LFTs
These two liver enzymes suggest hepatocellular dysfunction.
What are ALT and AST?
Name three markers used to assess HBV infections.
What are HBsAg, Anti-HBs, Anti-HBc, HBeAg, Anti-HBc IgM, Hep B viral DNA
According to the CDC, this demographic group should be screened for HCV.
Name one test that should be done if a patient is diagnosed with HCV.
HIV testing
Name two conditions cause an intraluminal obstruction of the CBD.
What are sclerosing cholangitis, stones, cholangiocarcinoma, helminths?
These two enzymes suggest a cholestatic liver injury.
What are ALP and bilirubin?
This treatment is suggested in mild cases of acute HBV.
What is supportive care?
This organization is a resource for HCV information in Canada.
What is CATIE.org!
They also provide information on HIV.
Name three risk factors for HBV.
Perinatal transmission, sexual activity, PWUIVD, working in healthcare, blood transfusion prior to 1970, household contacts, patients on hemodialysis, indigenous people (per CATIE).
This investigation is useful as an initial assessment of the liver.
What is an ultrasound?
This enzyme is necessary to rule out extrahepatic dysfunction (eg. bones).
What is GGT?
Evidence of a chronic infection is suggested by these HBV markers.
What are HbsAg and Anti-HBc IgG/total?
HCV testing is done this way in Saskatchewan.
•HCV antibody positive -> reflex HCV viral load à detectable HCV RNA = active infection OR no detectable HCV RNA = previously treated / spontaneously clearance
•HCV antibody negative -> no HCV infection
Chronic hepatitis is a risk factor for this type of cancer.
What is hepatocellular carcinoma (HCC)?
Name two symptoms that may suggest a dysfunction with the liver.
What are fatigue, loss of appetite, weight loss, RUQ pain, pruritus?
This test is frequently used to prognosticate in liver dysfunction.
What is INR?
In SK, the HBV vaccine is given at this age.
What is grade 6?
These two medications are used for treatment of HCV.
•Glecaprevir 300 mg / pibrentasvir 120 mg TID for 8 weeks (Maviret)
•Sofosbuvir 400 mg / velpatasvir 100 mg OD for 12 weeks (Epclusa)
IVDU, blood transfusion prior to 1992, incarceration/imprisonment, unhygienic tattoos or piercing, chronic hemodialysis, infant born to mother with HCV, needle stick injury, sexual contact, homelessness, high risk sexual activity, HIV infection
These physical signs are classically associated with advanced liver disease.
What are jaundice, palmar erythema, caput medusae, spider angiomas, thin skin, xanthomas, ascites, lower limb edema, hepatomegaly?
This condition causes a 2:1 rise in AST:ALT.
What is alcoholic liver disease?
Anti-HBs +/-
Anti-HBc IgG/Total +
This outcome is prevented with treatment of HCV.
Name two patient populations that should be referred for specialist treatment of HCV.
-Pregnancy
-Childhood
-HIV coinfection
-Post-liver or kidney transplant
-Renal impairment
-Decompensated cirrhosis
This is the approach to management if a pregnant patient tests positive for acute HBV.