Exam 2 HEPATITIS Flashcards
Hep A transmission?
Chronic?
Fecal/Oral
No
Hep A risk factors? (3)
Travel (50%)
Close contact
MSM
Hep A presentation?
Acute
Kids asympt
Prodrome: flu sxs, RUQ pain
Icteric Phase: jaundice, dark urine, pruritis, light stool
Hep A labs? (3)
LFT = ↑AST/ALT, ↑bilirubin
+ IgM Ab = acute infection
+ IgG Ab = immunity (past infection)
Hep A tx? (2)
Post-exposure?
Admit when? (3)
Supportive
Ig or vaccine for close contacts
Post-exposure:
Pts 12mo - 40yo and healthy, vaccine w/i 2wks
Otherwise IG
Hospitalize if:
Old
Co-morbidities
Underlying liver dz
REPORTABLE
Hep B type of virus?
Transmission?
Leading cause of what?
DNA
Blood/Body fluid
Cirrhosis and Hepatocellular CA
Hep B risk factors? (5)
Close contact MSM/Multiple partners IV drug users Infants from mother Health workers
95% of infected adults clear virus w/o getting dz
Acute Hep B presentation? (3)
Labs? (1)
Flu sxs
RUQ pain
Jaundice
LFT = ↑AST/ALT
Rarely hepatic failure
Chronic Hep B presentation? (4)
C asympt
Anorexia/Wgt loss
Fatigue
Heaptomegaly
Chronic Hep B labs? (2)
LFT = mild ↑AST/ALT
Hep B surface antigen = + > 6mo
Chronic Hep B complications? (2)
Cirrhosis
Hepatocellular CA
Hep B surface antigen (HBsAg) is?
HALLMARK OF ACTIVE INFECTION 1st marker ↑ before sx onset Detectible ~4wks post exposure Detectible > 6 mo = chronic infection
Antibody to hep B surface antigen (anti-HBs) tells us?
Signifies recovery and IMMUNITY
Hep B vaccine = + anti-HBs
Antibody to hep B core antigen (anti-HBc) tells us:
IgM anti-HBc?
IgG anti-HBc?
IgM anti-HBc:
Detectible shortly after HBsAg
Indicates acute or recent infection
Persists ~6 mo
IgG anti-HBc:
Indicates prior or resolving infection
Persists forever
Hep B envelope antigen (HBeAg) tells us?
Infective state (virus replicating)
Antibody to hep B envelope antigen (anti-HBe) tells us?
Lower levels of virus
Hep B Immunity from infection vs vaccine:
Hep B surface antibody (anti-HBs)?
Hep B core antibody IgG (anti-HBc IgG)?
Anti-HBs:
Infection = +
Vaccine = +
Anti-HBc IgG:
Infection = +
Vaccine = -
Hep B post-exposure prophylaxis?
IG protects
and ↓ severity if given w/i 7 days of exposure
Acute Hep B tx?
Admit when? (4)
Supportive
P anitviral
r/o Hep D co-inf
Admit if: Underlying liver dz Co-morbids Old Signs of failure
REPORTABLE
Chronic Hep B tx:
Goal?
Which pts?
F/U?
Goal: Stop replication (-HbeAg, +anti-HBe)
Pts w/ active replication:
+HBeAg, +Hep B DNA, ↑AST/ALT
Monitor for cirro and H CA
Vaccine
Hep C type of virus?
Transmission?
Most C of what?
RNA
Blood/Body fluid
Chronic bloodborne infection
(80% become chronic)
Liver transplant
Hep C Rule of 20s?
20% infected will clear virus
20% w/ chronic will get cirrhosis w/i 20 yrs
20% of them will get H CA
Hep C risk factors? (5)
IV drug use Blood trans/Clotting factors HIV Infants from mom Close contact less likely
Acute Hep C presentation? (4)
Most are asympt
Flu sxs
RUQ pain
Jaundice
Chronic Hep C presentation?
Most asympt
Diagnosed from ↑ LFT w/ varying patterns
Hep C diagnostics?
Antibody to hep C (anti-HCV) = past or ongoing infection If + order HCV RNA to: 1) confirm active virus 2) determine viral load 3) Determine genotype
Hep C management? (6)
Liver bx for staging dz NO EtOH No new meds w/o careful review Screen and vacc for Hep A/B Screen HIV Monitor for cirro and H CA
Hep C pt precautions? (3)
Can’t donate blood/organs
Don’t share personal items
Cover open wounds
Hep C Rx tx?
Cured when?
Interferon + Ribavirin
6-12 mo
+ protease inhib if geno 1
Cure = no detectible virus > 6 mo
Hep D type of virus?
Seen when?
Delta RNA
Only as co-inf w/ Hep B
Hep D diagnositcs?
Delta RNA with +HBsAg
*test all Hep B pts for Hep D
Hep D tx?
Treat Hep B
Hep E type of virus?
Transmission?
E RNA
Fecal/Oral
U from travel
Hep E diagnostics?
Prognosis?
Tx?
Hep E RNA
Fatal in 20% of preggos,
Otherwise <1%
Supportive
