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G.I & Nutrition > Acute and Chronic Hepatitis > Flashcards

Acute and Chronic Hepatitis Flashcards

1
Q

Most common cause of viral hepatitis

A

Hep A

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2
Q

Transmission of hepA

A

fecal-oral –> intestine –> PV –> liver –> hepatocyte replication

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3
Q

T/F hepA is highly resistant to degradation by environmental factors

A

T

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4
Q

How long does hepA last?

A

acute only –> no chronic disease, rare fulminant infection, benign, self-limited

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5
Q

Dx of hepA

A

HAV IgM (acute)

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6
Q

Transmission of hepB

A

sexual, blood, IVA, perinatally

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7
Q

Chronicity of hepB

A

5% get chronic infection among adults, 90% of children get chronic infection

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8
Q

+ HBsAg, + HBcAb IgM or IgG

A

acute HBV

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9
Q

+ HBsAG, + HBcAb IgG

A

chronic HBV

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10
Q

+HBsAb

A

vaccinated

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11
Q

+HBsAb, +HBcAb

A

cleared infection

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12
Q

Contemporary Tx of hepatitis B

A

tenofovir, entecavir, vaccine at birth, HBIG in neonates

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13
Q

Where does hepD replication take place?

A

only liver –> HepB is necessary for coating HDV virions for spreading cell to cell

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14
Q

Transmission of HDV/delta agent

A

percutaneous exposure

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15
Q

Transmission of HCV

A

mostly IVDA, some sexually, some transfusion

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16
Q

What is the significance of anti-hcv antibody

A

not immunity like in the case of HBV…just implies you’ve had or have it

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17
Q

How many HCV become chronic?

A

most (75-85%)…30% leading to cirrhosis

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18
Q

Hepatitis E transmission

A

enteric –> fecal-oral –> pregnant women at high risk

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19
Q

Markers of HEV

A

IgM anti-HEV during symptomatic course w/elevated ALT, IgG kicks in soon after

20
Q

Features of autoimmune hepatitis

A

hepatocellular necroinflammation, autoantibodies, hypergammaglobulinemia, responsiveness to steroids

21
Q

M/F autoimmune hepatitis

A

F>M w/biomodal distribution

22
Q

Prognosis of autoimmune hepatitis

A

40% mortality in symptomatic patients

23
Q

Spectrum of autoimmune hepatitis

A

acute hepatitis (25-30%, young, icteric acute viral-like picture), asymptomatic (15-20%), fulminant failure (potentially reversible, 5%)

24
Q

Antibodies in type 1 autoimmune hepatitis

A

ANA/SMA, SLA/LP, pANCA, ASPGR

25
Q

Antibodies in type 2 autoimmune hepatitis

A

LKM1, SLA/LP

26
Q

Which is more common among autoimmune hepatitis, Type 1 or 2?

A

2

27
Q

Histologic finding in autoimmune hepatitis

A

lymphoplasmacytic interface hepatitis

28
Q

Tx of autoimmune hepatitis

A

prednisone +/- azathiporine

29
Q

PBC

A

primary biliary cholestasis –> ongoing inflammatory destruction of interlobular and septal bile ducts leading to chronic cholestasis and BILIARY cirrhosis (most patients dont have liver cirrhosis)

30
Q

Antibody in PBC

A

AMA

31
Q

M/F PBC and other features of patient

A

F >M, 50 years old…elevated alk phos, possible asymptomatic, fatigue, pruritis, xanthelasma, hepatosplenomegaly, hyperpigmentaiton, jaundice

32
Q

Dx of PBC

A

AMA, elevated Alkphos, damage to epithelia of small bile ducts, ductopenia, noncaseating granulomas

33
Q

Tx of PBC

A

ursodiol, vitamins, cholesterol

34
Q

PSC

A

primary sclerosing cholangitis –> chronic disease of unknown etiology with inflammation and fibrosis of biliary tree

35
Q

M/F PSC

A

M>F

36
Q

antibody in PSC

A

pANCA

37
Q

Histologic finding in PSC

A

onion skin fibrosis around bile duct

38
Q

What disease do most people with PSC start off with?

A

IBD

39
Q

PSC Cancer risk

A

cholangiocarcinoma…up to 30%

40
Q

Risk factors for DILD

A

age, gender (f), obesity, alcohol, history, polypharmacy

41
Q

2 classifications of DILD

A

intrinsic (dose dependent, predictable, non-genetic, hepatocellular injury by toxic metabolite)
vs.
idiosyncratic (not dose dependent or predictable, gene link, cholestatic/mixed effect, hypersensitivity type)

42
Q

Most common cause of acute liver failure in US

A

acetaminophen –> metabolite NAPQI is directly toxic (intrinsic)

43
Q

Tx of acetominophen toxicity

A

N-acetylcysteine to increase metabolism of NAPQI

44
Q

Prognosis of DILI +ALF

A

poor –> depends on drug

45
Q

Hy’s Law

A

in DILI with ALF, hepatocellular injury + jaundice leads to 10% mortality

G.I & Nutrition (43 decks)

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