Goljan Viral hepatitis Flashcards
Phases of acute viral hep
prodrome;
jaundice;
recovery
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
Wht is associated w/ jaundice from acute viral hep?
variable finding that depends on type of hepatitis=> increased urine bilirubin and urine UBG
Micro findings of acute viral hep
lymphocytic infiltrate w/ destruction of hepatocytes;
persistent inflammation and fibrosis (not good sign)
What does persistent inflammation and fibrosis in viral hep mean?
chronic hep progressing to postnecrotic cirrhosis
When are Councilman bodies found?
apoptosis of hepatocytes from acute viral hepatitis
List in order of commonality of the viral causing hepatitis diseases
A > B > C > D > E
How is HAV transmitted?
fecal oral
Epidemiology of HAV
infectious;
incubation 15-50days;
most preventable infection in travelers;
day care centers; prisons; travelers; anal intercourse; parents adopting from other countries
Clinical findings of HAV
jaundice >70%;
fever;
N/V;
abdominal pain
lasting effects of HAV?
majority recover, no carrier state;
NO chronic hepatitis
Serology of HAV
anti-HAV-IgM => active infection
anti-HAV-IgG=> recovery from infection or vaccination (protective)
How is passive immunization for HAV accomplished?
Ig for pre-exposure prophylaxis and postexposure prophylaxis
How is active immunization for HAV accomplished?
protective Abs in 1mo from infection
transmission of HBV
parenteral;
oral;
sexual;
vertical (pregnancy, breast feeding)
What is primary spread of HBV? How long is incubation period?
blood and sexually;
incubation is 30-180days
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
Recovery potential in HBV?
> 90% of immunocompromised pts;
1-2% develop chronic hep
Who is most likely to develop chronic hep?
newborns and immunodeficient pts
Complications of HBV infection
fulminant hepatitis <1% esp if coinfected w/ HDV;
hepatocellular carcinoma secondary to postnecrotic cirrhosis
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)
what defines chronic HBV?
HBsAg longer than 6mo;
anti-HBc-IgM converts to anti-HBc-IgG
What are the infective particles of HBV?
HBeAg and HBV-DNA
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