011315 viral hepatitis

Question 1

clinical manifestations of acute viral hepatitis

Answer 1

fever, malaise, anorexia, nausea, vomiting, jaundice, abdominal/RUQ pain, hepatomegaly

Question 2

is there inflammation in chronic hepatitis?

Answer 2

no (only in acute)

Question 3

what is the one test for diagnosing hep A?

Answer 3

Hep A antibody

Question 4

what does Hep A IgG suggest?

Answer 4

previous exposure (more than 6 months out) and now immune or vaccination

Question 5

does getting hepatitis A provide you with a protective antibody?

Answer 5

yes, the IgG is protective

Question 6

is hep A acute or chronic?

Answer 6

acute (can kill you in couple wks)

Question 7

how do you prevent hep A

Answer 7

hygiene (hand washing)
sanitation (clean water sources)

immune globulin (pre and post exposure)
hep A vaccine (pre exposure)

Question 8

how is hep A transmitted?

Answer 8

fecal oral

Question 9

uses of hep A immunoglobulin

Answer 9

pre-exposure:
travelers to HAV-endemic areas

post-exposure (within 2 wks)

Question 10

how to diagnose hep E?

Answer 10

hep E Ab (hep E IgM represents acute, hep E IgG represents previous exposure and now immune)

Question 11

does hep IgG protect against future infection?

Answer 11

yes

Question 12

tx for acute hep E

Answer 12

supportive

Question 13

presence of HBeAg represents

Answer 13

lot of virus in bloodstream

Question 14

presence of anti-HBe represents

Answer 14

seroconversion-means you have cleared virus from the bloodstream

Question 15

seroconversion for hep B occurs in whom?

Answer 15

adults

Question 16

presence of HBsAg suggests

Answer 16

you have Hep B disease (4-24 wks after exposure for an adult, will be positive)

Question 17

presence of anti HBc Ig

Answer 17

IgM is postive during acute phase

IgG is positive in chronic

Question 18

anti HBs

Answer 18

means you are immune to Hep B

Question 19

in chronic hep B, what is different from acute hep B?

Answer 19

the HBsAg doesn’t go away

the HBeAg doesn’t go away

Question 20

how can you diagnose hep B

Answer 20

hep B surface antigen + means current hep B (acute or chronic)

hep B surface ab positive means immunity (recovered from natural infec or vaccine)

IMPORTANT test is core antibody, which represents natural exposure

Question 21

transmission of hep B occurs how?

Answer 21

high risk-blood, serum, wound exudates

moderate-semen, vaginal fluid, saliva

Question 22

risk factors for hep B

Answer 22

heterosexual sex
MSM
IV drug users
household contacts of HbsAg + ppl
travelers to endemic areas
people occupationally exposed
chronic renal failure pts

Question 23

what to do for unvaccinated pt who’s contracted hep B

Answer 23

give hep B Ig within one week
or
hep B vaccine within one week

Question 24

in hep B surface antigen + mothers, what do you give newborn?

Answer 24

both HBIG and vaccine

Question 25

chronic hep B-goal of therapy

Answer 25

eliminate or significnatly suppress HBV replication prevent progression to cirrhosis and possibly HCC ALT normalization histological improvement (reduce inflam) loss of HBeAg, development of HBeAb loss of HBsAg

Question 26

how to tx chronic hep B

Answer 26

IFN (interferon) to activate immune system nucleotide/nucleoside analogues to block reverse transcriptase which is necessary for HBV replication

Question 27

nucleotide analogs are used for chronic hep B in the attempt to do what?

Answer 27

try to make seroconversion happen (use entacavir and tenofovir only b/c these are the ones that viruses are not resistant to)

Question 28

Peg-IFN is used for

Answer 28

Hep B--if low viral load and high ALT/AST

Question 29

why is therapy for hep B important?

Answer 29

prevents progression to cirrhosis and possibly HCC

Question 30

what happens in HBV/HDV coinfection?

Answer 30

HDV RNA and HBsAg are seen transiently eventually, anti-HDV IgG goes away

Question 31

what happens in HBV/HDV superinfection

Answer 31

ALT fluctuates with HDV RNA present HDV RNA and HBsAg are seen anti HDV IgG persists

Question 32

how to diagnose hep D?

Answer 32

hep D IgM means acute infec | hep D IgG means previous exposure

Question 33

is hep D IgG protective?

Answer 33

no

Question 34

how to diagnose hep C

Answer 34

hep C antibody seen in all exposures and remains present in all pts including those who spontaenously clear virus or undergo successful tx hep C viral RNA is there only in viremic pts