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Z MD1 GI block > Disease of the liver > Flashcards

Disease of the liver Flashcards

1
Q

which cells does the Hep E virus effect

A

hepatocytes and Kupffer cells

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2
Q

how is Hep C prevented

A
  • blood donor screening - risk behaviour modification
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2
Q

what is HBeAg

A

pre-core region protein of the C reading frame

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3
Q

how long is Hep E secreted in the faeces before symptoms occur

A

2 weeks

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4
Q

which Hep viruses can cause chronic infection

A

B, C and D

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4
Q

explain immunity to Hep c

A

there isnt any there is no protective antibody response identified

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5
Q

how do you diagnose acute viral hepatitis

A
  • serological tests - ELISAs - test for IgM or IgG antibody to viral proteins - nucleic acid tests - PCR from blood/faeces
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5
Q

complications of Hep A

A
  • fulminant hepatitis - cholestatic hepatitis
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5
Q

why is Hep A vaccine expensive to produce

A
  • only grows in diploid cells (only has a limited number of generations) - needs to be tested that the vaccine is actually inactivated
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5
Q

structure of the Hep E virus

A
  • non-enveloped - icosahedral shape - +ve sense RNA
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5
Q

incubation period of hep c

A

6-7 weeks (2-26)

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6
Q

how can you tell the difference between acute and chronic serological response to hepatitis A

A

presence of IgG or IgM antibodies - IgM first - then wains - IgG later –> increases and then stays high

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6
Q

how is Hep D prvented

A
  • pre/post exposure immunization - risk behaviour modification
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7
Q

incubation period of Hep A

A

average 30 days (15-50)

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8
Q

what is the family name of the hepatitis A virs

A

Picornaviridae

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10
Q

structure of the Hep A virus

A
  • non-enveloped - outer protein capsid - +ve sense RNA
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11
Q

Distribution of chronic Hep B virus worldwide

A

high prevalence in Asia and Africa

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12
Q

vaccination for HBV also protects you against

A

HDV

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13
Q

3 modes of transmission for hep B

A

Sexual parenteral (IDU, HCW) perinatal

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14
Q

in which part of the hepatocyte does hepatitis replicate

A

in the cytoplasm (RNA virus)

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15
Q

what is the life cycle of Hep A and Hep E viruses

A

transmitted from the bile and faeces into the environment –> contaminates food/water –> ingested –> replicates in intestinal epithelia –> viremia –> liver –> massive replication in the hepatocytes –> secreted into the bile duct –> faeces

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16
Q

what is the most likely hepatitis virus that can be transmitted from sexual intercourse

A

Hep B

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16
Q

for diagnosis what is HBeAG used for

A

indicates active replication of virus and therefore effectiveness of therapy

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18
Q

what is the main acute viral hepatitis

A

hep A

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19
Q

at what time do the symptoms of Hep A appear

A

coincide with the emergence of the immune response against the virus

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20
Q

which specific gene SNP is associated with HCV recovery

A

IL28B C/C - predicts spontaneous clearance and sustained virological response

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21
Q

which areas of the world have the highest rates of Hep A

A

in countries with poorer sanitation - faecal oral spread more readily facilitated

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21
Q

how many times more prevalent is Hepatitis compared to HIV in Australia and in Victora

A

Australia - 18x Victoria - 16x

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22
Q

what is the gold standard for diagnosis of hepatitis

A

ELISA - only test that tells you about timing of the infection (change in antibodies)

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22
Q

Hep A prevention

A
  • sanitation - immune globulin - inactivated vaccine
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22
Q

what is the family of the Hep E virus

A

hepeviridae family

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23
Q

what is the age relationship of getting chronic infection of hep b

A
  • less than 5 –> 30-90% change of having chronic infection - more than 5 –> 2-10%
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24
Q

how is HBV vaccine made

A

now in yeast (used to be purified from blood and then inactivated)

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25
Q

what causes liver damage due to hepatitis

A

the immune response to the virus

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26
Q

treatment for Hep E

A

supportive therapy

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28
Q

how is the Hep A virus inactivated for the vaccine

A

with formalin

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29
Q

what proportion of children under 5 show jaundice when catching hep b

A

less than 10%

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30
Q

how is Hep B prevented

A

pre/post exposure immunisation

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31
Q

which virus is more common? Hep B or Hep C?

A

Hep C

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33
Q

treatment for Hep A

A

supportive rehydration and nutrition

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34
Q

which state in Australia has the highest rate of Hep A

A

northern territory - high prevalence in Indigenous communitees

34
Q

what is the difference in serology between acute and chronic infections of hep b

A

acute - surface antigen level increases and then decreases to nothing chronic - surface antigen level increases and stays high. Also HBeAg stays high

35
Q

structure of hep b

A
  • outer envelope and inner capsid = double walled structure - dsDNA genome - incomplete double
36
Q

how many vaccination doses are needed for Hep A

A

2-3

36
Q

incubation time of hep b

A

average 60-90 days (45-180)

37
Q

for diagnosis what is Anti-HBe Ig used for

A

to know that virus is no longer replicating (however the patient can still be positive for HBsAg which is made by integrated HBV)

39
Q

What serological result tells you that you have acute hepatitis infection

A
  • rising IgG titre - IgM antibody
40
Q

what is the most common cause of liver cancer

A

chronic sequelae of hep b

41
Q

what proportion of people present with jaundice when affected with hep c

A

20-30%

42
Q

for diagnosis What is HBV-DNA used for

A

indicates active replication of the virus, more accurately than HBeAG - used mainly for monitoring response to thearpy

43
Q

how do you get hepatocellular carcinoma from hep b

A

repeated hepatocyte destruction and regeneration leading to accumulations of chromosomal mutations (?possible role of HBV X-gene)

44
Q

for diagnosis what is anti-HBs Ig used for

A

to document recovery and/or immunity to Hep B infection, but also successful vaccination

45
Q

what is the response rate of giving IFN-alpha to HBV infected people

A

30-40%

47
Q

how are Hep B, C and D transmitted

A

blood/blood-derived body fluids

49
Q

what is your time window for giving immune globulin for Hep A

A

within 14 days getting the infection

50
Q

replication cycle in the cell of Hep b

A
  • enters the nucleus –> RNA primer undergoes reverse transcriptase to allow complete circular DNA episome - makes pregenomic RNA by reverse transcriptase - can either go back on to the ER and bud off to become active infectious viral particles.. or - re-enter the nucleus to make more covalently closed circular DNA episome
51
Q

how long do the symptoms last for Hep A

A

2-3 weeks (immune response dependent)

52
Q

where does the hepatitis virus replicate

A

in the: - intestinal epithelium - hepatocytes

53
Q

what is the increased probability if i have hep b that i will then go on to get hep c

A

100x more likely

54
Q

when do you give IFN-alpha for HBV

A

for HBeAg +ve carries which chronic active hepatitis

56
Q

what is the difference between Hep A and Hep E for prevention of getting the disease

A

immune serum globulin is NOT effective for Hep E

57
Q

what is the treatment now for HCV in Australia

A

peg-IFNalpha + ribavirin + direct acting antibirals

58
Q

structure of Hep D virus

A

delta antigen covering ssRNA - in turn, covered by HBsAg

59
Q

what percentage of those infected with Hep C clear the virus completely at the acute stage of infection

A

30%

60
Q

For diagnosis: what is HBsAG used as

A

a general marker of infection

61
Q

for diagnosis what is anti-HBc IgM and IgG used for

A

anti-HBc IgM - marker of acute infection anti-HBc IgM - marker of chronic infection

63
Q

what is the mainstay prevention for hepatitis A and E viruses

A

sanitation

63
Q

what does hep B bring in with it

A

viral DNA polymerase short RNA primer 5’ cap 2 short direct repeats

64
Q

how many reading frames does the genome for hep b have? and what are they?

A

4 - C = core - S = surface - P = polymerase - X = immune evasion

65
Q

what hepatitis virus is closely associated with IV drug users

A

Hep C

66
Q

When can you get Hep D

A

only when you have been infected with Hep B previously or if you are coinfected with Hep B at the same time

67
Q

what are the difference in outcomes between getting Hep D from coinfection with Hep B, or superinfection of Hep D when already previously infected with Hep B

A

coinfection –> severe acute disease with low risk of chronic disease superinfection –> usually develop chronic HDV disease and high risk of severe chronic liver disease

68
Q

what is the treatment now for HCV in America

A

IFN-free DAA combination

70
Q

case fatality of Hep E

A
  • 1-2% overall - 15-25% in pregnant women
71
Q

diagnosis of Hep E

A
  • serology - ELISA - nucleic acid assays - immune electromicroscopy
72
Q

what is the viral family of hep C

A

flavivirus

74
Q

explanation of age-related outcomes of hepatitis

A

exposure in early life results in less severe acute disease due to less T cell response, but higher rates of chronic infection

75
Q

which hepatitis virus is the major cause of liver transplant

A

Hep C

77
Q

symptoms of Hep A

A
  • jaundice - vomiting - pale faeces - dark urine
79
Q

which hepatitis viruses can be passed to the infant during childbirth with medication

A

Hep B

80
Q

what is the serology marker of the presence of infectious virus

A

HbeAg

81
Q

what proportion of people get chronic hepatitis from hep c

A

70%

82
Q

incubation period of Hep E

A

~40 days (2-10 weeks)

84
Q

high, medium and low concentrations of Hep b virus in various body fluids

A

high: blood, serum and wound exudates medium: semen, vaginal fluid, saliva low/not detectable: urine, faeces, sweat, tears, breastmilk

85
Q

current antiviral drugs used in Australia for HBV

A
  • IFN-alpha - nucleoside and nucleotide analogues
86
Q

explain the genome of Hep c

A

ss linear RNA

87
Q

what is the most likely hepatitis virus that can be transmitted from IV drug using

A

HEP C then Hep B

88
Q

which hepatitis viruses do NOT have chronic sequelae

A

Hep A and E

89
Q

replication of hep b, c and D in the body

A
  • replication in the liver - viremia –> blood, semen and secretions - sex/close contact - penetration of mucosal epithelium (not replication) - blood (viremia) - replication in the liver
90
Q

which facts about Hep A makes it fabulous to make a vaccination against it?

A
  • there is only a single serotype worldwide - replicates in cell culture
91
Q

what is the difference between the acute and chronic serological responses to hep A and E viruses

A

Hep A - IgG increases and then stays high Hep E - IgG increases and then decreases.. but still higher than IgM Ab

92
Q

which hepatitis viruses can be passed to the infant during childbirth with no medication

A

Hep B!! little Hep C

93
Q

what proportion of people over the age of 5 show jaundice as an acute sign of catching hep b

A

30-50%

94
Q

adult symptoms and signs of Hep E

A
  • jaundice - malaise - anorexia - abdominal pain - hepatosplenomegaly - nausea and vomiting - fever - pruritus
95
Q

describe the structure of hep c virus

A
  • 2 envelope proteins - lipid envelope - ss RNA genome inside nucleocapsid core
96
Q

what is the surface antigen for hep B

A

HbsAg

97
Q

what is the chance if you have hep b that you will go on to get hepatocellular carcinoma

A

2-10%

98
Q

what causes jaundice

A

hyperbilirubinaemia

99
Q

describe the organisation of the hep C genome

A

translated as 1 long polypeptide that is then cleaved into smaller peptides that are either structural or non-structural

100
Q

most outbreaks of Hep E are related to…

A

faecally contaminated drinking water

101
Q

which hepatitis viruses are transmitted by the faecal-oral route

A

A and E

102
Q

what is the progression of hep b

A

acute infection –> chronic hepatitis –> cirrhosis –> liver cancer

Z MD1 GI block (18 decks)

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