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LIVER

Terms in this set (52)

A young patient presents with elevated liver enzymes and a chest x-ray that resembles emphysema, which is most likely?

A. Hereditary Hemochromatosis
B. Wilsons Disease
C. Autoimmune hepatitis
D. Alpha 1 Anti-trypsin deficiency
D. Alpha 1 anti-trypsin deficiency
A young patient comes in with elevated liver enzymes and has tremors, and some psych complaints. Iris is outlined with a grey-green ring.

A. Hereditary Hemochromatosis
B. Wilsons Disease
C. Autoimmune hepatitis
D. Alpha 1 Anti-trypsin deficiency
E. ANA
B. Wilsons Disease
You identify that the discolored ring around the eye is not normal, but what is it called?

A. Kaysler Fleisher
B. Grey-Turner
C. Cullen's
D. Courvoisier
A. Kaysler Fleisher
If you are suspecting Wilson's disease, what do you need to screen?

Will it be low or high?

A. TIBC
B. Ferritin
C. Ceruloplasmin
D. Alpha1-antitrypsin levels
E. ANA
C. Ceruloplasmin, low
Patient presents with bronze skin, cirrhosis and diabetes. Patient reports he is not much of a drinker.

A. Hereditary Hemochromatosis
B. Wilsons Disease
C. Autoimmune hepatitis
D. Alpha 1 Anti-trypsin deficiency
A. Hereditary hemochromatosis
Which occurs more in women?


A. Hereditary Hemochromatosis
B. Wilsons Disease
C. Autoimmune hepatitis
D. Alpha 1 Anti-trypsin deficiency
C. Autoimmune hepatitis
Which is likely to present with a concurrent autoimmune disorder?

A. Hereditary Hemochromatosis
B. Wilsons Disease
C. Autoimmune hepatitis
D. Alpha 1 Anti-trypsin deficiency
C. Autoimmune hepatitis
You are in-between autoimmune hepatitis and primary biliary cirrhosis bc they both affect women and they are both autoimmune. How do they differ?

hint, labs
Autoimmune hepatitis -- elevated liver enzymes (AST, ALT)

Primary biliary cirrhosis (inc. alk phos and direct bili)
As a general rule, you want to biopsy all liver disorders to identify and stage the liver damage. You also want to make sure you vaccinate them. Which ones? (2)

Hep A
Hep B
Hep C
Hep D
Hep E
Vaccines only avail for A and B
How would you distinguish NAFLD from alcoholic fatty liver dz?
Biopsy and history
Your patient has a AST/ALT ratio <1 with a history of diabetes, htn, dyslipidemia

Which condition are you suspecting?

A. NAFLD
B. AFLD
A. Non alcoholic fatty liver disease
What is NASH?
Non-alcoholic steatohepatitis

NAFLD can be fatty liver (hepatic steatosis) or fatty liver with inflam (steatohepatitis)
How to manage patients with NASH?
Weight loss/life-style can reverse fatty liver
What lab values do we associate with alcoholic liver disease?

AST/ALT ratio is ______
GGT is (up/down)
Hgb (up/down)
AST/ALT >1
GGT up
Hgb down
Say your patient has progressed alcoholic liver disease, how would you expect the lab values to present?

Albumin (up/down)
INR (up/down)
Platelets (up/down)
Bilirubin (up/down)
These are indicative of cirrhosis

Albumin down
INR up
Platelets down
Bili up
Which of these transmit fecal/oral?

Hep A
Hep B
Hep C
Hep D
Hep E
A and E
Which is fatal in pregnancy?

Hep A
Hep B
Hep C
Hep D
Hep E
E
If you test for Hepatitis B, you also need to test for?

Hep A
Hep B
Hep C
Hep D
Hep E
Hep D
Most common cause of chronic liver disease?

Hep A
Hep B
Hep C
Hep D
Hep E
Hep C
Which of these are acute?

Hep A
Hep B
Hep C
Hep D
Hep E
A and E
Would a person with Hep A present with jaundice, hepatomegaly and flu like symptoms?
Yes
Which of these will likely have elevated liver enzymes >1000?

Hep A
Hep B
Hep C
Hep D
Hep E
Hep A -- hep A is acute, will have acute injury
Patient presents with a positive IgM anti-Hep A, what does this indicate?
Acute infection
Patient presents with positive IgG anti Hep A, what does this indicate?
Immunity
How would you manage Hep A?
Supportive, but hospitalization for elderly and those with comorbidities
Leading cause of cirrhosis and hepatocellular carcinoma?

Hep A
Hep B
Hep C
Hep D
Hep E
Hep B
How will MOST patients with Hep B present?

Symptomatic or asymptomatic?
Asymptomatic, majority of pts will clear it
What is a positive HBsAg indicative of?
Active infection
What is a positive anti-HBs indicative of?
Recovery/immunity
What does a positive IgM anti HBc indicate?
Acute/recent infection
What does a positive IgG anti HBc indicate?
An ongoing infection, it persists indefinitely
What do we use the HBeAg and antibody tests for?
Index of infectivity, levels of DNA
If you need to be immune to Hep B for clinicals, which of these are we testing?

HBsAg
Anti-HBs
IgM anti-HBc
IgG anti-Hbc
HBeAg
Anti-HBs

we need this to be positive
If a patient is immune to Hep B due to a previous infection, their Anti-HBc IgG will be ______

Pos/neg?
Positive
If a patient is immune to Hep B due to a previous infection, their Anti-HBc IgG will be ______

Pos/neg?
Negative
Your patient has chronic hepatitis B, you've been treating this patient with anti-viral therapy, how would you know there is cessation of viral replication?
Loss of HBeAg and development of anti-HBe

slide 59
Your patient has a positive anti-HCV, we do not know if it indicates a previous exposure or if its an ongoing infection, how would you test for ongoing infection?
HCV RNA
What would a HCV RNA qualitative vs quantitative tell us?
Qual: presence of circulating virus

Quant: viral load
Your patient has chronic hepatitis C and has been taking Epclusa for the past 12 weeks. How would we know that the anti-viral has worked?

(what test are you ordering)
SVR - sustained viral response
Your patient with chronic hepatitis C just finished their anti-viral therapy. How soon do you want to test their SVR?
4 and 12 weeks
How will a patient with cirrhosis present?

LFT (up/down)
INR (up/down)
platelet count (up/down)
albumin (up/down)
hct (up/down)
LFT- up
INR- up
Platelet - down
Albumin - down
hct - down
Which is the most common complication of cirrhosis?

A. Splenomegaly
B. Esophageal varices
C. Ascites
D. Hepatic Encephalopathy
C. Ascites
Your patient has liver cirrhosis, has recurrent ascites and is now presenting with a fever and rebound tenderness.

What does the patient have?
Spontaneous bacterial peritonitis
How would you want to treat spontaneous bacterial peritonitis?
Paracentesis, broad spect abx
If a patient has cirrhosis and cannot effectively clear ammonia, how would this present?
Hepatic encephalopathy

ammonia is a neurotoxin
If ammonia is a neurotoxin, what symptoms are we expecting?
neuropsych symptoms, asterixisf
What is asterixis?
flappy hands
How would you treat hepatic encepholopathy?

A. Lactaid
B. Lactulose
B. Lactulose
Cancer marker associated with hepatocellular carcinoma?

A. Alpha-fetoprotein
B. Ca-19
C. Carcinoembryonic antigen
D. BRCA
A. alpha feto protein
While we're here...

Tumor marker assoc with colorectal?

A. Alpha-fetoprotein
B. Ca-19
C. Carcinoembryonic antigen
D. BRCA
C. CEA
Tumor marker assoc with pancreatic cancer?

A. Alpha-fetoprotein
B. Ca-19
C. Carcinoembryonic antigen
D. BRCA
B. Ca-19
How would you manage a patient with cirrhosis?
- NO Alcohol
- low Sodium
- Diuretics
- Paracentesis
- Esophageal varices screening
-Vaccines
-Transplant
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