Hepatitis

Question 1

Chronic hepatitis characterized by circulating autoantibodies (not thought to be part of the pathophysiology) & high levels of serum globulin concentrations

Answer 1

autoimmune hepatitis

Question 2

Treatment for autoimmune hepatitis

Answer 2

corticosteroids. azathioprine 2nd line

Question 3

Genetic disease due to autosomal recessive gene HFE. Most common single gene disorder

Answer 3

hemachromatosis

Question 4

Increased iron load leads to eventual cirrhosis, cardiomyopathy, DM, and hypogonadism

Answer 4

hemochromatosis

Question 5

When do symptoms of hemochromatosis usually present?

Answer 5

age 40 or when iron stores reach 15-40g

Question 6

Classic presentation of hemochromatosis

Answer 6

cutaneous hyperpigmentation w/ diabetes & cirrhosis

Question 7

Gold standard for confirmation of hemochromatosis in addition to elevated serum transferrin saturation and elevated serum ferritin

Answer 7

liver biopsy

Question 8

The mainstay of treatment for hemochromatosis is phlebotomy. What lifestyle modifications should a patient also make?

Answer 8

avoid red meat, Fe vitamins, ETOH, and the handling/eating of raw seafood. Get Hep A&B vaccines

Question 9

Autosomal recessive disease that affects copper metabolism. Organ damage due to copper build up in the liver and brain

Answer 9

Wilson’s disease

Question 10

Generally presents between 1st-3rd decades with liver disease, neurologic and psych symptoms

Answer 10

Wilson’s Disease

Question 11

Pathognomic for Wilson’s disease

Answer 11

kayser-fleischer rings in the eyes

Question 12

Treatment for Wilson’s disease

Answer 12

chelation therapy w/ D-penicillamine

Question 13

Can occur within hours of a large alcohol binge & if continues to drink can progress. May have tender hepatomegaly. Transaminases mildly elevated. Can also occur in obese individuals and pregnancy

Answer 13

fatty liver

Question 14

Physical exam may reveal spider angiomas, palmar erythema, gynecomastia, parotid enlargement, testicular atrophy, ascites, encephalopathy

Answer 14

fatty liver

Question 15

Distinguishing feature of transaminases associated with fatty liver disease that is rarely seen in other forms of liver disease

Answer 15

AST: ALT ratio usually greater than 2:0

Question 16

Histology finding associated with fatty liver disease

Answer 16

Mallory bodies

Question 17

Treatment of fatty liver disease

Answer 17

alcohol cessation, glucocorticosteroids for severe cases, possible liver transplant

Question 18

Most common cause of liver failure in the US

Answer 18

drug induced liver injury (DILI)

Question 19

Common group of drugs that induce asymptomatic elevations in liver enzymes without causing disease

Answer 19

statins

Question 20

Most common drugs implicated in DILI in US

Answer 20

acetaminophen and antibiotics

Question 21

Treatment for acetaminophen overdose

Answer 21

Activated charcoal if ingested within 2-3 hours. N-acetylcysteine for severe overdose

Question 22

T/F All patients with liver tenderness and jaundice secondary to acetaminophen should received N-acetylcysteine

Answer 22

true

Question 23

General signs of viral hepatitis on exam

Answer 23

jaundice, RUQ pain, hepatomegaly

Question 24

Viral hepatitis where there is no chronic infection and no documentation of maternal-fetal transmission

Answer 24

hepatitis A

Question 25

Fecal-oral route predominates. Close personal contact (e.g. household contact, sex contact, day care centers). Contaminated food/water
Blood exposure

Answer 25

hepatitis A

Question 26

Serology results with positive IgM antiHAV, what does patient have?

Answer 26

acute hepatitis A

Question 27

Major mode of transmission of Hep B in developed and underdeveloped countries

Answer 27

developed ususally sexual and underdeveloped usually perinatal transmission

Question 28

Postexposure prophylaxis for hep B

Answer 28

first dose of vaccine. Administer HBIG at same time—different site than vaccine

Question 29

Extrahepatic manifestations due to circulating immune complexes include: fever, rash, arthralgias/arthritis, polyarteritis nodosa, glomerular dz

Answer 29

hepatitis B

Question 30

In hepatitis B, appears prior to onset of sx and if resolves becomes undetectable in 4-6 months. Persistance past 6 months indicates chronic infection

Answer 30

Hepatitis B surface antigen (HbsAg)

Question 31

Intracellular antigen in affected hepatocytes. What does the rresence of Anti-HBc of IgM class indicates?

Answer 31

acute HBV infection

Question 32

What does the presence of anti-HBs only indicate?

Answer 32

immunity to HBV by vaccination

Question 33

Secretory protein. Marker of HBV replication and infectivity. occurs early in patients w/ acute infection

Answer 33

Hepatitis B e antigen (HbeAg)

Question 34

Agent of choice for chronic HBV infection (ie those with HBeAg, high serum HBV DNA levels, and active liver disease/elevated LFTs)

Answer 34

Interferon or peginterferon

Question 35

What is the cause for the majority of liver transplants in the US usually caused by IV drug use or sex with IV drug user?

Answer 35

hepatitis C

Question 36

Most common complaint of hepatitis C

Answer 36

fatigue

Question 37

What do you use to assess response to treatment in chronic HCV infection?

Answer 37

sustained HCV RNA negativity

Question 38

Do liver transplants help HCV patients?

Answer 38

NO. a non-infected liver transplanted into an HCV infected patient becomes infected and decreases survival

Question 39

Required for hepatitis D replication

Answer 39

hepatitis B

Question 40

RNA virus. Enterically transmitted, waterborne virus. U.S. cases usually have travel history to endemic area. NO chronic form

Answer 40

hepatitis E