hep A to G Flashcards

1
Q

hepatitis clinical presentation?

A

Ascites

caput medusae

icterus

palmar erythema

teleangiectasia

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2
Q

biochem results?

A

Causes of Elevated ALT (sGPT) or AST (sGOT) Values in Asymptomatic Patients*

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3
Q

hep and its causes?

A

A Autoimmune hepatitis
B Hepatitis (A)-B
C Hepatitis C-(G)
D Drugs or toxins
E Ethanol
F Fatty liver
G Growths (i.e., tumors)
H Hemodynamic disorder (congestive heart failure)
I Iron (hemochromatosis), copper (Wilson’s disease) or alpha
1
-antitrypsin deficiency
M Muscle injury

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4
Q

acute vs chronic?

A

Acute (viral) hepatitis:
asymptomatic
mild icterus, elevated transaminases
severe, prolonged icterus
fulminant hepatitis with liver failure

Chronic (viral) hepatitis:
chronic persisting hepatitis
(virus detectable, few symptoms)
chronic active hepatitis
(continuous tissue destruction)
liver cirrhosis
primary liver cell carcinoma (hepatocellular)

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5
Q

hep clinical pic

A
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6
Q

hep A virus?

A

picornavirus, nonenveloped, ss (+) RNA (~10 kbases)
very stable: pH 3 or 60
oC for 10 h

frequently mild or anicteric, „yellow-flu / liver flu“
acute hepatitis, no persistence or chronic outcome
significantly more severe course in chronic hepatitis C

enteral (fecal/oral) transmission, „travel hepatitis“
transmission through contaminated water or raw foods, eg. Oysters (muckeaters…), and in hygienic facilities/ toilets
HAV epidemic in USA (Pittsburgh) from Chi-Chi® food products in the
‚Beaver Valley Mall‘: 490 cases, 3 deaths from liver failure (15.11.03)

(Dead)- vaccine with inactivated HAV (Havrix®: GlaxoSmithKline
Biologicals). The virus (strain HM175) is propagated in MRC-5 human
diploid (lung) cells which were taken from a male fetus aborted at 14 weeks
gestation.

Vaccination recommended for travellers in endemic areas,
and patients with chronic hepatitis B or C. 3 i.m. immunizations (0, 14 days,
6 months), children from 12 months of age.

for immediate / travel protection: passive immunization with
anti-HAV-positive immunoglobulins and/or a 2 step vaccination schedule (0,
4 to 6 months). Basic immunity conferred after the first vaccination

the best way to control hepatitis A infection in the hospital setting is good
 hygienic practise  (re GI viral infections !!!)
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7
Q

hpe a diagnostic marker?

A

virus in stool, vriema, transaminase increase/icterus (3-9 months)

ttoal anti-HAV (3-12 months)

anti-HAV IgM (3-12 top at 6 months, low at 12 and 3 months.)

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8
Q

Hep E virus?

A

spherical, non-enveloped, single stranded RNA virus, approximately
32 to 34 nm in diameter.
HEV belongs to a genus of HEV-like viruses (genus Hepevirus).
? preliminarily placed as ‘calicivirus‚ (re GI virus infections)

transmission and clinical properties like HAV:
fecal / oral transmission
usually mild icterus, elevated transaminases
rarely: severe, prolonged icterus, high case fatality in pregnancy
the major etiological agent of enterically transmitted hepatitis
worldwide: especially prevalent in South East Asia and Africa
In 2005 detected in Welsh patients and traced back to PORCINE
HEV…. (part of a Year 3 SSC with NPHS virology and Andrew Godkin)

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9
Q

hep b?

A

very small ds DNA virus: ca. 3.200 base pairs, Hepadna-Virus
infects only humans and chimpanzees
replication via RNA intermediates using a reverse transcriptase
Pararetrovirus

Enveloped ‚Dane particle‘, filamentous / oval virus-like particles (VLP‘s),
‚Australia antigen

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10
Q

antigen markers for hep b?

A
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11
Q

hep b markers through months?

A
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12
Q

diff between acute and chronic hep b markers?

A

chronic = no anti-HBs

HBsAg is longer.

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13
Q

all the heps and their antigens?

A
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14
Q

hep b flashcard?

A

Virus: Hepadna virus, no serotypes, ds circular 3200 bp DNA/RNA chimera

Reservoir tissue: human liver cells

Incubation time: 45 – 180 days (~6 months)

Clinical picture: mostly assymptomatic, icterus: < 5 years: < 10%, > 5
years: 30% - 50%, mortality during acute infection 0,5% - 1%, in
chronic infections < 5 years: 30 - 90%, > 5 years: 2 - 10%. 20%
leading to chronic hepatitis and 0.5% ending in hepatocellular
carcinoma.

Epidemiology: global

Mechanisms of cancerogenesis: unclear (chronic inflammation?)

Lab diagnostics: serology, qual / quant PCR

Prevention: recombinant protein-vaccine: HBsAg from yeast HBvax
Pro®, Aventis Pasteur MSD, combined with inactivated

HAV: Twinrix®,

GlaxoSmithKline Biologicals; combined active-passive vaccination in
HBsAg-positive mothers with unknown status, vaccinations of all
newborns, vaccination of individuals in high risk groups(dialysis
patients, drug abusers)

Therapy: RT inhibitors, eg Lamivudine® (3TC - 2’deoxy, 3’thiacytidine); new
in 2006 entecavir, clevudine, telbivudine

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15
Q

hep D?

A

Coinfection of HBV with HDV
severe acute hepatitis
low risik of chronic infection
Superinfection
invariably develops into chronic infection
high risik for severe chronic hepatitis
Hepatitis D
Hepatitis D is caused by the Delta agent (Hepatitis D virus: HDV)
HDV is a defective circular small ss (-) RNA virus (1700 bases; viroid-like) and
can only be packaged in the presence of HBsAG in HBV infected cells
=> hepatitis D can only occur in association with HBV infection (satellite virus)
Discovered in 1977 by Dr. Mario Rizzetto and associates in Italy: in
patients affected by Hepatitis B. They observed a new antigen in
hepatitic liver cells different than surface, core and envelope systems that
they called “delta antigen”.
(Gut 18:997-1003,1977)

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16
Q

hep b with HDV superinfection marker?

A

GOT

HBsAg

HDV RNA

total anit-HDV

no anti-HBs

IgM anti-HDV

17
Q

hep c virus?

A

Family: Flaviviridae
Genus: Hepacivirus
Density: 1,03 - 1,2 g/cm3
Size: 50 - 60 nm
Genome: (+) RNA, ~9,6 kb
Properties of the Hepatitis C virus (HCV)
EM morphology of HCV
Cell culture system: Wakita et al. 2005
Genotype 2a strain of HCV, JFH-1
Genotype 2a chimera, FL-J6/JFH
Genotype 1a (Hutchinson strain) H77S: Lemon et al.
In vitro system: Bartenschlager et al. 2003
G418-replicon by Bartenschlager and Rice-mostly
useful for drug screening

risk factors

1.iv

2unclear

3.sexual

18
Q

hep B risk factors?

A
  1. sexual
  2. oarenteral
  3. perinatal
19
Q

diagnostic markersof hep c infection?

A

HCV RNA

anti-HCV

GOT

20
Q

hcv genotype?

A

I. Epidemiology
Confirm patient-to-patient transmission in outbreak investigations (eg
dentist North Wales 2006)
Types 1, 2, 3: global, prevalent in US and Europe
Type 4: Middle east and Africa
Type 5: South Africa
Type 6: Asia

II. Prediction of clinical outcome
Subtype 1b infections are more acute and tend to reinfect liver transplants
Type 2 infections are associated with type II cryoglobulinaemia

III. Genotype-specific treatment response

Type 4 good response
Type 2
Type 3
Type 1 (1b) no treatment response

21
Q

hep c flah card?

A

Virus: Flavivirus (Genus hepacivirus), no serotypes, ss (+) lin RNA
Reservoir tissue: human liver cells, suspected dendritic cells
Incubation time: 2 - 26 weeks (~6 months), highly infectious
Clinical picture: mostly assymptomatic, rarely fulminant hepatitis (type
2a/ JFH strain), ~50% leading to chronic hepatitis and up to 7% ending
in hepatocellular carcinoma.
Epidemiology: globally more significant than HIV or HepB
Mechanisms of cancerogenesis:
1. apoptosis inhibition (NS5a)
2. cell cycle effects G1> S (E2 (?), NS5: Rb binding proteins)
Lab diagnostics: serology, qual / quant PCR, genotyping
Prevention: no vaccine approved; peptide vaccine in phase 1 trials,
therapeutic vaccine under development (Biomerieux- MVA vaccine)
Therapy: pegylated interferon alpha combined with ribavirin / genotype
dependent response

22
Q

hep f

A

Thus, there is no hepatitis F virus, but the position in the nomenclature
has been occupied for the time being .

23
Q

hep g virus?

A

very similar to but distinct from Hepatitis C virus (Flaviviridae):
ss (+) RNA, 10 kb
preliminarily placed into a group of new agents called GB viruses
(GB virus A, GB virus B and GB virus C)
not associated with any acute or chronic liver disease:
benign virus that is widely present throughout the world.
Replicates best in lymphocytes/ not hepatocytes.
no association with poor outcomes of patients who are
infected with Hepatitis C / HIV and Hepatitis G at the same time.
Hep G may actually slow down HepC and HIV

transmitted following receipt of blood from HGV RNA-positive donor
moderate liver enzyme (ALT) elevations.

persistent infection (HGV RNA-positive) for as long as nine years.

24
Q

route of heps?

A
25
Q
A