Term
| what is considered chronic hepatitis? |
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Definition
| hepatitis lasting for 6 mos |
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Term
| can HMG-CoA reductase inhibitor cause hepatitis? |
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Definition
| yes, which is usually associated with myalgia - esp in the thigh muscles |
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Term
| how can pts with autoimmune chronic hepatitis present? |
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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. |
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Term
| how might pts with alcoholic liver disease present? |
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Definition
| similar to rx use, fatty degeneration in cells, periportal inflammation, *no bridging necrosis/piecemeal necrosis, increases in severity. |
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Term
| what are symptoms which might have you consider viral hepatitis? |
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Definition
| *nausea, fatigue, malaise, RUQ pain |
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Term
| what drug can cause melanosis coli? |
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Definition
| oxyphenisatin - a laxative |
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Term
| why do you need to be careful medicating people over 50 exposed to TB? |
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Definition
| b/c isoniazid can cause a rise in LFTs |
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Term
| what kind of hepatitis can halothane cause? |
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Definition
|
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Term
| what kind of cirrhosis does alcohol cause? |
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Definition
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Term
| do you need to bx a cirrhotic liver? |
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Definition
|
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Term
| what is on the ddx for chronic hepatitis? |
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Definition
| alcohol, biliary, IBD, UC, crohns, primary biliary cirrhosis, wilson's disease, and drug toxicity |
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Term
| what things can cause chronic hepatitis? |
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Definition
| chronic abuse of alcohol, viral infection, autoimmunity, medications/drugs, cryptogenic, biliary cirrhosis, and iron |
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Term
| what is chronic persistent hepatitis? how should pts with this be treated? |
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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. |
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Term
| what can the histologic pattern of a liver bx tell you? |
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Definition
| whether the condition is likely to worsen |
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Term
| in the case of hepatitis, particularly in women, what determines whether acute necrosis is going to occur? |
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Definition
| the immunologic response, as opposed to the viral titer |
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Term
| what characterizes the symptoms associated with chronic liver disease? |
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Definition
| nothing severe enough to send the pt to the hospital: myalgias, arthralgias, nausea, low grade fever, anorexia, weakness, acne, polyarthragia, amenorrhea, etc |
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Term
| what is the criteria for chronic hepatitis tx? |
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Definition
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Term
| what does a liver bx tell you? |
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Definition
| the degree of inflammation |
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Term
| if a chronic hepatitis pt is on steroid, but they continue to have flare-ups, what is the next step in tx? |
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Definition
| an immune suppressant/modulator such as azathioprine |
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Term
| what are the side effects of chronic steroid use? |
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Definition
| acne, buffalo hump, DM, HTN, RAS dysfunction, etc |
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Term
| what is indicative of successful chronic hepatitis tx? |
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Definition
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Term
| what is the correlation between how a pt feels/LFTs and histologic resolution as successful tx progresses? |
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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). |
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Term
| what is the normal time period for chronic hepatitis relapse? |
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Definition
| w/in ~ 6 mos - pts will again present with nausea, malaise, fatigue, diarrhea and LFTs will start to rise |
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|
Term
| what are considerations for pts w/active chronic hepatitis? |
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Definition
| abstinence from: alcohol, oral contraception, tranquilizers, becoming pregnant |
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Term
| before discontinuing therapy, what needs to be checked on a pt w/chronic hepatitis? |
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Definition
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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 |
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Term
| what is the leading cause of cirrhosis in the US? |
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Definition
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Term
| once a pt has hep C and cirrhosis, how does their risk for hepatocellular CA increase? |
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Definition
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|
Term
| what are the risk factors for hep C? |
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Definition
| IVDA, multiple sex partners, other drug use, prison, low socioecomonic bracket, tattoos, household contacts, hair transplants, occupational |
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Term
| what is the presentation of hep C pts? |
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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. |
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|
Term
| who should be serologically tested for viral hepatitis? |
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Definition
| pts w/risk factors: less education, low socioeconomic bracket, ER/dialysis staff, and pts w/abnormal liver enzymes. |
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Term
| what is the only way of determining liver damage due to viral hepatitis? |
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Definition
|
|
Term
| what tests do you run on a confirmed hep C pt? |
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Definition
| anti-HCV, HCV RNA test (good to get quantitative at first to determine efficacy of tx), bx, and LFTs |
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|
Term
| do hep A and B also give sometimes normal ALTs like hep C can? |
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Definition
|
|
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 |
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Term
| what is the sensitivity of the ELISA-2 for hep C? |
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Definition
|
|
Term
| when does detection of the HCV Ab following infection usually occur? |
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Definition
|
|
Term
| how quickly does PCR-HCV-RNA show up following infection? |
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Definition
|
|
Term
| when is a ELISA-2 for hep C usually diagnostic? |
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Definition
| in pts with elevated LFTs and risk factor presence |
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|
Term
| what can lead to false hep C ELISA-2 positives? |
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Definition
| autoimmune hepatitis, hypergammaglobulemia, sjogren's, lupus, IBD, hashimotos, other autoimmune diseases |
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Term
| what can lead to false hep C ELISA-2 negatives? |
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Definition
| immunosuppressed pts - those on chemo/organ transplant and chronic dialysis pts |
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|
Term
| when antibody tests are inconclusive, what is best as a confirmation? |
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Definition
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|
Term
| if a pt has elevated LFTs and risk factors for hep C, what is used to determine if they are infected? |
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Definition
|
|
Term
| if a pt has normal ALT levels, but has a positive anti-HCV result, what can be used to r/o infection? |
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Definition
| RIBA (recumbent immunoblot assay) |
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|
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 |
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Term
| what is NIH-recommended IFN therapy for chronic hep C? |
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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. |
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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. |
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Term
| what are ADRs associated with IFN? |
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Definition
| cardiovascular and pulmonary disease, coagulation disorders, severe myleosuppression, DM w/predisposition for ketoacidosis, flu-like symptoms, GI symptoms, alopecia, and somnolence/depression |
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Term
| what is the benefit of binding IFN to PEG with riboviron? what is the caveat? |
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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. |
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|
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) |
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|
Term
| what are the extrahepatic manifestations of HCV infection? |
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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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