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Gastrointestinal System > EXAM #2: VIRAL HEPATITIS > Flashcards

EXAM #2: VIRAL HEPATITIS Flashcards

1
Q

Describe the histologic appearance of hepatitis.

A
  • Blue= bad, lymphocytes

- Pink= good

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2
Q

What are the complications of hepatitis?

A

1) Cirrhosis

2) Hepatocellular carcinoma

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3
Q

How does cirrhosis appear histologically?

A
  • Fibrosis (blue) with islands of normal liver tissue (pink)
  • Regenerative nodules
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4
Q

What are the signs and symptoms of hepatitis?

A
  • Majority of patients are asymptomatic

- Some with acute hepatitis have vague flu-like symptoms

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5
Q

What is self-limiting hepatitis?

A

Hepatitis that is self-resolving

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6
Q

What is fulminant hepatitis?

A

Overwhelming liver inflammation that leads to liver failure

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7
Q

List the etiologies of hepatitis.

A

1) Infectious
2) Immune related
3) Chemicals/toxins
4) Medications
5) Ischemia
6) Hereditary
7) Pregnancy
8) Alcohol
9) NAFLD

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8
Q

What are the immune related causes of hepatitis?

A

1) PBC–primary biliary cirrhosis
2) Primary Sclerosing Cholangitis (complication of UC)
3) Autoimmune

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9
Q

What are the self-limited causes of viral hepatitis?

A

HAV and HEV

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10
Q

What patient population is autoimmune hepatitis most common in?

A

Middle aged females

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11
Q

What antibodies are positive in autoimmune hepatitis?

A

1) Antinuclear antibody (ANA)
2) Anti-smooth muscle antibody (ASMA)
3) Anti-LKM

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12
Q

How is autoimmune hepatitis treated?

A
  • Steroids

- Immunomodulators–Azathioprine

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13
Q

What is the classic histologic finding in autoimmune hepatitis?

A

Severe inflammation of the portal triads

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14
Q

What is Primary Biliary Cirrhosis?

A

Immune mediated destruction of the BILE CANALICULAE

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15
Q

What antibody is associated with PBC?

A

Anti-mitochondrial antibody (AMA)

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16
Q

What are patients with PBC at risk for?

A

1) Hyperlipidemia

2) Osteoporosis

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17
Q

What is the treatment for PBC?

A

Urso (bile acid supplement)

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18
Q

What is PSC?

A

Immune mediated destruction of the large bile ducts leading to stricture/ obstructive jaundice

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19
Q

What disease is PSC strongly associated with?

A

UC

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20
Q

How is PSC treated?

A

Currently there is no effective therapy

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21
Q

What is the most common cause of non-hepatitis virus infection causing hepatitis?

A

EBV (mononucleosis)

22
Q

What is unique about the liver reaction to Isoniazid (INH)?

A
  • Undetected hepatitis from INH can lead to cirrhosis

- Mandated that INH administration is followed with LFT measuring

23
Q

What four chemicals will cause a dose-dependent liver destruction?

A

1) Tylenol*
2) Amanita Phalloides (mushroom)
3) White phosphorus
4) Carbon Tetrachloride

24
Q

What type of virus is HAV?

A

Picornoviridae–ssRNA

25
Q

What is HAV infection associated with?

A

Traveling is considered classic

  • South America
  • Africa
  • SE Asia
  • Greenland*

HOWEVER, in the US, DAYCARE is the most common

26
Q

How is HAV transmitted? What are the unusual modes of transmission?

A

Fecal-oral

  • Homosexual activity
  • IVDA
27
Q

What lab test is associated with symptomatic HAV infection?

A

ALT elevation is associated with symptomatic HAV

28
Q

What are the worrisome variants of HAV infection?

A

1) Cholestatic hepatitis
2) Relapsing hepatitis
3) Fulminant hepatitis

29
Q

What type of virus is HBV?

A

Hepadnaviridae–dsDNA

30
Q

Is HBV enveloped?

A

Yes

31
Q

How is HBV transmitted?

A

Parenterally:

  • IVDA
  • Transfusion
  • Sex

Most of the transmission world-wide happen via the mucosa at birth

32
Q

What population in the US has the most HBV?

A

Immigrants from Asia

  • Africa is 2nd
  • Both together= 80%

*Note this data comes from Olmsted Count, MN (Mayo Clinic)

33
Q

How is the transmission of HBV from mother to child described?

A

“Vertical transmission”

34
Q

What is the risk of HBV infection becoming chronic? How is the risk different between infants and adults?

A

Infants= 90% likelihood

Adults= 5% likelihood

35
Q

What is the most likely outcome of HBV infection in adults? What are the treatment implications?

A
  • Self-limited recovery occurs 95% of the time

- Don’t treat

36
Q

When is HBV infection “chronic”?

A

Six months

37
Q

When is HBV infection treated?

A

Once it is chronic

38
Q

What are the complications of chronic HBV infection?

A

1) Cirrhosis

2) HCC

39
Q

What does HBsAg indicate?

A

Current infection

40
Q

What does HBsAB IgG ALONE indicate?

A

Confirms vaccination

41
Q

What is the integral component of the HBV vaccination?

A

HBsAg

42
Q

What is HBV immune tolerance?

A

The baby’s reaction to HBV

  • Tons of HBV DNA present
  • No immune system reaction
43
Q

What antibody markers the carrier/ infective state of HBV infection?

A

HBe

44
Q

In Taiwan, what was the impact of HBV vaccination on HCC?

A

Vaccination lowered the incidence of HCC

45
Q

What is the only treatment for HBV that is definitive in its elimination?

A

Interferon–but it has major adverse side effects

46
Q

What are the oral medications for HBV that has little adverse effects?

A

1) Lamivudine
- Nucleoside analog
- Prevents viral replication by incorporating in replicating DNA strand
2) Adefovir
- Used to treat Lamivudine mutants

47
Q

What is the only medication that is safe for HBV infection in pregnancy?

A

Lamivudine

48
Q

What does HDV require for infection?

A

HBV

49
Q

When is HDV infection seen in the U.S?

A

IDVA

50
Q

What is worse, coinfection or superinfection of HDV?

A

Superinfection

- HBV infection with HDV added ontop

51
Q

When can HEV cause fulminant hepatitis?

A

Pregnant women

52
Q

What is the reservoir for HEV in the US?

A

Swine i.e. pigs in the midwest

Gastrointestinal System (42 decks)

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