Exam 2 HEPATITIS Flashcards by Wendy Pitts

Hep A transmission?

Chronic?

Fecal/Oral

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Hep A risk factors? (3)

Travel (50%)
Close contact
MSM

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Hep A presentation?

Acute
Kids asympt
Prodrome: flu sxs, RUQ pain
Icteric Phase: jaundice, dark urine, pruritis, light stool

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Hep A labs? (3)

LFT = ↑AST/ALT, ↑bilirubin
+ IgM Ab = acute infection
+ IgG Ab = immunity (past infection)

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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

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Hep B type of virus?

Transmission?

Leading cause of what?

DNA

Blood/Body fluid

Cirrhosis and Hepatocellular CA

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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

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Acute Hep B presentation? (3)

Labs? (1)

Flu sxs
RUQ pain
Jaundice

LFT = ↑AST/ALT

Rarely hepatic failure

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Chronic Hep B presentation? (4)

C asympt
Anorexia/Wgt loss
Fatigue
Heaptomegaly

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Chronic Hep B labs? (2)

LFT = mild ↑AST/ALT

Hep B surface antigen = + > 6mo

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Chronic Hep B complications? (2)

Cirrhosis

Hepatocellular CA

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Hep B surface antigen (HBsAg) is?

HALLMARK OF ACTIVE INFECTION
1st marker
↑ before sx onset
Detectible ~4wks post exposure
Detectible > 6 mo = chronic infection

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Antibody to hep B surface antigen (anti-HBs) tells us?

Signifies recovery and IMMUNITY

Hep B vaccine = + anti-HBs

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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

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Hep B envelope antigen (HBeAg) tells us?

Infective state (virus replicating)

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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