Hep Flashcards
All Hep viruses are RNA except___
B=DNA
Prodrome of Hep
Anorexia N/V Malaise URI sx Aversion to smoking Late stage= enlarged and tender liver + jaundice
What are the lab values in Hep
WBC=normal ALT-elevated AST-elevated Bilirubin-elevated Alkaline phosphate-elevated
Hep A
Feco-oral transmission Incubation time=4wks Replication limited to liver Shed in feces for 2 wks prior to clinical symptoms NO CHRONIC HEP A
Dx Hep A
IgM HAV Ab + (IgM anti-HAV)
IgG HAV Ab + (IgG anti-HAV) c (-) IgM HAV Ab = past exposure or immune
Tx Hep A
Self-limiting
Hep B
Transmission: Sex, needle sharing, contact with blood
HBsAg
1st evidence of HBV infection. Acute infection if positive .
HBsAb
Anti-HBs Distant resolved infection or vaccination
HBcAb
IgG=Anti-HBc represents past infection
IgM=Acute infection
HBeAg
Increase in viral replication and infectivity, if positive for greater then 3 months=chronic infection
HBeAb
(Anti HBe) Indicated a decrease in viral replication and infectivity
HBV DNA
Most specific and most sensitive for early detection indicated active replication in the liver.
Tx for Hep B
Acute=Supportive
Chronic= Alpha interferon, lamivudine, adefovir
When to admit pt with Hep B
encepholopathy, liver failure, unable to maintain hydration
Hep C
Transmission: Parenteral (IV drugs), hemodialysis, prison, co-infection with HIV 30%
DX Hep C
Anti-HCV +
HCV RNA means active infection.
If HCV RNA is - but Anti-HCV is + then you have a resolved case.
Tx for Hep C
Pegylated interferon for 6-24 months. Ribavirn added if HCV RNA is not cleared after 3 months.
Hep C prognosis
Chronic in 85% of people
30% of chronic get cirrhosis which increases risk for heptocarcinoma
Hep D
Defective Virus that requires HBC to cause co-infection or superimposed infection.
—-faster progression to cirrhosis
Hep E
feco-oral transmission associated c water
Self-limiting
Dx= IgM anti-HEV +
Fulminant Hepatitis
Acute Liver Failure
-Rapid liver failure c encephalopathy and coagulopathy.
What is the most common cause of fulminant hep
Acetaminophen overuse or tox
What dx increases the risk of fulminant hep?
What condition makes it worse?
DM
Obesity
Coagulopathy
Due to decreased hepatic production of coagulation factiors
Encephalopathy
vomiting, coma, AMS, seizures, asterixis (flapping tremor of hand) increase ICP.
Caused by increase in Ammonia levels which is neurotoxic
Lab results of fulminant hep
Increased ammonia
increased PT/INR>1.5
Increased LFT
Hypoglycemia
