The ABCs of Hepatitis
The different modes of transmission for hepatitis C.
What are IV or intranasal drugs, blood transfusions before 1992, sexual contact with infected persons?
Common lab findings in alcoholic hepatitis.
What is an AST:ALT >2:1 with absolute values typically <300-500
Two scores commonly used to estimate cirrhosis prognosis and transplant candidacy.
What are MELDNa (or 3.0) and Child-Pugh
Second line therapy for patients with recurrent hepatic encephalopathy despite adherence to lactulose.
What is Rifaximin?
This is the most common cause of liver disease
NAFLD
Patients with hepatitis A exposure who should receive HAV vaccine and immune globulin.
Who are non-immune individuals older than 40?
The indications for steroid administration in alcoholic hepatitis.
What is alcoholic hepatitis with a Maddrey discriminant function score ≥32, MELD score >20, or hepatic encephalopathy.
The reason cirrhotic patients should avoid eating raw shellfish and wounds in brackish water.
What is Vibrio Vulnificus?
The most common grading criteria for hepatic encephalopathy.
What are the West Haven Criteria?
The method and frequency of HCC screening in patients with NAFLD & NASH.
What is ultrasound Q3 years or Q6 months if fibrosis/cirrhosis is present?
What are vasculitis, (essential mixed) cryoglobulinemia, lymphoma (NHL), membranoproliferative glomerulonephritis, prophyria cutanea tarda, diabetes mellitus, thyroiditis?
The treatment for acetaminophen overdose.
What is N-acetylcysteine and activated charcoal if within 4 hours of ingestion?
Conditions associated with decompensated cirrhosis (name 4)
What are hepatic encephalopathy, esophageal varices, ascites, SBP, hepatorenal syndrome, and gastric varices/portal hypertension?
These are the diagnostic criteria for SBP.
What are ascitic fluid absolute PMN ≥ 250 without an evident intra-abdominal surgically treatable source?
Indications for albumin administration with SBP treatment.
What are creatinine >1mg/dL, BUN >30 mg/dL, or tBili >4mg/dL?
This is the serologic profile of an individual with immune tolerant hepatitis B. (Provide HBeAg, HBeAb, ALT, and HBV DNA)
What is HBeAg+, HBeAb-, ALT wnl, and HBV DNA typically >1,000,000
Contraindications to steroids in alcoholic hepatitis (name 4).
What are active infection, GIB, CKD, pancreatitis, or multiorgan failure?
Health maintenance recommendations for an individual with cirrhosis.
What are immunizations (all routine non-live vaccines, hep A and B), DEXA scan, and screening for HCC (US± AFP q6 months)
Precipitants of hepatic encephalopathy.
What are infection, sedating medications, volume depletion, GIB, and lactulose noncompliance?
Patients with indications for SBP antibiotic prophylaxis.
Who are patients with cirrhosis and:
gastrointestinal bleeding, prior SBP, or ascitic fluid protein is <1.5 g/dL (15 g/L) along with either impaired renal function or liver failure?
Impaired renal function is defined as a creatinine ≥1.2 mg/dL (106 micromol/L), a blood urea nitrogen level ≥25 mg/dL (8.9 mmol/L), or a serum sodium ≤130 mEq/L (130 mmol/L]).
Liver failure is defined as a Child-Pugh score ≥9 and a bilirubin ≥3 mg/dL (51 micromol/L).
Indications to treat hepatitis B
What is:
1. Acute liver failure
2. Chronic immune active- elevated ALT, HBcAb+, and HBV DNA >2000 U/mL if HBeAg- or >20,000 if HBeAg+
3. Reactivation - rising HBV DNA level, seroconversion of HBsAg and HBcAb positive
The treatment of alcoholic hepatitis (be specific and give justification for the treatment of severe cases).
What is hydration, nutrition including vitamin supplementation (eg, thiamine, folate, and pyridoxine), and prednisolone/methylprednisolone.
Prednisone is not preferred because it requires hepatic metabolism to be activated.
Criteria for hepatorenal syndrome.
What are:
Type 1: Cr ≥ 0.3 mg/dl and/or ≥ 50% from baseline within 48 hours, bland UA, normal renal US, no other causes of AKI (especially volume depletion), low FENa and oliguria
Type 2: Gradual decline in kidney function associated w/ refractory ascites
These are the manifestations of hepatopulmonary syndrome?
What are pulmonary vasodilation leading to intrapulmonary right-to-left shunting with platypnea-orthodeoxia syndrome and hypoxemia?
The defining lab and clinical findings of HELLP (or Acute Fatty Liver of Pregnancy).
Give the lab findings, timing, 3 physical exam findings/symptoms, and 1 additional finding noted in AFLP
Hemolysis, elevated liver enzymes, low platelets,
Third trimester
Proteinuria, hypertension, RUQ pain, N/V, jaundice
Preeclampsia, microangiopathic hemolytic anemia