Acute and Chronic Hepatitis

Question 1

Most common cause of viral hepatitis

Answer 1

Hep A

Question 2

Transmission of hepA

Answer 2

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

Question 3

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

Answer 3

T

Question 4

How long does hepA last?

Answer 4

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

Question 5

Dx of hepA

Answer 5

HAV IgM (acute)

Question 6

Transmission of hepB

Answer 6

sexual, blood, IVA, perinatally

Question 7

Chronicity of hepB

Answer 7

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

Question 8

+ HBsAg, + HBcAb IgM or IgG

Answer 8

acute HBV

Question 9

+ HBsAG, + HBcAb IgG

Answer 9

chronic HBV

Question 10

+HBsAb

Answer 10

vaccinated

Question 11

+HBsAb, +HBcAb

Answer 11

cleared infection

Question 12

Contemporary Tx of hepatitis B

Answer 12

tenofovir, entecavir, vaccine at birth, HBIG in neonates

Question 13

Where does hepD replication take place?

Answer 13

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

Question 14

Transmission of HDV/delta agent

Answer 14

percutaneous exposure

Question 15

Transmission of HCV

Answer 15

mostly IVDA, some sexually, some transfusion

Question 16

What is the significance of anti-hcv antibody

Answer 16

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

Question 17

How many HCV become chronic?

Answer 17

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

Question 18

Hepatitis E transmission

Answer 18

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

Question 19

Markers of HEV

Answer 19

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

Question 20

Features of autoimmune hepatitis

Answer 20

hepatocellular necroinflammation, autoantibodies, hypergammaglobulinemia, responsiveness to steroids

Question 21

M/F autoimmune hepatitis

Answer 21

F>M w/biomodal distribution

Question 22

Prognosis of autoimmune hepatitis

Answer 22

40% mortality in symptomatic patients

Question 23

Spectrum of autoimmune hepatitis

Answer 23

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

Question 24

Antibodies in type 1 autoimmune hepatitis

Answer 24

ANA/SMA, SLA/LP, pANCA, ASPGR

Question 25

Antibodies in type 2 autoimmune hepatitis

Answer 25

LKM1, SLA/LP

Question 26

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

Answer 26

2

Question 27

Histologic finding in autoimmune hepatitis

Answer 27

lymphoplasmacytic interface hepatitis

Question 28

Tx of autoimmune hepatitis

Answer 28

prednisone +/- azathiporine

Question 29

PBC

Answer 29

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)

Question 30

Antibody in PBC

Answer 30

AMA

Question 31

M/F PBC and other features of patient

Answer 31

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

Question 32

Dx of PBC

Answer 32

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

Question 33

Tx of PBC

Answer 33

ursodiol, vitamins, cholesterol

Question 34

PSC

Answer 34

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

Question 35

M/F PSC

Answer 35

M>F

Question 36

antibody in PSC

Answer 36

pANCA

Question 37

Histologic finding in PSC

Answer 37

onion skin fibrosis around bile duct

Question 38

What disease do most people with PSC start off with?

Answer 38

IBD

Question 39

PSC Cancer risk

Answer 39

cholangiocarcinoma...up to 30%

Question 40

Risk factors for DILD

Answer 40

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

Question 41

2 classifications of DILD

Answer 41

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)

Question 42

Most common cause of acute liver failure in US

Answer 42

acetaminophen --> metabolite NAPQI is directly toxic (intrinsic)

Question 43

Tx of acetominophen toxicity

Answer 43

N-acetylcysteine to increase metabolism of NAPQI

Question 44

Prognosis of DILI +ALF

Answer 44

poor --> depends on drug

Question 45

Hy's Law

Answer 45

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