011315 viral hepatitis Flashcards
clinical manifestations of acute viral hepatitis
fever, malaise, anorexia, nausea, vomiting, jaundice, abdominal/RUQ pain, hepatomegaly
is there inflammation in chronic hepatitis?
no (only in acute)
what is the one test for diagnosing hep A?
Hep A antibody
what does Hep A IgG suggest?
previous exposure (more than 6 months out) and now immune or vaccination
does getting hepatitis A provide you with a protective antibody?
yes, the IgG is protective
is hep A acute or chronic?
acute (can kill you in couple wks)
how do you prevent hep A
hygiene (hand washing)
sanitation (clean water sources)
immune globulin (pre and post exposure) hep A vaccine (pre exposure)
how is hep A transmitted?
fecal oral
uses of hep A immunoglobulin
pre-exposure:
travelers to HAV-endemic areas
post-exposure (within 2 wks)
how to diagnose hep E?
hep E Ab (hep E IgM represents acute, hep E IgG represents previous exposure and now immune)
does hep IgG protect against future infection?
yes
tx for acute hep E
supportive
presence of HBeAg represents
lot of virus in bloodstream
presence of anti-HBe represents
seroconversion-means you have cleared virus from the bloodstream
seroconversion for hep B occurs in whom?
adults
presence of HBsAg suggests
you have Hep B disease (4-24 wks after exposure for an adult, will be positive)
presence of anti HBc Ig
IgM is postive during acute phase
IgG is positive in chronic
anti HBs
means you are immune to Hep B
in chronic hep B, what is different from acute hep B?
the HBsAg doesn’t go away
the HBeAg doesn’t go away
how can you diagnose hep B
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
transmission of hep B occurs how?
high risk-blood, serum, wound exudates
moderate-semen, vaginal fluid, saliva
risk factors for hep B
heterosexual sex MSM IV drug users household contacts of HbsAg + ppl travelers to endemic areas people occupationally exposed chronic renal failure pts
what to do for unvaccinated pt who’s contracted hep B
give hep B Ig within one week
or
hep B vaccine within one week
in hep B surface antigen + mothers, what do you give newborn?
both HBIG and vaccine
chronic hep B-goal of therapy
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
how to tx chronic hep B
IFN (interferon) to activate immune system
nucleotide/nucleoside analogues to block reverse transcriptase which is necessary for HBV replication
nucleotide analogs are used for chronic hep B in the attempt to do what?
try to make seroconversion happen (use entacavir and tenofovir only b/c these are the ones that viruses are not resistant to)
Peg-IFN is used for
Hep B–if low viral load and high ALT/AST
why is therapy for hep B important?
prevents progression to cirrhosis and possibly HCC
what happens in HBV/HDV coinfection?
HDV RNA and HBsAg are seen transiently
eventually, anti-HDV IgG goes away
what happens in HBV/HDV superinfection
ALT fluctuates with HDV RNA present
HDV RNA and HBsAg are seen
anti HDV IgG persists
how to diagnose hep D?
hep D IgM means acute infec
hep D IgG means previous exposure
is hep D IgG protective?
no
how to diagnose hep C
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
