Chapter 3.25 Hepatitis Viridae

Question 1

What infection is caused by viral hepatitis?

Answer 1

infection of liver hepatocytes by viruses

Question 2

What are the 5 known RNA viruses that infect the liver?

Answer 2

Hep A
Hep C
Hep D
Hep E
Hep G

Question 3

What is the 1 DNA virus that infects the liver?

Answer 3

Hep B

Question 4

Which hepatitis infections are transmitted by fecal-oral route?

Answer 4

Hep A and E

*A and E are at both ends of ABCDE so they are transmitted by both ends of the GI tract: A=anal E=enteric

Question 5

How are most hepatitis infections transmitted?

Answer 5

via blood-to-blood (parenteral) contact

*BCD= BlooD

Question 6

What viruses can cause acute viral hepatitis?

Answer 6

all- ABCEG

Question 7

What viruses can cause chronic viral hepatitis?

Answer 7

HBV, HCV, HDV

Question 8

What is the clinical manifestation timeline of a patient with acute viral hepatitis?

Answer 8

1- systemic symptoms- fatigue, low grade fever, muscle/joint aches, cough, runny nose
2- (1-2 weeks)- jaundice (bilirubin buildup), liver cell necrosis
3- painful enlarges liver, high liver-enzyme count

Question 9

What enzymes are produced when hepatocytes necrose?

Answer 9

AST- aspartate aminotransferase
ALT- alanine aminotransferase
GGT- gamma-glutamyl transpeptidase
alkaline phosphatase

Question 10

What elevated levels in the blood signal acute viral hepatitis?

Answer 10

AST, ALT, GGT, alkaline phosphatase

Question 11

Why is chronic viral hepatitis difficult to diagnose?

Answer 11

patient is asymptomatic with only enlarged tender liver and mildly elevated liver enzymes

Question 12

What is the difference in enzyme levels between acute viral hepatitis and stone blocking bile duct?

Answer 12

acute viral hepatitis- AST and ALT are high and moderaly GGT and alkaline phosphatase (initially) then they all rise higher (later)
stone- GGT and alkaline phosphatase high only

Question 13

What is the shape of Hep A virus?

Answer 13

naked icosahedral capsid with + single stranded RNA

*in Pico family

Question 14

Examples of Hep A transmission?

Answer 14

infected food handler contaminating food after poor hand washing
persons ingesting fecal contaminated water
close person-to-person contact in fay care

Question 15

Who are most frequently infected with Hep A?

Answer 15

young children

Question 16

What serology can be done to distinguish Hep A?

Answer 16

detect anti-HAV IgM and anti-IgG in serum

*HAV is antigenic capsule resulting in host anti-HAV IgM and anti-HAV IgG

Question 17

Where does Hep B virus colonize in the body?

Answer 17

body fluids- semen, urine, saliva, blood, breast milk

Question 18

What is the shape of HBV

Answer 18

Big virus with enveloped icosahedral capsid and double stranded circular DNA
*HBV= Big and Bad

Question 19

What is the intact HBV virus called?

Answer 19

Dane particle (Big like a great DANE)

Question 20

What does the Hep B surface antigen look like?

Answer 20

filamentous structures that have and envelope and capsid proteins

Question 21

Why is Hep B surface antigen important?

Answer 21

having anti-HBsAg means a patient is immune

Question 22

What is the marker for active Hep B disease and highly infectious state?

Answer 22

HBeAg

Question 23

What is the relationship between pregnant mothers and Hep B?

Answer 23

pregnant mothers with HBeAg will almost always transmit HBV to offspring

Question 24

How is HepB transmitted?

Answer 24

from blood-to-blood
non-oral transmission called parenteral transmission
ex. needle sharing, accidental medical exposure, sexual contact, blood transfusions

Question 25

What kinds of hepatitis can Hep B cause?

Answer 25

acute hepatitis, fulminant hepatitis, chronic hepatitis, and co-infection with hepatitis delta virus

Question 26

What are the 3 kinds of Chronic hepatitis?

Answer 26

1. asymptomatic carrier- never develops antibodies and harbors virus without injury 2. chronic-persistent hepatitis- patient with low-grade hepatitis 3. chronic active hepatitis- has acute hepatitis state that continues without normal recovery for 6-12 months

Question 27

How does liver injury occur from HBV?

Answer 27

cell-mediated immune system attack on HBV | *immune complexes of antibody and HBsAg deposit in tissues and activate immune system

Question 28

What cancer can be a complication of HBV?

Answer 28

primary hepatocellular carcinoma

Question 29

What permanent damage to the liver can occur from HBV?

Answer 29

cirrhosis

Question 30

What form of hepatitis is occurring if serology testing has HBsAg present?

Answer 30

LIVE virus and infection (chronic or acute)

Question 31

What form of hepatitis is occurring if serology testing has anti-HBsAg present?

Answer 31

immune, cure, no active disease

Question 32

What form of hepatitis is occurring if serology testing has HBcAg present?

Answer 32

use to understand how long the infection has been ongoing

Question 33

What form of hepatitis is occurring if serology testing has IgM anti-HBcAg or IgG anti-HBcAg present?

Answer 33

IgM - acute | IgG - chronic

Question 34

What form of hepatitis is occurring if serology testing has HBeAg present?

Answer 34

High infectivity

Question 35

What are the characteristics of HDV?

Answer 35

RNA helical shaped virus transmitted parenterally and can only replicate with the help of HBV

Question 36

How does HDV use HBV for help?

Answer 36

HDV uses HBV's envelope, HBsAg | *HBV + HDV = Big Bad Dude

Question 37

What is the activity of HDV without HBV?

Answer 37

defective

Question 38

What is the superinfection that HDV can cause?

Answer 38

HDV infects people with chronic HBV | *causes acute hepatitis in a patient who already is chronically infected with HBV

Question 39

What hepatitis is the leading cause of chronic hepatitis in the US?

Answer 39

Hep C

Question 40

What is the shape of Hep C?

Answer 40

enveloped icosahedral RNA virus in flavivirus family

Question 41

How is HCV transmitted?

Answer 41

parenterally primarily through injection of drugs

Question 42

What is the incubation period for Hep C?

Answer 42

6-12 weeks

Question 43

What is the clinical presentation of patient with HPV

Answer 43

acute infection- asymptomatic | chronic infection - chronic hepatitis

Question 44

How to diagnose HCV?

Answer 44

test for anti-HCV antibodies that is detectable in 6-8 weeks

Question 45

Which hepatitis is known as the non-A hepatitis?

Answer 45

Hep E

Question 46

How is Hep E transmitted?

Answer 46

fecal-oral route- usually through water contamination

Question 47

What are the characteristics of Hep G?

Answer 47

RNA virus in the flavivirus family - transmitted by transfusion and parenteral routes - not conclusively known to cause liver disease