Acute and Chronic Hepatitis... the sequel Flashcards Preview

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Flashcards in Acute and Chronic Hepatitis... the sequel Deck (25)
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1
Q

What’s one of the few things that can get liver enzymes over 10,000 (units)?

A

Acetominophen

2
Q

Review: What’s the liver enzyme ratio to remember for alcoholic hepatitis?

A

> 3:1 AST:ALT

he says 3:1, Krok said 2:1…

3
Q

What are the absolute levels of liver enzymes like in alcoholic hepatitis compared to other types of hepatitis?

A

They tend to be low, due to the nutritional deficiencies that go with alcoholism.

4
Q

Non-hepatic causes of AST and ALT elevation?

A

Celiac, hypothyroidism, muscle problems

5
Q

If you see elevated Alk Phos, you should think…

A

Cholestasis

6
Q

Places other than liver that Alk Phos can come from?

A

bone, placenta, kidney

7
Q

Which hepatitis viruses are spread enterically?

A

HAV and HEV

they’re non-enveloped

8
Q

Trivia?: What’s the only hepatitis virus that’s a DNA virus?

A

HBV

9
Q

What’s the post-exposure prophylaxis for HAV?

A

Immune globulin

Vaccination

10
Q

What can a positive anti-HBc alone mean? (no HBs-Ag, no anti-HBs-Ab, no anti-HBc IgM)

A

Past infection, but immunity has waned.
False positive.
Very rarely - chronic infection.

11
Q

What’s the significance of HBe-Ag?

A

It’s present when HBV is actively replicating - associated with high viral loads and contagiousness.
(can get a false negatives in some HBV strains with mutated pre-core Ag)

12
Q

If a patient has high HBe-Ag, but normal liver enzymes, what’s going on?

A

They’re immune tolerant - the virus is there replicating a lot, but the immune system isn’t napalming the liver.

13
Q

Review: What 3 drugs are the first-line therapy for chronic HBV?

A

Peginterferon alfa-2a
Tenofovir
Entecavir

14
Q

What’s a good endpoint for treatment of HBV?

A

Loss of HBe-Ag.

Cure (loss of HBs-Ag and gain of anti-HBs IgG) only happens 5% of time.

15
Q

What’s the leading cause of liver cancer in the US / world?

A

HCV

16
Q

Does HCV have a lot of extrahepatic manifestations?

A

Yep… including necrotizing vasculitis, cryoglobulinemia, others.

17
Q

Is HCV curable?

A

Yes, it seems so, and will be moreso soon.

18
Q

What’s the old treatment for HCV?

A

PEGylated interferon + ribavirin.

19
Q

How do you distinguish steatosis from steatohepatitis?

A

Biopsy

20
Q

Best treatment for NAFLD?

A

Weight loss.

forget pioglitazone

21
Q

Review: 2 drugs notorious for intrinsic drug-induced liver injury (DILI)?

A

Acetominophen

Methotrexate

22
Q

Are people with existing liver disease more likely to get idiosyncratic DILI?

A

No.

Take-home point: Don’t be afraid to use statins if people need them.

23
Q

What formula is used to evaluate biochemical patterns of DILI?

A

R value: Which is ( ALT / upper limit of normal) / (Alk Phos / upper limit of normal).
Different values suggest hepatocellular, cholestatic, or mixed patterns of injury.

24
Q

Review: What’s Hy’s law?

Not-review: What’s quantitative version of this?

A

Hepaptocellular injury + jaundice from DILI predict at least 10% mortality.
Quantitative: ALT > 3x upper limit of normal and Total Bili > 2x upper limit of normal leads to at least 10% risk of mortality.

25
Q

If you see AMA (fatigue, pruritis, and xanthomas), think…

A

PBC