Hepatitides Flashcards
Risk factors for liver dz?
ETOH Hyperlipidemia, obesity, DM Previous blood transfusion (esp. before 1992) Autoimmune dz IVDU High risk sexual behavior foreign travel
What labs are included in LFT’s?
Bilirubin Albumin Total Protein ALP AST ALT
What lab can be used as adjunct to LFT’s to determine hepatocyte injury more specifically?
GGT
Where is bilirubin conjugated?
Liver
Where is albumin synthesized?
liver
Where does AST originate?
Hepatocytes and skeletal and cardiac muscle
Where does ALP originate?
Hepatocyte, bone, intestine, and placenta
What are the two types of hepatotropic viral infections that can occur?
Acute
Chronic
How is Hep A transmitted?
Fecal-oral transmission
Where does viral replication occur in Hep A?
in the liver
How long does it take for virus to be found in blood/feces after infection of Hep A?
10-12 days
How long might viral excretion occur after onset of symptoms in Hep A?
3 weeks
In Hep A children are generally symptomatic/asymptomatic?
asymptomatic
in Hep A adults are generally symptomatic/asymptomatic?
symptomatic
When is the greatest probability of communicability in Hep A?
2 weeks before onset of jaundice
How long will the Hep A virus be in the environment for after exposure?
months
Risk factors for Hep A?
close contact
Ingestion of contaminate food/water
Blood exposure
Incubation (28-30 days)
Tx for Hep A?
IG-passive transfer of neutralizing antibodies
Prevents infection or clinical expression of dz
How long does pre-exposure prophylaxis last for Hep A?
3-5 mos
How soon after exposure must pt’s be given post-exposure prophylaxis for Hep A?
within 14 days
How many doses are required for Pre-expsure Hep A vaccine?
2
How old must a pt be to receive the Hep A vaccine?
older than 1 year (and before 24 mos. preferrably)
How long does the Hep A vaccine last?
at least 20 years (unsure)
What is the MC source of HBV infection in US?
Heterosexual contact
What is the most likely reason for decrease in viral hep A in US?
Universal vaccinations even for those not at risk
Considering risk factors for HBV infection which body fluid increases the concentration of virus?
Blood and serum (+wound exudate)
If you get HBV as an infant was is the risk that it will become chronic?
90%
What do we look for in a serum draw to see if Hep B virus is still present?
HBsAg
HBeAG tells us it’s still active
If a mother is positive for HBsAG and HBeAg what is the risk % of her child becoming infected?
70-90%
If a mother is positive for HBsAG only what is the risk % of her child becoming infected?
5-20%
What is used to prevent HBV infection?
HBIG (post exposure)
HBVaccine (Pre and post exposure)
Currently:
Vaccine for infants and everyone else!!
What is the primary component of the HBV vaccine?
HBsAg
what was the HCV outbreak in NH due to in 2012?
diversion of narcotics in cardiac cath lab
Why has there been a decrease of HCV infection reported?
number of acute clinical cases underreported
What percent of those who contract HCV go on to have a persistent infection?
Majority! 75-80%
What risk factor is HUGE with HCV!!??
ETOH use
What carries a higher risk of contraction of HCV IVDU or Sexual intercourse?
IVDU
Clinical presentation of HCV?
80% asymptomatic
loss of appetite, abdominal pain, fatigue, nausea, dark urine, jaudice
How is HCV diagnosed?
IgG assay for anti-HCV (may have false negative in first 15 weeks)
Nucleic acid amplification test
Tx for HCV?
in the process of evolving now.
Pegylated interferon and ribavirin for 24-48 wks - 50% success (sustained viral response)
What other virus does Hep D require in order to be contracted?
HBV
What 2 different ways can Hep D be acquired?
confection with HBV at same time
Superinfection with HBV already present
What vaccine exists for Hep D?
Hep B vaccine! BC you need Hep B to get Hep D
Which is it more common for a pt to have fulminant liver failure in a pt with Confection HDV or Superinfection HDV
Superinfection (5%)
How is Hep E transmitted?
Fecal Oral
Where is Hep E virus more common?
Japan, and europe (zoonotic and foodborne)
What are the 2 phases of the Hep E virus?
Prodromal
Icteric
Prodromal phase of HEV presentation
Myalgia arthralgias fever mild temp elevation anorexia N/V Wt loss Dehydration RUQ pain increased with activity
Icteric phase of HEV presentation?
Jaudice (serum bili is greater than 3)
Dark urine
Light colored stool
Pruritis
How is HEV diagnosed?
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.
TX for HEV?
supportive
Prevention for travelers concerned with HEV?
no vaccine/drug available
avoid possible contaminants (meat, water, etc)
Prognosis for HAV?
usually mild/self limited
infection confers lifelong immunity
Rare complications: relapse, cholestatic hepatitis, FHF
Prognosis for HBV?
Risk of chronic infection high in younger children
FHF develops in small present but fatality in those is high
Prognosis of HCV?
Chronic infxn common (50-60%) at risk for chronic active hepatitis, cirrhosis
High death rate
Prognosis of HDV w/ co-infected HBV:
Chronic HDV is common
Rapildy progressive acute/subacute hepatitis 70-80% develop into cirrhosis
Prongnosis of HEV?
mild-self limiting
Case fatal in higher in pregnant women
does not result in chronic dz
