Acute Viral Hep Flashcards
All hepatitis viruses are RNA viruses except for ____ which is a DNA virus
Hep B
Phase of Viral Hepatitis
- Systemic and variable
- Constitutional: anorexia, nausea/vomiting, fatigue, malaise, arthralgia, myalgias, headache, pharyngitis, cough, coryza, fever
- Precedes jaundice by 1-2 weeks
- Dark urine and clay-colored stools: 1-5 days prior to jaundice
Prodromal Phase
Phase of Viral Hepatitis
- Constitutional symptoms disappear
- Liver enlargement and biochemical abnormalities persist
- 2-12 weeks; prolonged on Hep B & C
- Complete clinical and biochemical recovery
+ Hepatitis A: 1-2 months
+ Hepatitis B & C: 3-4 months (uncomplicated) - Uncomplicated Hepatitis B infection is 95-99% self-limited
- Hepatitis C is 15-20% self-limited
Recovery Phase
Phase of Viral Hepatitis
- With the onset of clinical jaundice, constitutional symptoms usually diminish
- Weight loss (2-2.5kg)
- Liver tenderness, RUQ discomfort
- Splenomegaly and cervical lymphadenopathy in 20% of cases
Icteric Phase
Lab Features of VIral Hepatitis
- ALT/AST (SGPT/SGOT)
- Bilirubin
- aminotransferase
- neutrophils
- lymphocytes
-protime
- Prodromal phase: ALT/AST (SGPT/SGOT) increase and precedes rise in bilirubin
+ Does not correlate with liver damage
+ ~400-4000IU - Bilirubin continue to rise despite falling aminotransferase levels
- Transient neutropenia and lymphopenia followed a relative lymphocytosis
- Protime
+ Prolongation reflects severe hepatic synthetic defect and extensive hepatocellular necrosis
- Nonenveloped, Icosahedral
- Hepatovirus
- Picornaviridae
- Fecal oral route
- Poor personal hygiene and Overcrowing
- Contaminated food, water, milk
- No carrier state has been identified for HAV
- Dx: IgM anti-HAV
Hepatitis A
- Nonenveloped
- Double-shelled, spherical
- Hepadnavirus
- Flaviviridae
- Percutaneous inoculation
- HBsAg identified in almost every body fluid
- Chronic HBV infected individuals constitute the main reservoir of HBV
Dx: Acute: HBsAg, anti-HBc IgM
Chronic: HBsAg, anti-HBc IgG
Hepatitis B
Hepatitis B: Serologic and Virologic Markers
- First virologic marker detected at 1-12 (8-12) weeks
HBsAg
Hepatitis B: Serologic and Virologic Markers
- establishes HBV infection when HBsAg is undetectable at low levels
IgM Anti HBc
Hepatitis B: Serologic and Virologic Markers
- detectable in serum 1-2 weeks after appearance of HBsAg and weeks to months before appearance of Anti-HBs
Anti-HBc
Hepatitis B: Serologic and Virologic Markers
- not detectable in serum (intracellular)
HBcAg
Hepatitis B: Serologic and Virologic Markers
- detectable after disappearance of HBsAg; Protective antibody
Anti-HBs:
Hepatitis B: Serologic and Virologic Markers
- appears shortly after HBsAg; marker for viral replication
HBeAg
- HBV is not directly ___
- ___ is involved in the pathogenesis of HBV-related liver injury
- viral target antigens that invite cytolytic T cells to destroy HBV-infected hepatocytes
- cytopathic
- Cellular immune responses
- HBcAg & HBeAg
HBV Infection
- Robust immune response with acute hepatic illness
- Chronicity is uncommon
- Hepatocellular carcinoma risk is low
later years of life
HBV Infection
- High level of immunologic tolerance
- Absence of an acute hepatic illness
- Chronic lifelong infection
- Culminates in cirrhosis and hepatocellular carcinoma
neonatal period
Clinical and laboratory features that suggest a complicated course in Hep B:
- Advanced age with serious comorbiditiews
- Ascites, peripheral edema, hepatic encephalopathy © poor prognosis
- Prolonged PT, low albumin, hypoglycemia, hyperbilirubinemia
- most feared complication of hepatitis
- Massive hepatic necrosis
- > 50% of cases are due to HBV with HDV co infection
- Occur primarily in older adults and persons with chronic liver disease
- > 80% mortality
Fulminant hepatitis
Clinical and laboratory features that suggest progression of acute to chronic HBV infection
- Lack of complete resolution of anorexia, weight loss, fatigue, hepatomegaly
- Bridging/interace or multilobular hepatic necrosis on liver biopsy
- Failure of aminotransferases, bilirubin, and globulin to normalize within 6-12 mos
- Persistence of HBeAg > 3 months or HBsAg > 6 months after acute hepatitis
Preexposure prophylaxis for Hep B:
HBV Vaccine 3 deltoid injections at 0, 1, and 6 months
Postexposure prophylaxis for Hep B:
HBIG (0.06ml/kg) + HB vaccine course
Perinatal Pophylaxis for Hep B:
single dose of 0.5m! IM immediately after birth followed by HB vaccine course
- Enveloped
- Hepacivirus
- Flaviviridae
- Percutaneous inoculation
- Formerly labeled as non-A, non-B hepatitis
- Diagnosis: Anti-HCV, HCV RNA (gold standard)
Hepatitis C
Transmission of Hep C
- transfusion,
- injection drug use,
- in hemodialysis units
Most frequent indication for liver transplant
Hep C
- Deltavirus
- Defective Ss-RNA
- Requires helper function of HBV
- Percutaneous inoculation
- Duration of HDV infection is determined by the duration of HBV infection
- HDV infection suppresses HBV infection
- Diagnosis: Anti-HDV, HDV RNA
Hepatitis D
massive hepatic necrosis seen with HDV and HBV superinfection
Fulminant hepatitis
- Nonenveloped icosahedral
- Hepevirus
- Hepeviridae
- Enteric
- Epidemic or Enterically-transmitted non-A, non-B hepatitis
- Virus detected in stool, bile, and liver
- Excreted in stool during the late incubation period
- Diagnosis: IgM/IgG Anti-HEV
Hepatitis E
Treatment
- Fulminant Hepatitis with jaundice and coagulopathy in Hep E
Ribavirin
