Notes in 04 Hepatitis and Chronic Liver Disease

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Published	02/29/2024	In addition to its use as an osmotic laxative, {{c2::lactulose}} may be used in the treatment of {{c1::hepatic encephalopathy}}
Published	02/29/2024	{{c1::Rifaximin}} is a poorly absorbed antibiotic that eradicates ammonia producing intestinal bacteria and thus treats {{c2::hepatic encephalopathy}}
Published	02/29/2024	What is the traditional standard treatment for hepatitis C?{{c1::Once weekly pegylated-interferon alpha with daily oral ribavirin::specific}}
Published	02/29/2024	{{c2::Simeprevir}} is a NS3/4A {{c1::protease}} inhibitor that may be used for the treatment of hepatitis C genotype 1
Published	02/29/2024	Second generation NS3/NS4A protease inhibitors and NS5A inhibitors are under clinical investigation to develop HCV treatment regimens that do not requ…
Published	02/29/2024	Normally, 95% of bile acids in the ileum are recycled back to the liver through {{c1::enterohepatic}} circulation
Published	02/29/2024	Loop diuretics may be used to treat {{c1::ascites}} in liver failure (e.g. cirrhosis)
Published	02/29/2024	{{c2::Spironolactone}}, a K+ sparing diuretic, may be used in the treatment of hepatic {{c1::ascites}}
Published	02/29/2024	~ 18% of urobilinogen is returned to the liver via {{c1::enterohepatic}} circulation
Published	02/29/2024	{{c1::Jaundice}} is a yellow discoloration of the skin and/or sclera
Published	02/29/2024	What is the earliest sign of jaundice?{{c1::Scleral icterus}}
Published	02/29/2024	Jaundice is due to increased serum {{c1::bilirubin}}, typically > 2.5 mg/dL
Published	02/29/2024	Viral hepatitis is characterized by elevated liver enzymes with ALT {{c1::>}} AST
Published	02/29/2024	Cirrhosis is characterized by disruption of normal hepatic parenchyma by bands of {{c1::fibrosis}} and {{c2::regenerative nodules}} of hepatocytes
Published	02/29/2024	Alcoholic cirrhosis may be associated with {{c1::sclerosis}} around central veins in early disease
Published	02/29/2024	Cirrhosis is often complicated by {{c1::portal}} hypertension
Published	02/29/2024	Portal hypertension can lead to {{c1::ascites}}, which is fluid in the peritoneal cavity
Published	02/29/2024	Portal hypertension may lead to congestive {{c1::splenomegaly}} and hypersplenism
Published	02/29/2024	{{c1::Hepatorenal}} syndrome is a complication of portal hypertension characterized by rapidly developing renal failure, secondary to cirrhosis
Published	02/29/2024	Neuropsychiatric symptoms of cirrhosis include hepatic {{c1::encephalopathy}} and {{c2::asterixis ("flapping tremor")}}
Published	02/29/2024	What antibiotics are used to treat hepatic encephalopathy? {{c1::rifaximin and neomycin::2}}
Published	02/29/2024	Dermatologic symptoms of cirrhosis include {{c1::jaundice}}, spider angiomas, palmar erythema, and petechiae/purpura
Published	02/29/2024	What is the most common cause of liver disease in the West? {{c1::Alcohol consumption}}
Published	02/29/2024	Alcoholic hepatitis may present with {{c1::painful::painful or painless}} hepatomegaly
Published	02/29/2024	{{c2::Alcoholic}} hepatitis is characterized by elevated liver enzymes with ALT {{c1::<}} AST
Published	02/29/2024	Risk factors for hepatocellular carcinoma include causes of {{c1::cirrhosis}} (e.g. alcohol, NAFLD, hemochromatosis, Wilson disease, A1AT deficiency)
Published	02/29/2024	{{c1::Spontaneous (primary) bacterial peritonitis}} is a common, potentially fatal bacterial infection in patients with cirrhosis and ascites
Published	02/29/2024	AST {{c1::>}} ALT in nonalcoholic liver disease suggests progression to advanced fibrosis or cirrhosis
Published	02/29/2024	Which liver enzyme is increased in cholestasis (e.g. biliary obstruction), infiltrative disorders, and bone disease? {{c1::Alkaline phosphatase}}
Published	02/29/2024	Which liver enzyme is increased in various liver/biliary diseases, but NOT in bone disease? {{c1::γ-glutamyl transpeptidase (GGT)}}
Published	02/29/2024	Portosystemic shunts may be treated with {{c1::TIPS}} between the portal and {{c2::hepatic}} veins
Published	02/29/2024	Treatment of portosystemic shunts with TIPS can precipitate {{c1::hepatic encephalopathy}} in cirrhotic patients
Published	02/29/2024	Which liver zone is the site of alcoholic hepatitis? {{c1::Zone III (centrilobular)}}
Published	02/29/2024	What are first-line agents (2) used to lower NH3 levels in hepatic encephalopathy?{{c1::Lactulose (1st line) and Rifaximin (2nd line)}}
Published	02/29/2024	Which diuretics are first-line therapy for cirrhotic ascites?{{c1::Furosemide and spironolactone::2}}
Published	02/29/2024	What is the appropriate interpretation of the following serological test results:HBsAg: NegativeAnti-HBs: PositiveAnti-HBc: PositiveAnti-HBe: Negative…
Published	02/29/2024	What is the appropriate interpretation of the following serological test results:HBsAg: NegativeAnti-HBs: PositiveAnti-HBc: PositiveAnti-HBe: Positive…
Published	02/29/2024	What is the appropriate interpretation of the following serological test results:HBsAg: NegativeAnti-HBs: PositiveAnti-HBc: NegativeAnti-HBe: Negative…
Published	02/29/2024	What serologic marker for HBV remains positive throughout the window period? {{c1::IgM anti-HBc}}
Published	02/29/2024	What is the appropriate interpretation of the following serological test results:HBsAg: PositiveAnti-HBs: NegativeIgG Anti-HBc: PositiveAnti-HBe: Nega…
Published	02/29/2024	What serologic markers should be measured to diagnose acute HBV infection?{{c1::HBsAg and IgM anti-HBc::2}}
Published	02/29/2024	What is the likely result of the following serologic tests in a patient vaccinated against hepatitis B? HBsAg: {{c1::negative}}HBsAb: {{c1::positive}}…
Published	02/29/2024	What is the likely result of the following serologic tests in a patient naturally immunized against hepatitis B? HBsAg: {{c1::negative}}HBsAb: {{c1::p…
Published	02/29/2024	What is the likely result of the following serologic tests in a patient with chronic hepatitis B? HBsAg: {{c1::positive}}HBsAb: {{c1::negative}}HBcAb:…
Published	02/29/2024	What antibody is typically positive during the window phase of hepatitis B infection?{{c1::IgM anti-HBc}}
Published	02/29/2024	In healthy adults, acute hepatitis B infection is self-limited in > {{c1::90-95}}% of cases
Published	02/29/2024	What is the likely diagnosis in a patient with recent travel out of the country that presents with fever, jaundice, and tender hepatomegaly with very …
Published	02/29/2024	Does hepatitis B have an envelope?{{c1::Yes}}
Published	02/29/2024	What is the first marker that appears in HBV infection?{{c1::HBsAg}}
Published	02/29/2024	What is the second marker that appears in HBV infection?{{c1::HBeAg}}
Published	02/29/2024	What markers are in the blood during early symptomatic HBV infection?{{c1::HBsAg; HBeAg}}
Published	02/29/2024	What is the first detectable antibody in HBV infection?{{c1::Anti-HBc IgM}}
Published	02/29/2024	Which serologic marker is detectable during the window period of HBV infection?{{c1::Anti-HBc IgM}}
Published	02/29/2024	Which serologic markers are detectable during the recovery period of HBV infection?{{c1::Anti-HBs IgG; Anti-HBc IgG}}
Published	02/29/2024	Which serologic marker is detectable due to immunization to HBV?{{c1::Anti-HBs IgG}}
Published	02/29/2024	Hepatitis {{c1::D}} virus cannot cause disease without hepatitis B HBsAg
Published	02/29/2024	What type of virus is Hepatitis D?{{c1::Negative sense RNA::DNA, RNA (sense), etc.}}
Published	02/29/2024	Does hepatitis D have an envelope?{{c1::Yes}}
Published	02/29/2024	What serologic marker must be present for HDV infection?{{c1::HBsAg}}
Published	02/29/2024	Which HDV infection has a worse outcome, co-infection with HBV or superinfection with HBV?{{c1::Superinfection with HBV}}
Published	02/29/2024	Does hepatitis A have an envelope?{{c1::No (naked)}}
Published	02/29/2024	Does hepatitis E have an envelope?{{c1::No (naked)}}
Published	02/29/2024	Does hepatitis C have an envelope?{{c1::Yes}}
Published	02/29/2024	What type of virus is Hepatitis A? {{c1::Positive sense RNA::DNA, RNA (sense), etc.}}
Published	02/29/2024	What is a source of hepatitis A virus in developing countries?{{c1::Contaminated water}}
Published	02/29/2024	What is a source of hepatitis A virus in developed countries?{{c1::Contaminated shellfish}}
Published	02/29/2024	HAV infection is commonly seen in {{c1::travelers}} to endemic areas
Published	02/29/2024	What type of virus is HCV? {{c1::Positive sense RNA::DNA, RNA (sense), etc.}}
Published	02/29/2024	Hepatitis C virus can be transmitted through {{c1::needle}} sticking or sharing
Published	02/29/2024	Hepatitis C infections become chronic in {{c1::60}}-{{c1::80}}% of cases
Published	02/29/2024	Hepatitis C RNA is found in the serum for {{c1::< 6}} months in the acute stage
Published	02/29/2024	The acute phase of HCV infection is marked by a rise and fall of {{c1::ALT::liver enzyme}} in 6 months
Published	02/29/2024	Hepatitis C RNA is found in the serum for {{c1::> 6}} months in the chronic stage
Published	02/29/2024	HCV can be treated with {{c1::protease::enzyme}} and {{c1::polymerase::enzyme}} inhibitors
Published	02/29/2024	All patients with chronic HCV except those with {{c1::limited life expectancy}} should be considered for treatment
Published	02/29/2024	HCV therapeutics with the suffix {{c1::-asvir}} work by inhibiting the NS5A protein, which plays an integral role in viral {{c2::replication}}
Published	02/29/2024	If a patient has moderately elevated serum Alkaline phosphatase levels, you should determine if hepatobiliary or bony origin by checking {{c1::GGT}} l…
Published	02/29/2024	If a patient has a varicocele, consider surgical ligation or {{c1::catheter embolization}} if associated with pain or infertility
Published	02/29/2024	Hepatitis D virus receives a(n) {{c1::viral coat}} from {{c2::HBsAg}} in order to penetrate the hepatocyte
Published	02/29/2024	Hepatitis B infectionWhat does the presence of anti-HBc and anti-HBs indicate?{{c1::Recovery from acute HBV}}
Published	02/29/2024	Hepatitis B infectionWhat does the presence of anti-HBs only indicate?{{c1::Vaccination}}
Published	02/29/2024	Hepatitis B infectionWhat does the presence of persistent HBsAg and HBV DNA indicate?{{c1::Chronic HBV infection}}
Published	02/29/2024	Hepatitis B infectionWhich serum HBV marker predicts infectivity?{{c1::HBeAg}}
Published	02/29/2024	What HBV antigen is positive in neonates with infection acquired at birth?{{c1::HBeAg}}
Published	02/29/2024	What type of virus is Hepatitis B? {{c1::Partially double-stranded DNA::DNA, RNA (sense), etc}}
Published	02/29/2024	What test is used to establish the diagnosis of spontaneous bacterial peritonitis?{{c1::Paracentesis}}
Published	02/29/2024	Hepatorenal syndrome occurs due to {{c1::splanchnic arterial}} dilation, which results in decreased vascular resistance and activation of the RAAS
Published	02/29/2024	What is the recommended management for variceal hemorrhage if there is continued bleeding after endoscopic therapy?{{c1::Balloon tamponade (until TIPS…
Published	02/29/2024	{{c1::Hepatitis B::virus}} or {{c1::Hepatitis C::virus}} = ↑ risk of hepatocellular carcinoma
Published	02/29/2024	Child-Pugh Score:A pre-op assessment of hepatic risk factors should include:{{c1::Bilirubin::breakdown product}}{{c1::PT/INR::coagulation}}{{c1::Album…
Published	02/29/2024	Hepatitis B is acquired via {{c1::sex / blood / birth::mechanism}}
Published	02/29/2024	Hepatitis C is acquired via {{c1::blood::mechanism}}
Published	02/29/2024	Anti-HBs and Anti-HBe or Anti-HBc Ab = {{c1::Recovery from Hep B}}
Published	02/29/2024	Anti-HBc IgM is the sole marker during the {{c1::window period}}
Published	02/29/2024	What is the likely diagnosis in a patient with fever, jaundice, tender hepatomegaly, and AST:ALT ratio > 2? {{c1::Alcoholic hepatitis}}
Published	02/29/2024	Elevated alkaline phosphatase and GGT is specific for {{c1::biliary}} pathology
Published	02/29/2024	What combined antiviral therapy is effective against most strains of hepatitis C (e.g. genotypes 1-6)?{{c1::Sofosbuvir-velpatasvir}}
Published	02/29/2024	Cirrhosis etiologies:V: {{c1::Viral}}W: {{c2::Wilsons}}H: {{c3::Hemochromatosis}}A: {{c4::Alpha-1 Anti-trypsin deficiency}}P: {{c5::Primary Sclerosing…
Published	02/29/2024	Hepatitis C virus is among the recommended universal prenatal screening{{c1::T::T/F}}
Published	02/29/2024	Alcoholic hepatitis may progress to {{c1::cirrhosis}}, which is scarring that forms septa and nodules (generally irreversible) and increase risk …
Published	02/29/2024	What commonly presents as acute liver decompensation (e.g. encephalopathy, worsening or bloody ascites, fever, SBP, etc)?{{c1::Hepatocellula…
Published	02/29/2024	Chronic viral hepatitis (HBV, HCV) and autoimmune diseases (PSC, PBC, autoimmune hepatitis) may cause {{c1::cirrhosis}} of the liver, w…
Published	02/29/2024	What is the most likely diagnosis in a patient with positive HBeAg, positive anti-HBc IgG, positive HBsAg, and a mild increase in LFTs?{{c1::Active ch…
Published	02/29/2024	{{c2::anti-HBc IgG}} indicates either that the form of Hepatitis B is either a(n) {{c1::active chronic}} or {{c1::inactive chronic}} infection
Published	02/29/2024	Does alcoholic hepatitis result in unconjugated or conjugated hyperbilirubinemia?{{c1::Both}}
Published	02/29/2024	{{c1::Lactulose::drug}} acidifies the bowel, converting NH3 into NH4+, which helps to treat {{c2::liver disease::disease}}
Published	02/29/2024	Compared to the normal liver cords on the left, the thickened liver cords on the right indicate {{c1::hepatocellular carcinoma (HCC)}}
Published	02/29/2024	The liver conjugates bilirubin with {{c1::glucuronic acid}} in order to make it more {{c2::water-soluble}}
Published	02/29/2024	Synthesis of FAs, cholesterol, and steroids; detoxification of drugs and alcohol; and conjugation of bilirubin occur in the {{c1::smooth ER and c…
Published	02/29/2024	The $80,000 cure for hepatitis C goes by the trade name Harvoni. It is a combination of {{c1::sofosbuvir}} and {{c1::ledipasvir}}
Published	02/29/2024	What is the route of transmission of Hepatitis A virus?{{c1::Fecal-oral}}
Published	02/29/2024	What is the definitive test for diagnosing Hepatitis A virus?{{c1::IgM serology}}
Published	02/29/2024	People with hepatitis A virus are more likely to be symptomatic if they are {{c1::older::older or younger}}
Published	02/29/2024	The route of transmission for hepatitis E virus is {{c1::water}} in developing countries and {{c1::zoonotic}} in developed countries
Published	02/29/2024	The highest rate of illness due to hepatitis E virus occurs in {{c1::adolescents and young adults::age group}}
Published	02/29/2024	Does hepatitis E virus induce a carrier state in infected individuals?{{c1::Only in immunocompromised}}
Published	02/29/2024	People with hepatitis B virus are more likely to be symptomatic if they are {{c1::older::older or younger}}
Published	02/29/2024	People with hepatitis B virus are more likely to develop chronic infection if they are {{c1::younger::older or younger}}
Published	02/29/2024	Chronic HBV infection will have {{c1::HBsAg* and anti-HBc IgG::2 serologic markers}}, while resolved HBV infection will have {{c1::anti…
Published	02/29/2024	{{c1::Co-infection}} is when HDV infection overlaps with acute HBV infection, and {{c1::superinfection}} is when HDV infection overlaps with chronic H…
Published	02/29/2024	The route of transmission for HDV is {{c1::parenteral}}
Published	02/29/2024	The country with the highest prevalence of hepatitis C virus is {{c1::Egypt}}
Published	02/29/2024	Vitamin K, albumin, and plasma proteins are synthesized by {{c1::hepatocytes::cell type}} in the liver
Published	02/29/2024	The gold standard for diagnosing non-alcoholic steatohepatitis is {{c1::liver biopsy}}
Published	02/29/2024	Direct bilirubin is a measure of {{c1::conjugated}} bilirubin, and indirect bilirubin is a measure of {{c1::unconjugated}} bilirubin
Published	02/29/2024	Diagnosis of chronic liver disease requires radiologic or histologic evidence of fibrosis or cirrhosis, or elevated ALT/AST for at least {{c1::6 …
Published	02/29/2024	Prior to testing, {{c1::transfusions}} were a major source of HBV and HCV infections
Published	02/29/2024	Diagnosis of cirrhosis can be supported by {{c1::nodular liver}}, {{c2::splenomegaly}}, and {{c3::portal collateral veins}} on imaging
Published	02/29/2024	{{c1::Elastography}} can non-invasively measure liver stiffness to support diagnosis of cirrhosis
Published	02/29/2024	Definitive diagnosis of portal hypertension is made by using a catheter to measure the {{c1::hepatic venous pressure gradient (HVPG)}}
Published	02/29/2024	What complication of cirrhosis presents with splenomegaly, thrombocytopenia, ascites, and varices?{{c1::Portal hypertension}}
Published	02/29/2024	TIPS is absolutely contraindicated in patients with severe {{c1::liver}} disease
Published	02/29/2024	TIPS is relatively contraindicated in patients with hepatic encephalopathy, heart failure, pulmonary hypertension, or active {{c1::infe…
Published	02/29/2024	{{c4::Decompensated}} cirrhosis presents as:{{c1::ascites}}{{c2::variceal bleeds}}{{c3::hepatic encephalopathy}}
Published	02/29/2024	Liver transplants used to be allocated based on {{c1::Child-Turcotte-Pugh}} scores, but now they are allocated based on {{c2::MELD}} scores
Published	02/29/2024	Child-Turcotte-Pugh scores continue to be used to predict mortality risk for {{c1::abdominal surgery}} in cirrhosis patients
Published	02/29/2024	The MELD score is based on {{c1::bilirubin}}, {{c2::INR}}, {{c3::creatinine}}, and {{c4::serum [Na]}}
Published	02/29/2024	In spontaneous bacterial peritonitis, administration of IV {{c1::albumin}} can reduce risk of hepatorenal syndrome
Published	02/29/2024	First-line treatment for ascites includes low-{{c1::sodium}} diet
Published	02/29/2024	Ascites that is not controlled by low-sodium diet and diuretics, paracentesis shows ANC < 250, SAAG > 1.1 = {{c1::serial therapeutic parace…
Published	02/29/2024	Ascites that is requiring therapeutic paracentesis too frequently = {{c1::TIPS + start transplant workup::next step}}
Published	02/29/2024	Ascites that is still requiring therapeutic paracentesis too frequently even after TIPS, did not qualify for transplant = {{c1::periton…
Published	02/29/2024	After paracentesis, administration of IV {{c1::albumin}} can reduce risk of {{c2::parecentesis-induced circulatory dysfu…
Published	02/29/2024	Hepatorenal syndrome is treated with {{c1::midodrine + octreotide + albumin::3}}
Published	02/29/2024	Grade {{c1::0-1}} hepatic encephalopathy = no confusion, no asterixis, some tests of cognitive function are abnormal
Published	02/29/2024	Grade {{c1::2}} hepatic encephalopathy = confusion, asterixis, disoriented to {{c2::time}}
Published	02/29/2024	Grade {{c1::3}} hepatic encephalopathy = somnolent or obtunded, disoriented to {{c2::location}}
Published	02/29/2024	Grade {{c1::4}} hepatic encephalopathy = comatose
Published	02/29/2024	Unlike its cousin HAV, HEV can rarely cause chronic infection, but only in {{c1::transplant}} patients
Published	02/29/2024	You start to see varices when HVPG > {{c1::10}} and variceal bleeds when HVPG > {{c1::12}}
Published	02/29/2024	Normal HVPG < {{c1::5}} mm Hg
Published	02/29/2024	You start to see ascites when HVPG > {{c1::10}}
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