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IM GASTRO > Acute Viral Hep > Flashcards

Acute Viral Hep Flashcards

1
Q

All hepatitis viruses are RNA viruses except for ____ which is a DNA virus

A

Hep B

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2
Q

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
A

Prodromal Phase

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3
Q

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
A

Recovery Phase

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4
Q

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
A

Icteric Phase

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5
Q

Lab Features of VIral Hepatitis
- ALT/AST (SGPT/SGOT)
- Bilirubin
- aminotransferase
- neutrophils
- lymphocytes
-protime

A
  • 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
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6
Q
  • 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
A

Hepatitis A

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7
Q
  • 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
A

Hepatitis B

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8
Q

Hepatitis B: Serologic and Virologic Markers

  • First virologic marker detected at 1-12 (8-12) weeks
A

HBsAg

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9
Q

Hepatitis B: Serologic and Virologic Markers

  • establishes HBV infection when HBsAg is undetectable at low levels
A

IgM Anti HBc

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10
Q

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
A

Anti-HBc

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11
Q

Hepatitis B: Serologic and Virologic Markers

  • not detectable in serum (intracellular)
A

HBcAg

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12
Q

Hepatitis B: Serologic and Virologic Markers

  • detectable after disappearance of HBsAg; Protective antibody
A

Anti-HBs:

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13
Q

Hepatitis B: Serologic and Virologic Markers

  • appears shortly after HBsAg; marker for viral replication
A

HBeAg

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14
Q
  • 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
A
  • cytopathic
  • Cellular immune responses
  • HBcAg & HBeAg
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15
Q

HBV Infection

  • Robust immune response with acute hepatic illness
  • Chronicity is uncommon
  • Hepatocellular carcinoma risk is low
A

later years of life

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16
Q

HBV Infection

  • High level of immunologic tolerance
  • Absence of an acute hepatic illness
  • Chronic lifelong infection
  • Culminates in cirrhosis and hepatocellular carcinoma
A

neonatal period

17
Q

Clinical and laboratory features that suggest a complicated course in Hep B:

A
  • Advanced age with serious comorbiditiews
  • Ascites, peripheral edema, hepatic encephalopathy © poor prognosis
  • Prolonged PT, low albumin, hypoglycemia, hyperbilirubinemia
18
Q
  • 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
A

Fulminant hepatitis

19
Q

Clinical and laboratory features that suggest progression of acute to chronic HBV infection

A
  • 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
20
Q

Preexposure prophylaxis for Hep B:

A

HBV Vaccine 3 deltoid injections at 0, 1, and 6 months

21
Q

Postexposure prophylaxis for Hep B:

A

HBIG (0.06ml/kg) + HB vaccine course

22
Q

Perinatal Pophylaxis for Hep B:

A

single dose of 0.5m! IM immediately after birth followed by HB vaccine course

23
Q
  • Enveloped
  • Hepacivirus
  • Flaviviridae
  • Percutaneous inoculation
  • Formerly labeled as non-A, non-B hepatitis
  • Diagnosis: Anti-HCV, HCV RNA (gold standard)
A

Hepatitis C

24
Q

Transmission of Hep C

A
  • transfusion,
  • injection drug use,
  • in hemodialysis units
25
Q

Most frequent indication for liver transplant

A

Hep C

26
Q
  • 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
A

Hepatitis D

27
Q

massive hepatic necrosis seen with HDV and HBV superinfection

A

Fulminant hepatitis

28
Q
  • 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
A

Hepatitis E

29
Q

Treatment
- Fulminant Hepatitis with jaundice and coagulopathy in Hep E

A

Ribavirin

IM GASTRO (10 decks)

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