Causes of severe aminotransferase elevations > 15xnormal - ANSWER Acute
viral hepatits (A-E, herpes)
Meds/toxins
Ischemic or Autoimmune hepatitis
Wilson disease
Acute bile duct obstruction
Acute Budd Chiari syndrome
Hepatic a. ligation
EUS - endoscopic ultrasonography - ANSWER most sensitive test for
detecting small lesions of the ampulla or pancreatic head and for detecting
portal vein invasion by pancreatic cancer. It is also accurate for detecting or
excluding bile duct stones.
Hep A - essentials of dx - ANSWER Prodrome of anorexia, N/V, malaise,
aversion to smoking.
Fever, enlarged and tender liver, jaundice
Norm to low WBC, markedly elevated aminotransferases
Hep A virus transmission - ANSWER fecal oral route
person to person or contaminated food/water
, Acute Hep B essentials of dx - ANSWER prodrome of anorexia, N/V malaise,
aversion to smoking
Fever, enlarged and tender liver, jaundice
Norm to low WBC, markedly elevated aminotransferases early in the course
Liver bx - hepatocellular necrosis and monomuclear infiltrate, but is rarely
indicated.
Hep B transmission - ANSWER blood or blood products
sexual -saliva, semen and vaginal secretions.
HBsAg pos mothers may transmit at delivery - high risk of chronic infection
in infant.
HBsAg - ANSWER first evidence of infection, appears before biochemical
evidence of liver dx, persists through clinical illness.
Persistence for more than 6 months after acute illness signifies Chronic hep B
Anti-HBc - ANSWER IgM anti-HBc appears shortly after HBsAg is detected.
Indicates acute Hepatitis B
Can persists for 3-6 mo or longer
HAV IgM - ANSWER acute infection - peak at 1st week of clinical dx and
disappear w/in 3-6 mo.
HAV IgG - ANSWER hepatitis A recovery or vaccination - "gone"
HEV IgM - ANSWER acute Hep E
HEV IgG - ANSWER recovery of Hep E
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