (low WBC, anemia, low Plt), elevated PT/PTT & LFTs; US (HSM, liver nodules/atrophy); endoscopy (varices); CT & bx (dx HCC) |
Most common primary for liver mets | Colon (no. 1), GI tract (adenocarcinoma), breast, lung. Primary liver cancer is uncommon. |
Risk factors for liver cancer | Aflatoxins (in food with Aspergillus flavus). Cirrhosis. Parasitosis (liver fluke: Clonorchis sinensis). Alpha-antitrypsin deficiency |
Types of liver cancer (4) | HCC (nodules with prominent vascularity). Cholangiocarcinoma (adenocarcinoma from bile ducts). Hepatoblastoma (HCC fetal variant w/familial adenomatous polyposis). Metastatic |
Portal HTN etiologies | Cirrhosis (EtOH, hepatitis, hemochromatosis). Budd-Chiari (phlebitis). Extrinsic compression (trauma, inflammation, tumor). Schistosomiasis |
In varices, collateral circulation develops thru: | coronary vein (stomach/esophagus), superior hemorrhoidal veins, anterior abd wall veins , plexus of Retzius |
Portal HTN tx | Vasopressin with nitrates, octreotide, propranolol |
Portal HTN surgical mgmt | Paracentesis and peritoneovenous conduits (for ascites). Portal decompression: TIPS, portosystemic shunt, splenectomy, GE devascularization (Sugiura). Liver transplant |
Elevated AST, ALT, indirect bilirubin = | Hepatitis |
Isolated elevated indirect bilirubin = | Gilbert syndrome |
Elevated indirect bilirubin w/defective glucuronyl transferase | Crigler-Najjar |
Photosensitivity, abd pain w/ neurologic dysfunction, erythema or skin fragility | Porphyria |
Spontaneous bacterial peritonitis (SBP) = | infected ascites |
Hep B transmission | Sex; bloodborne (1 in 63K risk); perinatal (c-section does not lower risk): vax+HBIG |
histological pattern of advanced fibrosis in liver = | cirrhosis |
Most common cause of abnormal liver tests | fatty liver dz |
Hep A incubation | average 30d |
Hep B incubation | average 60-90d |
Hep C incubation | average 6-7 wk |
Hep A clinical sxs | 80% jaundice pts >14 yo; fulminant or cholestatic hep |
Hep B clinical stuff | 15-25% premature mortality; cirrhosis/hepatocell ca; Asians |
Hep C clinical stuff | 40% jaundice; 70% chronic; persistent; AA men in 40s; No. 1 indication for liver transplant |
Most common benign liver tumor | hemangioma; W>M, 20-40 (2nd most common: FNH: focal nodular hyperplasia) |
No. 1 indication for liver transplant | Hep C |
Hep B: more likely to become chronic if: | young at age of infxn (or immunocompromised); 95% of pts clear the virus & develop Abs; chronic Hep B increases risk of cirrhosis & HCC |
Created by:
Abarnard
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