C14-Hepatite

Question 1

Markeri injurie celulara

Answer 1

GOT, GPT, GGT,LDH

Question 2

Markeri pt inflamatie

Answer 2

CRP, α2MG,
haptoglobina

Question 3

Markeri pt fibrogeneza

Answer 3

citokine
profibrinogenice
chemokine

Question 4

Markeri pt fibroza

Answer 4

ac. Hialuronic, TIMP, MMP,
laminina

Question 5

FibroTest-metoda indirecta

Answer 5

Varsta, Sex, alfa-2 macroglobulina, GGT,
apolipoproteina A1, haptoglobina,
Bilirubina totala

Question 6

Indice Forns-metoda indirecta

Answer 6

Numar trombocite, GGT, Varsta, Colesterol

Question 7

ELF-metoda directa

Answer 7

Acid hialuronic, polipeptidul terminal al
colagenului III si TIMP-1

Question 8

Factorii asociati progresiei catre ciroza si HCC la pacientii infectati cronic VHB:

Answer 8

1. Factori virali
   ■ Nivel inalt de replicare
   ■ Co-infectia VHC, VHD, HIV
   ■ Genotip C >B
   2.Factori care tin de gazda
   ■ Varsta > 40 ani sau durata indelungata a infectiei
   ■ Sexul masculin
   ■ Rasa (africana, asiatica)
   ■ Istoric familial de HCC
2. Alti factori
   ■ Consumul de bauturi alcoolice, fumatul, expunerea la aflatoxina

Question 9

Manifestari extrahepatice in VHB

Answer 9

mediate de depunerea de complexe imune: edem angioneurotic, poliarterita nodoasa, vasculita cutanata, fenomen Raynaud, glomerulonefrita, crioglobulinemie mixta
esentiala tip II

Question 10

Vaccinare VHB

Answer 10

● Eficacitatea schemei de vaccinare tripla doza este >90%
● Testarea antiHBs e recomandata la 1-2 luni post-vaccinare;
eficienta e indicata de titrul> 100 UI/ml

Question 11

Selectia pacientilor pentru terapia antivirala se face pe baza:

Answer 11

• ALT> valoarea maxima a normalului
• ADN VHB >2000 UI
• necroinflamatie moderat-severa
• preferabil inainte de atingerea stadiului cirotic

Question 12

Terapie in VHB (prima linie)

Answer 12

PEG-IFN
Analogi nucleotidici:
Entecavir
Tenofovir disoproxil fumarate (Viread)
Tenofovir alafenamide (Vemlidy)

Question 13

“Dried blood spots”

Answer 13

pot fi de asemenea utilizate ca o
alternativa la punctia venoasa, mai ales ca se pot testa atat Ac anti VHC cat si ARN VHC

Question 14

Biopsie hepatica VHC

Answer 14

● Hepatita periportala
● Steatoza
● Granuloame limfoide
● Leziuni de ducte biliare

Question 15

Selectia pentru terapia antivirala-VHC

Answer 15

● Toti pacientii ARN VHC (+) (replicativi)
● Indiferent de nivelul transaminazelor sau
activitatea inflamatorie si indiferent de stadiul
fibrozei

Question 16

Evaluarea rasp la terapia antivirala VHC

Answer 16

Prin RVS->la 12-24 sapt de la finalizarea terapiei ARN VHC nedetectabil

Question 17

Tinte terapeutice VHC-antivirale directe

Answer 17

inhibitorii de proteaze asociate NS3: evir
inhibitorii complexurilor de replicare asociate NS5A: asvir
inhibitorii NUC asoc NS5B: sofosbuvir
inhibitorii non-NUC asoc NS5B: dasabuvir