EXAM #2: VIRAL HEPATITIS Flashcards
Describe the histologic appearance of hepatitis.
- Blue= bad, lymphocytes
- Pink= good
What are the complications of hepatitis?
1) Cirrhosis
2) Hepatocellular carcinoma
How does cirrhosis appear histologically?
- Fibrosis (blue) with islands of normal liver tissue (pink)
- Regenerative nodules
What are the signs and symptoms of hepatitis?
- Majority of patients are asymptomatic
- Some with acute hepatitis have vague flu-like symptoms
What is self-limiting hepatitis?
Hepatitis that is self-resolving
What is fulminant hepatitis?
Overwhelming liver inflammation that leads to liver failure
List the etiologies of hepatitis.
1) Infectious
2) Immune related
3) Chemicals/toxins
4) Medications
5) Ischemia
6) Hereditary
7) Pregnancy
8) Alcohol
9) NAFLD
What are the immune related causes of hepatitis?
1) PBC–primary biliary cirrhosis
2) Primary Sclerosing Cholangitis (complication of UC)
3) Autoimmune
What are the self-limited causes of viral hepatitis?
HAV and HEV
What patient population is autoimmune hepatitis most common in?
Middle aged females
What antibodies are positive in autoimmune hepatitis?
1) Antinuclear antibody (ANA)
2) Anti-smooth muscle antibody (ASMA)
3) Anti-LKM
How is autoimmune hepatitis treated?
- Steroids
- Immunomodulators–Azathioprine
What is the classic histologic finding in autoimmune hepatitis?
Severe inflammation of the portal triads
What is Primary Biliary Cirrhosis?
Immune mediated destruction of the BILE CANALICULAE
What antibody is associated with PBC?
Anti-mitochondrial antibody (AMA)
What are patients with PBC at risk for?
1) Hyperlipidemia
2) Osteoporosis
What is the treatment for PBC?
Urso (bile acid supplement)
What is PSC?
Immune mediated destruction of the large bile ducts leading to stricture/ obstructive jaundice
What disease is PSC strongly associated with?
UC
How is PSC treated?
Currently there is no effective therapy
What is the most common cause of non-hepatitis virus infection causing hepatitis?
EBV (mononucleosis)
What is unique about the liver reaction to Isoniazid (INH)?
- Undetected hepatitis from INH can lead to cirrhosis
- Mandated that INH administration is followed with LFT measuring
What four chemicals will cause a dose-dependent liver destruction?
1) Tylenol*
2) Amanita Phalloides (mushroom)
3) White phosphorus
4) Carbon Tetrachloride
What type of virus is HAV?
Picornoviridae–ssRNA
What is HAV infection associated with?
Traveling is considered classic
- South America
- Africa
- SE Asia
- Greenland*
HOWEVER, in the US, DAYCARE is the most common
How is HAV transmitted? What are the unusual modes of transmission?
Fecal-oral
- Homosexual activity
- IVDA
What lab test is associated with symptomatic HAV infection?
ALT elevation is associated with symptomatic HAV
What are the worrisome variants of HAV infection?
1) Cholestatic hepatitis
2) Relapsing hepatitis
3) Fulminant hepatitis
What type of virus is HBV?
Hepadnaviridae–dsDNA
Is HBV enveloped?
Yes
How is HBV transmitted?
Parenterally:
- IVDA
- Transfusion
- Sex
Most of the transmission world-wide happen via the mucosa at birth
What population in the US has the most HBV?
Immigrants from Asia
- Africa is 2nd
- Both together= 80%
*Note this data comes from Olmsted Count, MN (Mayo Clinic)
How is the transmission of HBV from mother to child described?
“Vertical transmission”
What is the risk of HBV infection becoming chronic? How is the risk different between infants and adults?
Infants= 90% likelihood
Adults= 5% likelihood
What is the most likely outcome of HBV infection in adults? What are the treatment implications?
- Self-limited recovery occurs 95% of the time
- Don’t treat
When is HBV infection “chronic”?
Six months
When is HBV infection treated?
Once it is chronic
What are the complications of chronic HBV infection?
1) Cirrhosis
2) HCC
What does HBsAg indicate?
Current infection
What does HBsAB IgG ALONE indicate?
Confirms vaccination
What is the integral component of the HBV vaccination?
HBsAg
What is HBV immune tolerance?
The baby’s reaction to HBV
- Tons of HBV DNA present
- No immune system reaction
What antibody markers the carrier/ infective state of HBV infection?
HBe
In Taiwan, what was the impact of HBV vaccination on HCC?
Vaccination lowered the incidence of HCC
What is the only treatment for HBV that is definitive in its elimination?
Interferon–but it has major adverse side effects
What are the oral medications for HBV that has little adverse effects?
1) Lamivudine
- Nucleoside analog
- Prevents viral replication by incorporating in replicating DNA strand
2) Adefovir
- Used to treat Lamivudine mutants
What is the only medication that is safe for HBV infection in pregnancy?
Lamivudine
What does HDV require for infection?
HBV
When is HDV infection seen in the U.S?
IDVA
What is worse, coinfection or superinfection of HDV?
Superinfection
- HBV infection with HDV added ontop
When can HEV cause fulminant hepatitis?
Pregnant women
What is the reservoir for HEV in the US?
Swine i.e. pigs in the midwest
