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chronic and acute hepatitis clinical
GI
51
Medical
Graduate
09/17/2010

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Cards

Term
what is considered chronic hepatitis?
Definition
hepatitis lasting for 6 mos
Term
can HMG-CoA reductase inhibitor cause hepatitis?
Definition
yes, which is usually associated with myalgia - esp in the thigh muscles
Term
how can pts with autoimmune chronic hepatitis present?
Definition
often: middle aged women in 30-40s developing myalgias/RUQ discomfort. hypergammaglobulinemia, cellular inflammation on liver bx, rising LFTs, positive LE cell tests (a kind of autoimmune serologic reaction), +/- jaundice. pts may have other diseases with an autoimmune basis, for ex: UC, sjogren's, celiac, crohn's, and autoimmune thyroiditis.
Term
how might pts with alcoholic liver disease present?
Definition
similar to rx use, fatty degeneration in cells, periportal inflammation, *no bridging necrosis/piecemeal necrosis, increases in severity.
Term
what are symptoms which might have you consider viral hepatitis?
Definition
*nausea, fatigue, malaise, RUQ pain
Term
what drug can cause melanosis coli?
Definition
oxyphenisatin - a laxative
Term
why do you need to be careful medicating people over 50 exposed to TB?
Definition
b/c isoniazid can cause a rise in LFTs
Term
what kind of hepatitis can halothane cause?
Definition
hypersensitivity
Term
what kind of cirrhosis does alcohol cause?
Definition
*micronodular*
Term
do you need to bx a cirrhotic liver?
Definition
not really
Term
what is on the ddx for chronic hepatitis?
Definition
alcohol, biliary, IBD, UC, crohns, primary biliary cirrhosis, wilson's disease, and drug toxicity
Term
what things can cause chronic hepatitis?
Definition
chronic abuse of alcohol, viral infection, autoimmunity, medications/drugs, cryptogenic, biliary cirrhosis, and iron
Term
what is chronic persistent hepatitis? how should pts with this be treated?
Definition
a histologic pattern of periportal inflammation, enzymes mildly elevated, w/pt not on meds/alcohol. pts with this usually follow a benign course and cirrhosis does not occur. pts may be put on steroids for this to prevent progression to a more severe form of hepatitis.
Term
what can the histologic pattern of a liver bx tell you?
Definition
whether the condition is likely to worsen
Term
in the case of hepatitis, particularly in women, what determines whether acute necrosis is going to occur?
Definition
the immunologic response, as opposed to the viral titer
Term
what characterizes the symptoms associated with chronic liver disease?
Definition
nothing severe enough to send the pt to the hospital: myalgias, arthralgias, nausea, low grade fever, anorexia, weakness, acne, polyarthragia, amenorrhea, etc
Term
what is the criteria for chronic hepatitis tx?
Definition
elevated LFTs
Term
what does a liver bx tell you?
Definition
the degree of inflammation
Term
if a chronic hepatitis pt is on steroid, but they continue to have flare-ups, what is the next step in tx?
Definition
an immune suppressant/modulator such as azathioprine
Term
what are the side effects of chronic steroid use?
Definition
acne, buffalo hump, DM, HTN, RAS dysfunction, etc
Term
what is indicative of successful chronic hepatitis tx?
Definition
LFTs drop
Term
what is the correlation between how a pt feels/LFTs and histologic resolution as successful tx progresses?
Definition
a pt will feel better and LFTs will rise faster before there is histologic resolution - have to warn pts that they need to continue coming back in (up to 2 yrs).
Term
what is the normal time period for chronic hepatitis relapse?
Definition
w/in ~ 6 mos - pts will again present with nausea, malaise, fatigue, diarrhea and LFTs will start to rise
Term
what are considerations for pts w/active chronic hepatitis?
Definition
abstinence from: alcohol, oral contraception, tranquilizers, becoming pregnant
Term
before discontinuing therapy, what needs to be checked on a pt w/chronic hepatitis?
Definition
check enzymes, bx
Term
what needs to be discussed with the pt if their hepatitis is the result of a contagious infection?
Definition
education on eliminating spread of disease
Term
what is the leading cause of cirrhosis in the US?
Definition
hep C
Term
once a pt has hep C and cirrhosis, how does their risk for hepatocellular CA increase?
Definition
3% every year
Term
what are the risk factors for hep C?
Definition
IVDA, multiple sex partners, other drug use, prison, low socioecomonic bracket, tattoos, household contacts, hair transplants, occupational
Term
what is the presentation of hep C pts?
Definition
hep C pts can be clinically asymptomatic w/normal LFTs - so just b/c liver enzymes are low does not mean they don’t have HCV.
Term
who should be serologically tested for viral hepatitis?
Definition
pts w/risk factors: less education, low socioeconomic bracket, ER/dialysis staff, and pts w/abnormal liver enzymes.
Term
what is the only way of determining liver damage due to viral hepatitis?
Definition
bx
Term
what tests do you run on a confirmed hep C pt?
Definition
anti-HCV, HCV RNA test (good to get quantitative at first to determine efficacy of tx), bx, and LFTs
Term
do hep A and B also give sometimes normal ALTs like hep C can?
Definition
no
Term
what are the symptoms of chronic hepatitis?
Definition
fatigue, pruritis, abdominal pain, dark urine, and nausea - can also have have diarrhea, cough, myalgias, arthralgias, anemias, pneumonitis
Term
what is the sensitivity of the ELISA-2 for hep C?
Definition
92-95%
Term
when does detection of the HCV Ab following infection usually occur?
Definition
~12 wks
Term
how quickly does PCR-HCV-RNA show up following infection?
Definition
w/in a week
Term
when is a ELISA-2 for hep C usually diagnostic?
Definition
in pts with elevated LFTs and risk factor presence
Term
what can lead to false hep C ELISA-2 positives?
Definition
autoimmune hepatitis, hypergammaglobulemia, sjogren's, lupus, IBD, hashimotos, other autoimmune diseases
Term
what can lead to false hep C ELISA-2 negatives?
Definition
immunosuppressed pts - those on chemo/organ transplant and chronic dialysis pts
Term
when antibody tests are inconclusive, what is best as a confirmation?
Definition
PCR-HCV-RNA
Term
if a pt has elevated LFTs and risk factors for hep C, what is used to determine if they are infected?
Definition
ELISA-2
Term
if a pt has normal ALT levels, but has a positive anti-HCV result, what can be used to r/o infection?
Definition
RIBA (recumbent immunoblot assay)
Term
what characterizes tx of hep C w/IFN 2a/2b?
Definition
pt needs to be older than 18 and liver bx/serologic testing needs to be done to confirm disease
Term
what is NIH-recommended IFN therapy for chronic hep C?
Definition
IFN-a 3 MIU 3x/week then measure viral load at 3 months. if HCV RNA is positive you have a nonresponder, if negative continue tx for at least a year. check again 6 mos after end of tx to r/o relapse.
Term
what are contraindications for IFN?
Definition
decompensated liver disesae, IFN hypersensitivity, active alcohol/drug use, cytopenia, autoimmune disorders, and relative contraindications: severe heart disease/renal failure/severe COPD/age >65/normal ALTs/normal liver bx.
Term
what are ADRs associated with IFN?
Definition
cardiovascular and pulmonary disease, coagulation disorders, severe myleosuppression, DM w/predisposition for ketoacidosis, flu-like symptoms, GI symptoms, alopecia, and somnolence/depression
Term
what is the benefit of binding IFN to PEG with riboviron? what is the caveat?
Definition
this decreases kidney secretion, allowing the drug to stay in the vascular tree for longer. the caveat is that if Hb drops, you have to discontinue or reduce dosage. this drug tends to work better w/middle eastern pts.
Term
what are characteristics of hep C pts who are likely to respond to IFN therapy?
Definition
histologically mild, low pretx viral load, short duration of disease, relatively young age, and genotype other than 1 (which is the genotype found mainly in the US)
Term
what are the extrahepatic manifestations of HCV infection?
Definition
cutaneous leukocytoclastic vasculitis (HCV, antibodies, antigens, and complement all bind together and precipitate out in the capillaries), kidneys may be affected, arthralgias, pulm fibrosis, mononeuritis, peripheral neuropathies, sjogren's syndrome, and HCV in intestines/other tissues
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