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46 Cards in this Set
- Front
- Back
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Hep A
-transmission -potential |
Fecal oral
Can be fulminant, never chronic |
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Hep A IgM means
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Acute disease
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Hep A IgG means
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Previous disease w/ recovery and immunity
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Risk of Chronic HBV infection is related to:
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age at acquisition - the younger you are the more likely you are to become chronic infected
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Hep B
-transmission -potential |
Sexual, blood
Can be fulminant, acute, chronic |
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What is meant by:
-Hep B surf Antigen + -Hep B surf Antibody + -Core antibody + |
HBsAg = CURRENT hep B
HBsAb = immune Core Ab = natural exposure, not a vaccine |
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2 types of core Ab:
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IgM - recent exposure
IgG - old exposure |
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How is Hepatitis C transmitted?
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parenteral - IVDA's, blood products
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How is Hep C active disease confirmed?
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With viral RNA
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How many Hep C infections clear spontaneously compared to Hep B?
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Hep C - minotiry
Hep B - majority |
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What are the 3 predominant groups that have the highest HCV prevalence?
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-Hemophilia
-Injecting drug abusers -Hemodialysis patients |
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What is the natural history of HCV infection after the acute phase s/p exposure?
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15% resolve
85% become chronic infected |
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What is the natural history of HCV infection for the 85% of chronic infected patients?
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20% develop cirrhosis within 10-15 years
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What happens to half of the patients with HCV cirrhosis 20 yrs into the disease?
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6% develop ESLD per year
4% develop HCC per year |
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Which of the enzymes is more liver-specific: AST or ALT?
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ALT
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What is the most helpful test for hepatocellular injury?
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Liver biopsy
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What enzyme indicates cholestatic injury?
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ALP
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In which type of liver disease do Vit K shots help the INR; hepatocellular or cholestatic?
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Only cholestatic; need bile in order to absorb the vit K
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If a patient had an ALT >500 what would you think?
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Hep A or B, autoimmune hepatitis, meds, or ischemia
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What disease rarely has ALT >200?
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Alcoholic hepatitis
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What is strongly suggestive of alcoholic liver disease?
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AST:ALT >2:1
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What test should you order to look for liver cancer?
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CT with contrast
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What blood test points to hepatocellular carcinoma?
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AFP >200
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Which hepatitis can progress directly into cancer?
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Hep B only
Alcoholic and Hep C first become cirrhosis, then cancer |
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What are 6 results of fulminant hepatic failure?
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JMRECC
jaundice, metabolic disturb., renal failure, encephalopathy, coagulopathy, cerebral edema |
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what is the leading cause of death in fulminant hepatic failure?
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cerebral edema
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What is the #1 cause of acute liver failure?
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acetaminophen
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Top four causes of FHF:
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1. acetaminophen
2. drugs 3. hep b 4. hep a |
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What is the best prognostic indicator in FHF?
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pH <7.3
or PT, creatinine, or encephalopathy grade 3 or 4 |
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What is the enzyme receptor for alcohol and acetaminophen?
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P450-2E1
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What happens when an alcoholic drinks a lot?
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P450-2E1 is induced
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What happens when an alcoholic takes acetaminophen?
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It binds the P450 2e1 and gets broken down into toxic metabolites instead of safe ones, causes FHF
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What % of the US population has fatty liver disease?
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20%
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What do 10% of patients with hepatosteatosis develop?
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Steatohepatitis (NASH)
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What do 35% of NASH patients develop?
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NASH with fibrosis
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What do 15% of NASH patients develop?
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cirrhosis
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What are 3 common causes of NASH?
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-Obesity
-Diabetes -Elevated triglycerides |
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Why does hepatic encephalopathy develop in patients with liver disease?
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Gut-derived neurotoxins fail to be pulled out of circulation by the liver and cross the BBB
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How is hepatic encephalopathy grade determined?
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Based on degree of MS changes
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What are 3 common precipitants of HE in liver patients?
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1. Dehydration
2. Meds/sedatives/tranqs 3. GI hemorrhage |
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What is MELD?
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Model for End-stage Liver Dis
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What are the 3 Child-Pugh classes of MELD?
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A - compensated 5-6
B - decompensated 7-9 C - decompensated >9 |
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What are the 5 criteria that determine Child-Pugh class?
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Albumin
Bilirubin INR Ascites Encephalopathy |
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What does the MELD score tell you?
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The probability of 5-yr survival in a patient with ELD
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What liver disease is commonly associated with vasculitis?
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hep B
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What liver disease is commonly associated with cryoglobulinemia and purpura?
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Hep C
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