11: Hepatitis Flashcards
1
Q
Hep A, B, C, D or E?
Blood borne.
A
Hep B
Hep C
2
Q
ALT or AST?
Hemachromatosis.
A
ALT
3
Q
Hep A, B, C, D or E?
40-60% develop chronic liver disease.
A
Hep C
4
Q
Hep A, B, C, D or E?
Sexually transmitted.
A
Hep B
5
Q
Hep A, B, C, D or E?
People at risk include sexual contacts, household contacts, IV drug users, healthcare workers, working/receiving blood products, residents/staff of facilities for developmentally disabled persons.
A
Hep B
6
Q
T/F Breastfeeding is contraindicated in Hep B+ moms.
A
False
7
Q
T/F PCR can detect Hep C 1-2 weeks after infection.
A
True. Detects HCV RNA.
8
Q
Hep A, B, C, D or E?
Picornavirus
A
Hep A
9
Q
Hep A, B, C, D or E?
Anorexia, nausea, malaise, jaundice, myalgia.
A
Hep D
10
Q
Genotype testing is used to inform treatment decisions with Hep C.
What type is the most common in the US?
What type is most likely to respond to treatment?
A
Most common = Type 1 HCV
Responds = Types 2/3 HCV
Type 1 is more resistant to treatment.
11
Q
ALT or AST?
More specific for measurement of liver disease.
A
ALT
12
Q
What’s the cause?
ALT and AST 5-8x normal limits.
A
Viral hepatitis
13
Q
ALT or AST?
More sensitive but less specific in detecting liver disease.
A
AST
14
Q
What is the goal of Hep B treatment?
A
Aimed at suppressing viral replication.
15
Q
Should you test before giving the Hep A vaccine?
A
Yes, if the adult is 40+ and born or traveled to HAV-endemic areas (Africa, Asia, South America, Central America).
16
Q
T/F Medication therapy stops viral replication in liver transplant and Hep C reinfection.
A
False. Viral activity continues with immunosuppressants. Recurrent infection is almost universal. Graft damage is related to the degree of immune suppression.
17
Q
What do you do if child tests positive for Hep C (6)?
A
- Repeat antibody testing (false positives)
- Screen for risk factors
- Draw viral load (RNA)
- Check LFTs
- Refer to hepatitis center
- Chronically infected are managed same as adults
18
Q
ALT or AST?
Tylenol toxicity.
A
AST
19
Q
ALT or AST?
SGOT
A
AST
20
Q
What are recommendations for Hep B in premature infants?
A
If birth weight less than 2000 grams and mom is positive or unknown, then vaccinate + IgG. Vaccinate again at 1 month.
21
Q
Hep A, B, C, D or E?
RNA virus.
A
Hep C
22
Q
Hep A, B, C, D or E?
Virus shed in stool during incubation period.
A
Hep A
23
Q
Found in liver, heart, kidney, muscle. Source is differentiated through isoenzymes.
A
Lactic Dehydrogenase (LDH)
24
Q
Elevated direct or indirect bili?
Viral hepatitis
A
Direct
25
Hep A, B, C, D or E?
| 75% progress to chronic hepatitis.
Hep C
26
What are the phases of Hep A (2)?
1. Preicteric phase (may be missed in children) - Fever, n/v, digestive/abd complaints.
2. Jaundice phase - after preicteric, urine darkens, stools clay colored. Diarrhea in infants, constipation in older children. Poor weight gain. Can last 1-6 months with relapses.
27
What indicates successful Hep B treatment for babies?
Antibody +
| Antigen -
28
Who should be vaccinated for hepatitis A/B (7)?
1. STD clinics
2. HIV counseling/testing sites
3. Correctional facilities
4. Drug treatment clinics
5. Sexual/household contacts
6. Healthcare workers, first responders
7. Diabetics
29
Treatment for babies born to untreated Hep B+ moms.
Vaccination + IgG and check antibody levels 2-3 months after vaccination.
30
IgA, IgE, IgD, IgM, or IgG?
| Results from B lymphocyte differentiation. Relates to antigen receptors.
IgD
31
Hep A, B, C, D or E?
| Jaundice at day 10.
Hep B
32
What does this lab show in acute viral hepatitis?
| CBC (3)
1. Low WBC, leukopenia.
2. Low polys, bands. Bandemia.
3. High lymphs. Lymphocytosis.
33
IgA, IgE, IgD, IgM, or IgG?
| Lines mucus membranes of GI, respiratory, urinary tracts.
IgA
34
Who should be tested for Hep C (9)?
1. IV drug users
2. HIV/Hep B
3. Unexplained ALT/Liver disease
4. HCV+ mother
5. Ever on hemodialysis
6. Needlestick
7. Sexual partners
8. Clotting factors pre 1987, blood/organ pre 1992
9. Born 1945-1965
35
Hep A, B, C, D or E?
| Anorexia, nausea, malaise, myalgia, rarely jaundice.
Hep C
36
Hep A, B, C, D or E?
| May be asymptomatic.
All of them
37
What is the Hep A dosing for travelers?
1. Dose 1 at least 4 weeks before travel. Dose 2 follows 6-12 months later for long-term protection.
2. Less than 4 weeks before travel is dose 1 plus 0.02 mg/kg Ig IM at different site.
38
Hep A vaccine candidates (8)?
1. United States: all children at 12–23 months
2. Unvaccinated adolescents, young adults: catch up by risk
3. IV drug users
4. Men who have sex with men
5. Travelers
6. Persons with any other chronic hepatitis
7. Clotting factor recipients
8. Persons who work with nonhuman primates
39
ALT or AST?
| Elevated in hepatitis.
AST
40
When would you refer to GI for treatment consideration with Hep B?
E antigen negative with abnormal ALT and viral load >10^5.
41
Where is bili produced (3)?
1. Liver
2. Spleen
3. Bone marrow
42
ALT or AST?
| Musculoskeletal trauma.
AST
43
Elevated direct or indirect bili?
| Obstruction of the bile flow, possible stones, tumor.
Direct
44
Hep A, B, C, D or E?
| Tender, palpable liver edge in 70%.
Hep B
45
Where is conjugated bili?
Liver (travels to bowel through bile ducts)
46
Hep A, B, C, D or E?
| More common in Western and Southern US and in developing countries.
Hep A
47
What are side effects of Hep C treatment (6)?
1. Nausea
2. Fatigue
3. Irritability
4. Hair loss
5. Anemia
6. Neutropenia
48
Lab testing detects Hep C antibodies _____ days after exposure.
28-90 days
49
Hep A, B, C, D or E?
| Spread through fecal/oral route and person-person contact.
Hep A
50
Which viruses cause hepatitis (10)?
1. Hep A
2. Hep B
3. Hep C
4. Hep D
5. Hep E
6. Hep G
7. EBV
8. CMV
9. Rubella
10. Herpes Simplex
51
Hepatocellular carcinoma (HCC) is associated with which hepatitis (2)?
Hep B
| Hep C
52
What autoimmune condition can cause hepatitis?
Common in lupus patients. More common in women than men.
53
T/F Hep D requires Hep B infection b/c it uses the Hep B protein shell.
True. Can occur as co-infection with Hep B or superinfection after Hep B.
54
Hep A, B, C, D or E?
| Fatigue, low-grade fever. Erythematous rash, urticaria, nausea, bloating, arthralgias.
Hep B
55
Hep A, B, C, D or E?
| 1% mortality in acute infection.
Hep C
56
What are meds for Hep B treatment (3)?
1. Pegylated interferon
2. Ribavirin
3. Protease inhibitors
57
Hep A, B, C, D or E?
| Incubation is 30-180 days (mean 60-90).
Hep B
58
Babies who are exposed to Hep C will retain mother's antibodies for 12-18 months. How do you manage after that?
1. Pronounced clear if they test negative after 18 months old.
2. Test for Hep C RNA (NAAT) test at age 1-2 months.
59
Hep A, B, C, D or E?
| Occurs only with HBV as coinfection or as superinfection in chronic HBV.
Hep D
60
Causes of hepatitis (6)?
1. Viruses
2. Alcohol
3. Drugs
4. Poisons
5. Idiopathic
6. Autoimmune-related
61
What does this lab show in acute viral hepatitis?
| Bili
Increased direct and total.
62
What is post-exposure prophylaxis for Hep B known exposure (4)?
1. As soon as possible, ideally within 24 hours.
2. Booster dose for those without documented post-vaccine titers.
3. HBIG and finish vaccine series for persons in midst of vaccine schedule.
4. Vaccine + HBIG for unvaccinated persons. Simultaneous administration, separate sites. Finish series of vaccines.
63
Hep A, B, C, D or E?
| Infectious 2 weeks before symptoms and 1 week after.
Hep A
| Hep E
64
ALT or AST?
| SGPT
ALT
65
What other viral infections can cause hepatitis in children (2)?
EBV and CMV
66
When is PCR test done in Hep B?
For treatment decisions, response to treatment, chronic infection, unusual presentation. Very expensive, but can detect as few as 10 copies/mL.
67
T/F Most children with Hep B acquire it later in life.
False. Most are born with it.
68
ALT or AST?
| Drug/chemical toxicity.
ALT
69
Hep A, B, C, D or E?
| Average is 28-day incubation period (15-50 days).
Hep A
70
Byproduct of RBC recycling.
Bilirubin
71
T/F Many, particularly baby boomers, have no known risk factors for Hep C when they test positive.
True
72
What does this lab show in acute viral hepatitis?
| Albumin
+/-
73
Does lab testing for Hep C distinguish acute from chronic?
No
74
T/F Chronic viral hepatitis can be asymptomatic until advanced disease or other event (co-infection).
True. It has a highly variable course.
75
T/F Hepatitis is contagious only when symptoms are present.
False. It can be spread when asymptomatic.
76
What is post-exposure prophylaxis for Hep B uncertain exposure (4)?
1. No treatment for vaccinated.
2. Complete vaccine series for those in midst of vaccine schedule.
3. Vaccine series started ASAP for unvaccinated.
4. No HBIG is given in this situation.
77
What is the vaccine schedule for Hep B?
3 doses. 0, 1-2 months, and 6 months.
78
Treatment for Hep B is based on what 4 things?
1. ALT abnormality
2. Viral load
3. +/- E antigen
4. Abnormal liver biopsy
79
What are the differentials of abnormal LDH (3)?
1. MI
2. Hemolytic anemias
3. Tumors
80
Hep A, B, C, D or E?
| 25% of childhood and 15% of adult chronic infections will develop cirrhosis, liver cancer.
Hep B (Chronic)
81
Hep A, B, C, D or E?
| Typically asymptomatic, indolent, prolonged course until advanced liver disease develops.
Hep C
82
What testing is done for hepatocellular carcinoma and how often?
Alpha fetoprotein and liver U/S q 6 months.
83
Hep A, B, C, D or E?
| Carrier and chronic state.
Hep B
| Hep C
84
ALT or AST?
| Acute pancreatitis.
AST
85
When is PCR testing used in Hep C (3)?
1. Acute infection suspected
2. Anti-HCV ambiguous or unconfirmed
3. Infection suspected with normal LFTs
86
Should you test after giving the Hep B vaccine?
Yes, if ongoing risk of exposure. Test 4-8 weeks after 3rd vaccine dose. Anti-HBs only. Full series revaccination for non-responders. But no testing after if not adult.
87
Hep A, B, C, D or E?
| 25% of patients develop jaundice.
Hep C
88
Should you test before giving the Hep B vaccine?
Maybe. Consider prevalence in patient population. Consider cost of testing including visit and vaccine. Consider antibody testing.
89
What is the vaccine schedule for Hep A and where is it given?
2 doses. 2nd dose in 6-12 months. Deltoid in adults. Vastus lateralis in children. Safe to give with other immunizations. Use separate site.
90
Hep A, B, C, D or E?
| Incubates over 6-7 weeks.
Hep C
91
When would you not treat Hep B?
E antigen negative with normal ALT and viral load <10^5. Follow with LFTs, alpha fetoprotein q 6 months.
92
T/F ALT may fluctuate widely in Hep C. This does not predict extent of liver damage.
True
93
How long is Hep C treatment?
Type 1 = 48 weeks
| Types 2/3 = 24 weeks
94
T/F Risk of Hep B transmission is 70-90% in HBsAg+ mothers.
True
95
ALT or AST?
| Sever burns.
AST
96
IgA, IgE, IgD, IgM, or IgG?
| Responds to parasites, allergens.
IgE
97
ALT or AST?
| Alcoholic liver.
ALT
98
What is management for Hep C in children (5)?
1. Vaccinate against other hepatitis viruses
2. Track growth—can be markedly decreased in children treated with interferon and ribavirin
3. Avoid other hepatotoxic medications
4. Teach alcohol avoidance
5. Provide long-term surveillance for liver cancer/failure
99
This is unconjugated bili.
Indirect
100
IgA, IgE, IgD, IgM, or IgG?
| Aids early immune response.
IgM
101
What does this lab show in acute viral hepatitis?
| LFTs (3)
1. AST - Prejaundice increase up to several thousand units. NOT prognostic.
2. ALT - Later increase up to several thousand units. NOT prognostic.
3. ALP/LDH - Elevated.
102
Hep A, B, C, D or E?
| Infectious 4-6 weeks before symptoms and unknown how long after.
Hep B
Hep C
Hep D
103
IgA, IgE, IgD, IgM, or IgG?
| Acts as primary, long-term antibody against virus/bacteria.
IgG
104
Enzyme in cells lining liver, biliary tract, and bone.
Alkaline Phosphatase (ALP)
105
This is conjugated bili.
Direct
106
Who should receive booster doses of Hep B?
For hemodialysis patients. Test annually for anti-HBs. Administer booster if level <10 mIU/mL. Undetermined for immunocompromised, but can be considered. Not needed for vaccinated persons with normal immunity and low exposure risk.
107
Hep A, B, C, D or E?
| Self-limited. Lifelong protection. Fatalities rare.
Hep A
108
Hep A, B, C, D or E?
| Fever, jaundice, anorexia, nausea, malaise, myalgia.
Hep A
| Hep E
109
What are cofactors that increase Hep C severity (4)?
1. Alcohol
2. 40+ age time of infection
3. HIV or other coinfection
4. Male
110
Hep A, B, C, D or E?
| Most common blood-borne infection in the US.
Hep C
111
Hep A, B, C, D or E?
| Anorexia, nausea, myalgia, malaise, jaundice to fatal hepatitis.
Hep B
112
ALT or AST?
| Leaked into serum via damage to tissues or changes in cell membrane permeability.
ALT
113
IgA, IgE, IgD, IgM, or IgG?
| Activates complement.
IgM
114
Hep A, B, C, D or E?
Risk groups include IV drug users, pre-1987 clotting factor recipients, pre-1992 transfusion/organ recipients, dialysis patients, persions with HIV/HBV, persons born from 1945-1965.
Hep C
115
Hep A, B, C, D or E?
| At one point comprised 50% of viral hepatitis in US.
Hep A
116
What is the vaccine schedule for babies with Hep B+ moms?
Dose 1 within 12 hours of birth.
Dose 2 at 1 month exactly.
Dose 3 at 6 months exactly.
Test for HBsAg and antibody 2 months after 3rd dose.
117
ALT or AST?
| MI.
AST
118
ALT or AST?
| Most sensitive and specific marker for viral liver infections.
ALT
119
Hep A, B, C, D or E?
80% of infants under 2 and 50% of children have a nonspecific illness or are asymptomatic. Older children and adults have more severe symptoms.
Hep A
120
Hep A, B, C, D or E?
| Hardy. Can live on environmental surfaces up to 7 days.
Hep B
121
Hep A, B, C, D or E?
| Fever, malaise, abdominal discomfort.
Hep A
122
Elevated direct or indirect bili?
| Hemolysis
Indirect
123
Which hepatitis has vaccines (2)?
Hep A
| Hep B
124
What's the cause (4)?
| AST higher than ALT (2x or more).
1. Alcoholic hepatitis
2. Alcoholic cirrhosis
3. Liver congestion
4. Liver metastases
125
Elevated direct or indirect bili?
| Hepatic disfunction
Direct
126
ALT or AST?
| Levels are greatly increased in acute liver damage such as viral hepatitis or toxic damage.
AST
127
ALT or AST?
| Acute hemolytic anemia.
AST
128
What are differentials of abnormal alk phos (5)?
1. Vitamin D deficiency
2. Cancer
3. Cholestasis
4. Infiltrative liver disease (tumor, abscess)
5. Granuloma
129
What does this lab show in acute viral hepatitis?
| H/H?
Mild anemia.
130
Hep A, B, C, D or E?
| Jaundice may or may not appear after a few days.
Hep A
131
ALT or AST?
| Fatty liver.
ALT
132
T/F Hepatitis virus will self-resolve without treatment in children.
True
133
What med improves outcomes with liver transplant and Hep B reinfection?
HBIG (expensive). Famciclovir is less promising. Lamivudine has greater resistance. Combination therapy of HBIG and vaccine is useful.
134
Where is unconjugated bili?
Spleen
135
The largest cohort of children at risk for Hep C are?
Children of HIV positive mothers. Others include children with hemophilia and children with mothers with Hep C.
136
What are meds for Hep C treatment (6)?
1. Ribavirin
2. Pegylated interferon
3. Telaprevir
4. Boceprevir
5. Simeprevir
6. Sofosbuvir
Multiple drug-drug interactions (CYP450).
137
How long is treatment for Hep C?
6-12 months depending on genotype, viral load, livery biopsy results.
138
What does this lab show in acute viral hepatitis?
| PT
+/-
| Prolonged duration indicates impending liver failure. Need to test for specific viral markers.
139
IgA, IgE, IgD, IgM, or IgG?
| Fixes complement.
IgG
140
People born after _____ have been vaccinated against Hep A. People born before _____ are vaccinated only by risk.
2006
141
Hep A, B, C, D or E?
| No carrier or chronic state.
Hep A
| Hep E
142
Candidates for Hep B vaccine (7)?
1. All infants at birth, catch up all others < 19
2. Multiple sex partners, MSM, STDs, HIV, HCV, chronic HBV+ sexual partner
3. Health care workers
4. IV drug users
5. Dialysis patients
6. Diabetics aged 19–59 (higher incidence, poorer outcomes)
7. Travelers
143
What is the management of Hep A in peds (6)?
1. Supportive
2. Rarely causes liver failure
3. Most fully recover
4. 12 months +, vaccinate within 2 weeks of exposure
5. Under 12 months, over 40 years, immunocompromised, or chronic liver disease - IgG
144
What is post-exposure prophylaxis for Hep A (3) and when?
Required within 2 weeks of exposure.
1. Under age 40, good health = Hep A vaccine.
2. 40+, health problems = IgG (passive protection)
3. Risk group = Vaccine + IgG
145
Hep A, B, C, D or E?
| Maternal transmission is possible.
Hep B
| Hep C
146
Which hepatitis should see an increase in primary care management as opposed to specialty?
Chronic Hep C
147
Who should be tested for Hep B (6)?
1. Anyone who presents with acute liver disease
2. Sexual contacts
3. IV drug users
4. Household contacts
5. Healthcare workers
6. Residents of endemic countries (Asia, sub-Saharan Africa)
148
Anti-HBc
Total Hep B core antiBODY
149
Indicates the patient has had an acute Hep B infection within the past 6 months.
Immunoglobulin M antibody to hepatitis B core antigen
150
Indicates the patient has previous or ongoing Hep B infection in an undefined time frame.
Total hepatitis B core antibody (anti-HBc, IgM and IgG)
151
Anti-HBs
Hep B surface antiBODY
152
Indicates the patient has immunity resulting from vaccination or previous infection with Hep B.
Hepatitis B surface antibody
153
HBsAg
Hep B surface antiGEN
154
Antibody is produced in response to the core antigen later in the course of the Hep B infection and usually persists for life.
Immunoglobulin G
155
Indicates the patient has acute or chronic hepatitis B virus infection and can transmit it to others.
Hepatitis B surface antigen
