Hep

Question 1

All Hep viruses are RNA except___

Answer 1

B=DNA

Question 2

Prodrome of Hep

Answer 2

Anorexia
N/V
Malaise
URI sx
Aversion to smoking
Late stage= enlarged and tender liver + jaundice

Question 3

What are the lab values in Hep

Answer 3

WBC=normal
ALT-elevated
AST-elevated
Bilirubin-elevated
Alkaline phosphate-elevated

Question 4

Hep A

Answer 4

Feco-oral transmission 
Incubation time=4wks
Replication limited to liver
Shed in feces for 2 wks prior to clinical symptoms
NO CHRONIC HEP A

Question 5

Dx Hep A

Answer 5

IgM HAV Ab + (IgM anti-HAV)

IgG HAV Ab + (IgG anti-HAV) c (-) IgM HAV Ab = past exposure or immune

Question 6

Tx Hep A

Answer 6

Self-limiting

Question 7

Hep B

Answer 7

Transmission: Sex, needle sharing, contact with blood

Question 8

HBsAg

Answer 8

1st evidence of HBV infection. Acute infection if positive .

Question 9

HBsAb

Answer 9

Anti-HBs Distant resolved infection or vaccination

Question 10

HBcAb

Answer 10

IgG=Anti-HBc represents past infection

IgM=Acute infection

Question 11

HBeAg

Answer 11

Increase in viral replication and infectivity, if positive for greater then 3 months=chronic infection

Question 12

HBeAb

Answer 12

(Anti HBe) Indicated a decrease in viral replication and infectivity

Question 13

HBV DNA

Answer 13

Most specific and most sensitive for early detection indicated active replication in the liver.

Question 14

Tx for Hep B

Answer 14

Acute=Supportive

Chronic= Alpha interferon, lamivudine, adefovir

Question 15

When to admit pt with Hep B

Answer 15

encepholopathy, liver failure, unable to maintain hydration

Question 16

Hep C

Answer 16

Transmission: Parenteral (IV drugs), hemodialysis, prison, co-infection with HIV 30%

Question 17

DX Hep C

Answer 17

Anti-HCV +
HCV RNA means active infection.
If HCV RNA is - but Anti-HCV is + then you have a resolved case.

Question 18

Tx for Hep C

Answer 18

Pegylated interferon for 6-24 months. Ribavirn added if HCV RNA is not cleared after 3 months.

Question 19

Hep C prognosis

Answer 19

Chronic in 85% of people

30% of chronic get cirrhosis which increases risk for heptocarcinoma

Question 20

Hep D

Answer 20

Defective Virus that requires HBC to cause co-infection or superimposed infection.
—-faster progression to cirrhosis

Question 21

Hep E

Answer 21

feco-oral transmission associated c water
Self-limiting
Dx= IgM anti-HEV +

Question 22

Fulminant Hepatitis

Answer 22

Acute Liver Failure

-Rapid liver failure c encephalopathy and coagulopathy.

Question 23

What is the most common cause of fulminant hep

Answer 23

Acetaminophen overuse or tox

Question 24

What dx increases the risk of fulminant hep?

What condition makes it worse?

Answer 24

DM

Obesity

Question 25

Coagulopathy

Answer 25

Due to decreased hepatic production of coagulation factiors

Question 26

Encephalopathy

Answer 26

vomiting, coma, AMS, seizures, asterixis (flapping tremor of hand) increase ICP.
Caused by increase in Ammonia levels which is neurotoxic

Question 27

Lab results of fulminant hep

Answer 27

Increased ammonia
increased PT/INR>1.5
Increased LFT
Hypoglycemia