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Senoir paeds > Childhood Hepatitis > Flashcards

Childhood Hepatitis Flashcards

1
Q

HEPATITIS

There are three major types of hepatitis. These are:
__________ hepatitis
______________ hepatitis
__________________ hepatitis.

A

Acute hepatitis
Chronic persistent hepatitis
Chronic active hepatitis.

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2
Q

ACUTE HEPATITIS

Definition: A __________ inflammation, diffuse ___________________.

A

self-limiting; liver cell damage

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3
Q

Ætiology:

(a) Viruses – ______________________________ . EBV, CMV, Coxsackie, A & B, Parvovirus B19, etc.
(b) Other organisms: Rickettsia, mycoplasma, systemic fungal infection, septicaemia
(c) Drugs - alcohol, trichloroethylene, iron overdosage, copper sulphate, phosphorus, halothane, antituberculous drugs, antiretroviral drugs, analgesics.
(d) Poisoning – amamit phalloides (toadstool poisoning), aflatoxin (aspergillus contamination of stored food)
(e) Heart failure – intrahepatic cholestasis and centrilobular congestion→Right sided failure, hepatocellular necrosis→Acute Left ventricular failure.

A

hepatitis viruses, A, B, C, δ, E & G

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4
Q

Epidemiology

The six known hepatotropic viruses are heterogeneous group of viruses that cause similar acute clinical illness, except for the more recent _______ which appears to cause no or mild disease.

HBV is a ______ virus
HAV, HCV, HDV; HEV & HGV are ______ viruses.

_______ & _______ are not known to cause chronic illness; _______, _______, & _______ cause important chronic infections.

HGV causes (acute or chronic?) infection, but unknown adverse effects

Cases of hepatitis without identifiable cause are denoted Non-A, Non-B, Non-C.
HAV(commonest),1/3rd –HBV,HCV(20%),HDV(minority)

A

HGV ; DNA ; RNA

HAV & HEV

HBV, HCV, & HDV

chronic

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5
Q

HEPATITIS A (____________ hepatitis)-1
____________ viridae family.

A highly contagious disease, spread by ____________ and through ____________.

Infection common in conditions of ____________ and ____________.

Spread occurs readily in __________ centers.

HA rarely, if ever, transmitted by ____________ route.

A

infectious ; picornaviridae

person-to- person contact; faeco-oral route.

poor sanitation ; overcrowding.

day care centers. ; parenteral

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6
Q

Hepatitis A

It is excreted in stools for up to ___________ before onset of symptoms.

All age groups are susceptible, but most illnesses occur in ___________ and it is (milder or more severe?) than in adults.

Highest incidence occurs in children of __________ age.

A

two weeks ; childhood

Milder ; school

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7
Q

HEPATITIS A (infectious hepatitis)-2

Sub-clinical and anicteric infections common in children years of age.

Most infants are protected by _____________ during the early months of life.

Incubation period  ___________ (mean 28 days) from exposure until the appearance of __________. Mortality is (low or high?) ; patient may be incapacitated for many weeks.
Full recovery is the usual.

Fulminant hepatitis (commonly or rarely?) associated.

(Carrier or No carrier?) state, no chronic liver damage. Immunity is lifelong.

A

maternal antibody

4-6 weeks ; jaundice.

low; ; rarely

No carrier state,

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8
Q

Hepatitis A in pregnancy or at the time of delivery does not result in clinical disease in the newborn, in teratogenic effects, or in increased risk of abortion.

T/F

A

T

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9
Q

Hepatitis B Virus is a (small or large ?) (DNA or RNA?) virus

The term serum hepatitis refers to the most common method of transmission, percutaneous or mucous membrane inoculation also occur.

Major route of transmission is by ___________________________.
Even a prick with a contaminated needle can transmit infection.
Those with persistent infection – hepatitis B _________ , represent the main pool of infectious individuals.

Peak incidence occurs during _________ period, _______ childhood, and adolescence

A

small ; DNA

inoculation with blood of carriers.

carriers ; perinatal

early

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10
Q

HEPATITIS B (Serum Hepatitis)-2

Higher rate of infection in children with __________ living in institutions cf those living in the home with families.

Incubation period is __________ (mean 3 months).
No seasonal prevalence.
Recent renewed awareness of the risk of transmission of viral infections through percutaneous exposure, was due mainly to the ________________.
However, the risk of transmission of HIV through this route is relatively (low or high?) compared with other infectious agents such as hepatitis B and C.

A

Down syndrome

2-5 months ; HIV pandemic.

low

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11
Q

Hepatitis B

Is transmitted via __________ , ______ally, ______ally or ______ally

In high endemic areas, 50-90% of the population has serological evidence of previous HBV infection

A

body fluids

parenter; sexu; perinat

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12
Q

Major routes of ransmission are horizontal _______________ ( _____abrasions such as impetigo, scabies, and infected insect bites provide the route into the body of susceptible children with whom they have skin to skin contact such as during wrestling; the sharing of toothbrushes and other personal items)
Vertical transmission

A

child- to-child

skin

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13
Q

Perinatal Transmission

Perinatal Transmission of Hepatitis B
Transmission: __________ / __________ / __________ contact
Risk: __________
HBeAg __________ (90%)
__________, 3rd trimester (70%)
Seqeulae: __________ carriers
__________
Hepatocellular

A

Intra-uterine / Labour / maternal contact

Maternal viraemia

positive carrier (90%)

Acute hepatitis 3rd trimester (70%)

Asymptomatic carriers
Chronic liver disease

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14
Q

HEPATITIS B (Serum Hepatitis)-3
Presence of HbeAg in maternal carriers correlate highly with ______________________________ . Transmission through breastfeeding is ___________.

Hepatitis B infection is (milder or more intense ?) in infants and children and is frequently unrecognized.

A

transmission of infection to their offspring

unproven; milder

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15
Q

Hepatitis B

About 90% of perinatal infections become ____________ ,1-5years(30-50%), cf 5% of infections in adults.

Risk of chronic liver disease or hepatocellular carcinoma later in life is _____eased in these infants.

A

chronic carriers

incr

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16
Q

Consequence of infection of Hepatitis B

Acute infection- asymptomatic or symptomatic (icteric or anicteric)

Chronic infection - inactive chronic infection; chronic active hepatitis; cirrhosis; hepatocellular carcinoma

Risk of developing chronic infection is determined by the ________ that infection occurs
Infants > ____%;
Early childhood < 5years _______%
Older child/adolescent/Adults <_____%; Elderly _____-____%

A

age ; 90%;

25-50%

3-5%

20-30%

17
Q

Hepatitis C Virus

Route of transmission - __________,___________, or ____________

Risk group include people with _________________,_______________ , intravenous drug users, etc.

Incubation period ________ (mean 8 weeksug).

A

percutaneous inoculation, exposure to blood or blood products.

haemophilia, haemoglobinopathies

2-24 weeks

18
Q

Clinical manifestations of Hepatitis C

similar to other hepatitis viruses. Acute disease (mild or severe?) and insidious in onset.
Only ____% of patients become jaundiced. Fulminant liver failure (commonly or rarely?) occurs.
About ____% of cases develop chronic liver disease.

A

Mild; 10

Rarely

85

19
Q

Hepatitis Delta virus

HDV occurs in only a small percentage of children who must _______________________.

It is An __________ (_________) RNA virus that multiply only in presence of ____________ - requires ________ (__________) to establish infection.

Infections may be concurrent with hepatitis B causing _____________ , which usually resolved.

A

have HBV infection.

incomplete ;defective

HbsAg ;envelope

co infection

20
Q

Hepatitis D

More importantly, can occur as _______________ in carriers of HB virus, causing _________ infection, and potentially severe hepatitis.

Infection is chronic in _____% of super-infection cases but only ___% in co- infection with worsening of chronic liver disease.
Transmission is by _________ inoculation. Incubation period ____________ (mean 7 weeks).
Symptoms similar to, but usually (more or less?) severe than other viruses.
May result in fulminant hepatitis.
Increases the likelihood of chronic liver disease in HbsAg carriers.

A

super-infection ; intercurrent

90% ; 2%

parenteral ; 2-4 months ;more

21
Q

Hepatitides E & G viruses

Hepatitis E Virus accounts for about 10-30% of non-A, non-B, non-C hepatitis.

The peak age incidence is ______ years.

Its route of transmission is ______ and has caused ______ epidemics in southeast and central Asia, Africa, and North America.

Incubation period similar to that of hepatitis ____, and ____ carrier state has been reported.

Associated with high case fatality rate in ______________.

A

15-34 years.

faeco-oral ; waterborne

hepatitis A ; no

pregnant women.

22
Q

Hepatitis G Virus: is new and no clinical infection has been associated with it yet.

A

Okay

23
Q

Management

History taking Relevant history:

A

percutaneous injections

24
Q

CLINICAL MANIFESTATIONS

In ___________ and ___________, hepatitis resemble the more severe disease seen in adults.

Hepatitis A and E tend to be (acute or chronic ?) in onset, hepatitis B & C have insidious onset.

Pre-icteric phase: Initial symptoms often non-specific - _______, _______, and _______,
GI Symptoms:- nausea, _______, ________, abdominal discomfort

These may be mild or go unnoticed in children.

A

older children ; adolescents

acute

fever ; headache ; fatigue,

emesis ; anorexia

25
Q

CLINICAL MANIFESTATIONS-2

(Sharp or Dull?) right upper quadrant pain or epigastric ____________ - may be exaggerated by ____________ or ____________.

Icteric phase: __________ and ________ coloured urine usually after onset of systemic symptoms, but may be presenting signs in children.

____________-coloured stools.

____________ 2° poor nutrition common than ____________.

Young infants may fail to ____________.

A

Dull ; fullness

exercise ; jolting.

Jaundice ; dark

Light or clay

Constipation ; diarrhoea.

gain weight.

26
Q

Clinical manifestations of Hepatitis

During convalescence, - gradual return of appetite, exercise tolerance, and feeling of well being.
These presentation is typical of Hepatitis _____ infection.
Hepatitis B infection may be heralded by ___________ or ____________

A

A; althralgia

skin eruption.

27
Q

CLINICAL MANIFESTATIONS

Papular acrodermatitis.

Course of infection often _________ and lasts (shorter or longer?) than hepatitis A.

___________ or ___________ may appear during the convalescence.

Other symptoms are similar to that of Hepatitis A.

A

longer

Haematuria or proteinuria

28
Q

Clinical manifestations

Physical examination reveals :

_________ skin and mucous membranes.

(Tender or Not tender?) hepatomegaly

Splenomegaly and Lymphadenopathy are (common or rare?) .

A

Icteric skin

Tender ; common.

29
Q

Laboratory data

LFT– SerumBilirubin, Serum Transaminases, albumin, PT.
_____eased Serum transaminases Liver transaminases suggests the extent and duration of injury – (AST or ALT ?) is more specific than (AST or ALT?) .

Tests of synthetic function (_________ ans _____________ concentration) assesses severity of the hepatitis.

A

Increased

ALT ; AST.

PT ; serum albumin

30
Q

Laboratory data

Hyperbilirubinaemia – ______eased direct and indirect serum bilirubin, Direct fraction more so in the early stage.
_____eased serum Urobilinogen and subsequently, in urine

FBC-Mild leucopaenia with relative lymphocytosis and atypical lymphocytes.

Hepatitis A,B,C viral screening.
Liver biopsy- Chronic hepatitis.

A

Increased

Increased

31
Q

Specific Serological tests
Antigens
List them

Antibodies
Anti-HBc(_____illness)
Anti- _________ (distinguishes acute infection/chronic or carrier)
Anti-_____(immunity)
Anti______

A

u HBsAg(onset)(>6 months indicates carrier)
u HBeAg
u HBcAg

acute; HBcIgm

HBs; HBe

32
Q

Specific serological tests

_________,__________, and ___________ are detectable early prior to the onset of icterus.

__________ is detected during the acute illness.

Presence of ________ distinguish between an acute infection and a carrier.

————- disappears in resolving infection and _________ appears.

Presence of __________ denotes an increased risk of transmission of HBV infection.

Presence of __________ only, indicative immunity.

In carriers, _________ persists indefinitely.

If _________ remains detectable after _________ patient has become a hepatitis B virus carrier.

A

DNA polymerase, HBeAg and HBsAg

Anti-HBc; anti-HBcIgM

HBeAg; anti-HBe; HBeAg

Anti-HBs; HBsAg

HBsAg; 6 months

33
Q

Prevention of Hepatitis-1

These include:
_____________
Simple _________ precautions to control HAV &HEV.
___________ of HBeAg positive carriers
Careful handling and _________ of blood, blood contaminated materials, and instruments.

A

Contact tracing

hygienic ; Counselling

screening

34
Q

Prevention of Hepatitis

Passive immunization; Hepatitis A- ____________________________ , Hepatitis B-______________________

Active immunization-vaccine- a ________ dose of _________________ vaccine provides ____-term protection, _____ vaccine is also effective.(plasma derived,Recombinant)
Screen pregnant women for HB virus. If HbsAg +ve, give baby ________ and _________ within ________ of birth.
Repeat HB vaccine at ________ and ________ of age.

A

normal human immunoglobin ; immunoglobulin (HBIG)

single; inactivated HA ; long; HB

HBIG & HB vaccine ; 12 hours

1 month ; 6 months

35
Q

Prevention of Hepatitis-2

Give all other infants Hepatitis B vaccine from age _________ of life.

Measures directed at HB virus also generally effective against _______ and _______

A

6-8 weeks

HCV & HDV

36
Q

Treatment of Hepatitis:
There is no specific therapy
_________ during the icteric phase appears helpful
Avoid _______
Avoid ___________

Diet- Light diet at the start of illness is preferable. Fruits, vegetables, sugars are well tolerated.

A

Bed rest; sedatives

corticosteroids

B-complex

37
Q

Prognosis of Hepatitis

___________ percent of children recover without sequelae in HAV infection.

Also, 95% become HBsAg negative at the time of clinical recovery in HBV infection.

________________________ may occur in children with Down syndrome, leukaemia and those undergoing chronic haemodialysis.

Persistence of neonatally acquired HBsAg is common, and presence of HBeAg in the HBsAg carrier convey a _______ prognosis.

70-85% of hepatitis C develop ________________

A

Ninety five

Persistent asymptomatic antigenaemia

poorer

chronic liver disease

38
Q

COMPLICATIONS

Most children recover (eventually or uneventfully?) from hepatitis

A few suffer serious or acute chronic complications

These include:
___________
_____________
________________
Aplastic anaemia
___________ especially in HBV infection
Hepatocellular carcinoma in young adulthood.

A

Fulminant hepatic failure
Chronic hepatitis
Liver cirrhosis

Nephrosis

Senoir paeds (25 decks)

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