Goljan Viral hepatitis Flashcards by Hunter Garrett

Phases of acute viral hep

prodrome;
jaundice;
recovery

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What is associated w/ prodrome in acute viral hep?

fever;
painful hepatomegaly (distaste for alcohol/cigs);
serum transaminases increase gradually=> peak BEFORE jaundice;
atypical lymphocytosis

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Wht is associated w/ jaundice from acute viral hep?

variable finding that depends on type of hepatitis=> increased urine bilirubin and urine UBG

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Micro findings of acute viral hep

lymphocytic infiltrate w/ destruction of hepatocytes;

persistent inflammation and fibrosis (not good sign)

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What does persistent inflammation and fibrosis in viral hep mean?

chronic hep progressing to postnecrotic cirrhosis

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When are Councilman bodies found?

apoptosis of hepatocytes from acute viral hepatitis

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List in order of commonality of the viral causing hepatitis diseases

A > B > C > D > E

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How is HAV transmitted?

fecal oral

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Epidemiology of HAV

infectious;
incubation 15-50days;
most preventable infection in travelers;
day care centers; prisons; travelers; anal intercourse; parents adopting from other countries

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Clinical findings of HAV

jaundice >70%;
fever;
N/V;
abdominal pain

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lasting effects of HAV?

majority recover, no carrier state;

NO chronic hepatitis

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Serology of HAV

anti-HAV-IgM => active infection

anti-HAV-IgG=> recovery from infection or vaccination (protective)

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How is passive immunization for HAV accomplished?

Ig for pre-exposure prophylaxis and postexposure prophylaxis

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How is active immunization for HAV accomplished?

protective Abs in 1mo from infection

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transmission of HBV

parenteral;
oral;
sexual;
vertical (pregnancy, breast feeding)

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What is primary spread of HBV? How long is incubation period?

blood and sexually;

incubation is 30-180days

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how does HBV infection present clinically?

variable fever; profound malaise; 
painful hepatomegaly (87%); 
serum sickness prodrome (15-20%);
immunocomplex disease (HBsAg + Ab);
vasculitis (PAN);
urticaria, polyarthritis, membranous glomerulopathy

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Recovery potential in HBV?

> 90% of immunocompromised pts;

1-2% develop chronic hep

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Who is most likely to develop chronic hep?

newborns and immunodeficient pts

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Complications of HBV infection

fulminant hepatitis <1% esp if coinfected w/ HDV;

hepatocellular carcinoma secondary to postnecrotic cirrhosis

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When does HBsAg appear? how long does it persist?

appears w/in 2-8wks after exposure (1st mark);

persists up to 4mo in acute hepatitis (last to leave)

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what defines chronic HBV?

HBsAg longer than 6mo;

anti-HBc-IgM converts to anti-HBc-IgG

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What are the infective particles of HBV?

HBeAg and HBV-DNA

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What is the nonprotective Ab of HBV infection? when is it present?

anti-HBc-IgM;
positive in acute infection;
present while HBsAg, HBV-DNA, HBeAg being absent

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What does anti-HBc-IgM convert to by 6mo?

converts entirely to anti-HBc-IgG by 6mo

What is anti-HBs indicate?

protective Ab; | marker of immunization after HBV vaccination

What indicates a "healthy" chronic carrier?

HBsAg and anti-HBc-IgG; | absence of DNA and e antigen;

Is a patient w/ HBsAg and anti-HBc-IgG and absence of DNA and e antigen contagious?

yes but much lower risk

What is present in a infective chronic carrier?

HBsAg, anti-HBs-IgG; | infective particles DNA and e antigen

What is the risk for a infective chronic carrier of HBV?

increased risk for postnecrotic cirrhosis and hepatocellular carcinoma

How is HBV prevented?

immunization w/ recombinant vaccine

What is the Tx for chronic hepatitis?

pegylated IFN-a; nucleoside analogues that block viral replication (lamivudine, entecavir); liver transplant

what Ab is present during the serologic gap?

anti-HBc-IgM

How is HCV transmitted? what is the incubation period for HCV?

transmitted parenteral or sexual => MC blood borne infection in US; incubation 2-26wks

What are infrequent ways of transmission of HCV?

post-transfusion hepatitis; | maternal-fetal transmission

Why is HCV such a difficult disease in US?

most common main indication for liver transplant

clinical findings w/ HCV

``` chronic hepatitis (>70% cases) mild hepatitis (70-80% subclinical); jaundice uncommon (80% anicteric) ```

Clinical assoc w/ HCV

``` type I MPGN, alcohol excess, PCT, lichen planus, B cell lymphoma ```

complications assoc w/ HCV

hepatocellular CA secondary to postnecrotic cirrhosis

prevention of HCV

NONE

Tx for HCV

early Tx of acute infection w/ pegylated IFN-a may prevent chronic infection; pegylated IFN-a used in chronic HCV; liver transplant

transmission for HDV

parenteral or sexual

pathogenesis for HDV infection

incomplete RNA virus that requires HBsAg to replicate

describe the chronic state of HDV infection

less likely w/ coinfection (HBV, HDV exposure at same time) than superinfection (HBV carrier exposed to blood containing HBV and HDV)

How often does chronic infection w/ HDV occur?

60-85% of ppl infected get chronic infection

prevention of HDV?

immunization w/ recombinant vaccine for HBV

transmission of HEV?

fecal-oral => water borne

Where is HEV most likely to be found? what does it lead to?

developing countries; | only produces acute hepatitis

who is at risk for fulminant hep from HEV?

pregnant women

How can HCV be screened?

enzyme immunoassay => EIA; presence of anti-HCV-IgG indicates active infection or recovery => 97% sensitive does not differentiate bw types of infection or provide protection

What are confirmatory tests for HCV?

recombinant immunoblot assay (RIBA)=> use if EIA is positive | HCV RNA using PCR;

What is the gold standard for Dx HCV? when does it detect?

HCV RNA using PCR => detects 1-2 wks after infection

What tests will confirm active HCV infection?

positive RIBA and HCV RNA

What tests will indicate recent recovery?

positive RIBA and negative HCV RNA

What indicates active HDV infection?

anti-HDV-IgM or IgG

Ab protection for HDV?

no => anti-HDV-IgG is NOT protective

what indicates active HEV infection?

anti-HEV-IgM

what indicates recovery from HEV infection? any Ab protection?

anti-HEV-IgG indicates recovery and provides a protective Ab

What is associated w/ CB20-50% in mixed hyperbilirubinemia?

decreased uptake/conjugation of UCB; | CB gains access to blood via damaged bile ductules

What would cause urine UBG elevation and increased urine bilirubin

CB is water soluble and filtered in kidneys; | UBG recycled back to inflamed liver is redirected to kidneys

What is the last liver enzyme to return to normal?

ALT