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Clin Med II - GI Exam > Hepatitides > Flashcards

Hepatitides Flashcards

1
Q

Risk factors for liver dz?

A 
ETOH 
Hyperlipidemia, obesity, DM
Previous blood transfusion (esp. before 1992)
Autoimmune dz
IVDU
High risk sexual behavior
foreign travel
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2
Q

What labs are included in LFT’s?

A 
Bilirubin
Albumin
Total Protein
ALP
AST
ALT
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3
Q

What lab can be used as adjunct to LFT’s to determine hepatocyte injury more specifically?

A

GGT

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4
Q

Where is bilirubin conjugated?

A

Liver

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5
Q

Where is albumin synthesized?

A

liver

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6
Q

Where does AST originate?

A

Hepatocytes and skeletal and cardiac muscle

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7
Q

Where does ALP originate?

A

Hepatocyte, bone, intestine, and placenta

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8
Q

What are the two types of hepatotropic viral infections that can occur?

A

Acute

Chronic

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9
Q

How is Hep A transmitted?

A

Fecal-oral transmission

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10
Q

Where does viral replication occur in Hep A?

A

in the liver

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11
Q

How long does it take for virus to be found in blood/feces after infection of Hep A?

A

10-12 days

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12
Q

How long might viral excretion occur after onset of symptoms in Hep A?

A

3 weeks

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13
Q

In Hep A children are generally symptomatic/asymptomatic?

A

asymptomatic

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14
Q

in Hep A adults are generally symptomatic/asymptomatic?

A

symptomatic

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15
Q

When is the greatest probability of communicability in Hep A?

A

2 weeks before onset of jaundice

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16
Q

How long will the Hep A virus be in the environment for after exposure?

A

months

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17
Q

Risk factors for Hep A?

A

close contact
Ingestion of contaminate food/water
Blood exposure
Incubation (28-30 days)

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18
Q

Tx for Hep A?

A

IG-passive transfer of neutralizing antibodies

Prevents infection or clinical expression of dz

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19
Q

How long does pre-exposure prophylaxis last for Hep A?

A

3-5 mos

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20
Q

How soon after exposure must pt’s be given post-exposure prophylaxis for Hep A?

A

within 14 days

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21
Q

How many doses are required for Pre-expsure Hep A vaccine?

A

2

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22
Q

How old must a pt be to receive the Hep A vaccine?

A

older than 1 year (and before 24 mos. preferrably)

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23
Q

How long does the Hep A vaccine last?

A

at least 20 years (unsure)

24
Q

What is the MC source of HBV infection in US?

A

Heterosexual contact

25
Q

What is the most likely reason for decrease in viral hep A in US?

A

Universal vaccinations even for those not at risk

26
Q

Considering risk factors for HBV infection which body fluid increases the concentration of virus?

A

Blood and serum (+wound exudate)

27
Q

If you get HBV as an infant was is the risk that it will become chronic?

A

90%

28
Q

What do we look for in a serum draw to see if Hep B virus is still present?

A

HBsAg

HBeAG tells us it’s still active

29
Q

If a mother is positive for HBsAG and HBeAg what is the risk % of her child becoming infected?

A

70-90%

30
Q

If a mother is positive for HBsAG only what is the risk % of her child becoming infected?

A

5-20%

31
Q

What is used to prevent HBV infection?

A

HBIG (post exposure)
HBVaccine (Pre and post exposure)
Currently:
Vaccine for infants and everyone else!!

32
Q

What is the primary component of the HBV vaccine?

A

HBsAg

33
Q

what was the HCV outbreak in NH due to in 2012?

A

diversion of narcotics in cardiac cath lab

34
Q

Why has there been a decrease of HCV infection reported?

A

number of acute clinical cases underreported

35
Q

What percent of those who contract HCV go on to have a persistent infection?

A

Majority! 75-80%

36
Q

What risk factor is HUGE with HCV!!??

A

ETOH use

37
Q

What carries a higher risk of contraction of HCV IVDU or Sexual intercourse?

A

IVDU

38
Q

Clinical presentation of HCV?

A

80% asymptomatic

loss of appetite, abdominal pain, fatigue, nausea, dark urine, jaudice

39
Q

How is HCV diagnosed?

A

IgG assay for anti-HCV (may have false negative in first 15 weeks)
Nucleic acid amplification test

40
Q

Tx for HCV?

A

in the process of evolving now.

Pegylated interferon and ribavirin for 24-48 wks - 50% success (sustained viral response)

41
Q

What other virus does Hep D require in order to be contracted?

A

HBV

42
Q

What 2 different ways can Hep D be acquired?

A

confection with HBV at same time

Superinfection with HBV already present

43
Q

What vaccine exists for Hep D?

A

Hep B vaccine! BC you need Hep B to get Hep D

44
Q

Which is it more common for a pt to have fulminant liver failure in a pt with Confection HDV or Superinfection HDV

A

Superinfection (5%)

45
Q

How is Hep E transmitted?

A

Fecal Oral

46
Q

Where is Hep E virus more common?

A

Japan, and europe (zoonotic and foodborne)

47
Q

What are the 2 phases of the Hep E virus?

A

Prodromal

Icteric

48
Q

Prodromal phase of HEV presentation

A 
Myalgia
arthralgias
fever mild temp elevation
anorexia
N/V
Wt loss
Dehydration
RUQ pain increased with activity
49
Q

Icteric phase of HEV presentation?

A

Jaudice (serum bili is greater than 3)
Dark urine
Light colored stool
Pruritis

50
Q

How is HEV diagnosed?

A

Anti-HEV IgM and IgG in serum
HEV RNA in serum/stool confirms serologic (seldom required)
No diagnostic tests have been approved by the FDA yet.

51
Q

TX for HEV?

A

supportive

52
Q

Prevention for travelers concerned with HEV?

A

no vaccine/drug available

avoid possible contaminants (meat, water, etc)

53
Q

Prognosis for HAV?

A

usually mild/self limited
infection confers lifelong immunity
Rare complications: relapse, cholestatic hepatitis, FHF

54
Q

Prognosis for HBV?

A

Risk of chronic infection high in younger children

FHF develops in small present but fatality in those is high

55
Q

Prognosis of HCV?

A

Chronic infxn common (50-60%) at risk for chronic active hepatitis, cirrhosis
High death rate

56
Q

Prognosis of HDV w/ co-infected HBV:

A

Chronic HDV is common

Rapildy progressive acute/subacute hepatitis 70-80% develop into cirrhosis

57
Q

Prongnosis of HEV?

A

mild-self limiting
Case fatal in higher in pregnant women
does not result in chronic dz

Clin Med II - GI Exam (14 decks)

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