Viral Hepatitis
In patients with Hepatitis D, what is the difference between coinfection and superinfection?
Coinfection: A person is exposed to and infected with both Hepatitis B (HBV) and Hepatitis D (HDV) at the exact same time.
Superinfection: A person who is already chronically infected with Hepatitis B is subsequently infected with Hepatitis D at a later date.
autoimmune hepatitis primarily affects this population of people
women
In esophogeal varices, these two veins swell up with blood due to portal hypertension.
left gastric vein and azygous vein
A 52-year-old man with a history of heavy alcohol use for 25 years presents with jaundice, ascites, and spider angiomata. Labs show AST:ALT ratio >2:1, elevated GGT, and thrombocytopenia. Liver biopsy reveals bridging fibrosis with regenerative nodules.
Alcoholic cirrhosis
shifting dullness, pericentesis
(clinical sign)
ascites
This population of people, if infected with Hepatitis E, have a greater risk of developing fulminant hepatic failure, which is when someone develops rapidly progressing acute liver injury without previous hepatic disease.
pregnant women
This drug, which is commonly used to treat autoimmune hepatitis, works by acting as a purine analog to inhibit DNA and RNA synthesis
azathioprine
How often should the following procedure shown in this image be repeated in patients?
every 1-8 weeks
A 38-year-old woman presents with fatigue and pruritus. Labs reveal a markedly elevated alkaline phosphatase and positive anti-mitochondrial antibodies (AMA). Liver biopsy shows granulomatous destruction of interlobular bile ducts.
primary biliary cholangitis (PBC)
Lactulose, asterixis
(disorder)
hepatic encephalopathy
A patient diagnosed with hepatitis C was given ribavirin, a guanosine analogue that prevents the synthesis of guanine. Two weeks later, the same patients comes back in due to fatigue, pale skin, and scleral icterus. Lab work is shown in the image. You diagnose the patient with this condition, which also happens to be an adverse effect of ribavirin.
hemolytic anemia
Typical signs of autoimmune hepatitis on a liver biopsy include the accumulation of these types of cells located in this particular location in the liver.
plasma cells; portal tract
This procedure involves the placement of a stent that allows for the connection of these two arteries in the liver.
transjugular intrahepatic portosystemic shunt (TIPS)
right portal vein, right hepatic vein
A 14-year-old boy presents with tremor, dysarthria, and declining school performance. Slit-lamp examination reveals golden-brown corneal rings. Labs show low serum ceruloplasmin and elevated 24-hour urine copper.
Wilson's disease
testicular atrophy, gynecomastia
(why these symptoms are observed in cirrhosis patients)
What is the mechanism of action for PEG-IFN-α?
It works by binding to cell-surface type I interferon receptors, which triggers the JAK/STAT signaling pathway. This cascade activates the transcription of genes that inhibit viral replication, induce tumor cell death, and stimulate the adaptive immune response.
Azathioprine is contraindicated in patients with this medical condition. See image for one of the ways in which it typically presents in patients.
decompensated cirrhosis
What is the mechanism of action for octreotide?
A somatostatin analogue that inhibits growth hormone secretion and causes splanchnic vasoconstriction (via decreased secretion of vasodilatory peptides such as glucagon).
A 60-year-old man with a long history of hereditary hemochromatosis presents with new-onset weight loss and right upper quadrant pain. AFP is markedly elevated. CT reveals a large, hypervascular mass in the right hepatic lobe with arterial enhancement and portal venous washout, arising within a background of cirrhosis.
Hepatocellular carcinoma (HCC)
polycythemia vera, nutmeg liver, SAAG > 1.1
(disease)
Budd-Chiari Syndrome
While liver biospies are often not indicated for patients with viral hepatitis, this finding shown in this image may be used to rule out certain differential diagnoses.
(Focus on the things outlined in yellow)
councilman bodies
Autoimmune hepatitis is commonly associated with other autoimmune conditions. For example, Type I autoimmune hepatitis is commonly associated with Hashimoto's thyroiditis, rheumatoid arthritis, and this disease shown on the histology slide.
ulcerative colitis
A 58-year-old man with a history of alcohol-induced liver cirrhosis, ascites, and medium to large esophogeal varices wants to start prophylactic treatment to prevent an episode of variceal bleeding.
A month ago, the patient came in due to jaundice and progressive fatigue. Labs showed a serum creatinine of 2.3 mg/dL (up from 1.0 mg/dL), extremely low urine sodium levels, and normal sized kidneys on ultrasound. Which medication should you avoid in this patient?
non-selective beta blockers (carvedilol, propanolol, nadolol)
A 28-year-old woman on oral contraceptives presents with acute onset severe abdominal pain and hypotension. She has no history of liver disease. CT abdomen reveals a 7 cm well-circumscribed, heterogeneous mass in the right lobe of the liver with evidence of active intraperitoneal hemorrhage. Histology of the resected specimen shows sheets of benign hepatocytes with prominent arterial vasculature but no bile ducts or portal tracts.
Hepatic adenoma
ANA + ASMA
(disease)
type I autoimmune hepatitis