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Internal medicine > Hepatitides and alcoholic liver disease > Flashcards

Hepatitides and alcoholic liver disease Flashcards

1
Q

What family does the hepatitis A virus belong to?

A

Picornaviridae

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2
Q

What is the structure of the hepatitis A virus?

A

Small, non-enveloped with ss + sense RNA

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3
Q

What is the route of hepatitis A transmission?

A

Fecal-oral

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4
Q

What is the course of hepatitis A infection?

A
  1. Incubation (2-6w)
  2. Prodrome (1-2w)
  3. Icteric phase (2w)
  4. Resolution of symptoms
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5
Q

What are the clinical features of the prodromal phase of hepatitis A infection?

A 
RUQ pain
Hepatomegaly
Fever
Malaise
Anorexia
N+V
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6
Q

What are the clinical features of the icteric phase of hepatitis A infection?

A

Jaundice
Dark urine
Pale stools
Pruritis

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7
Q

How do you diagnose hepatitis A infection?

A 
Bloods
- transaminases
- bilirubin
- HAV RNA
- antiHAV IgM 
- antiHAV IgG
Liver biopsy
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8
Q

What will you see on liver biopsy in a hepatitis A infection?

A 
Periportal inflammation
Hepatocyte swelling
Ballooning degeneration
Bridging necrosis
Councilman bodies
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9
Q

Which hepatitis viruses are fecal-oral?

A

HAV
HEV

Vowels = bowels

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10
Q

What family does the hepatitis E virus belong to?

A

Hepeviridae

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11
Q

What is the structure of the hepatitis E virus?

A

Non-enveloped with ss + sense RNA

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12
Q

What is the route of hepatitis E transmission?

A

Fecal-oral transmission

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13
Q

In which region is hepatitis A commonly found?

A

Tropical

Subtropical

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14
Q

In which region is hepatitis E commonly found?

A

Equatorial

Developing countries

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15
Q

What is the course of hepatitis E infection?

A
  1. Incubation (2-8w)
  2. Prodrome (1-2w)
  3. Icteric phase (2w)
  4. Resolution of symptoms
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16
Q

What are the clinical features of the prodromal phase of hepatitis E infection?

A 
RUQ pain
Hepatomegaly
Fever
Malaise
Anorexia
N+V
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17
Q

What are the clinical features of the icteric phase of hepatitis E infection?

A

Jaundice
Dark urine
Pale stools
Pruritis

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18
Q

How do you diagnose hepatitis E infection?

A 
Bloods
- transaminases
- bilirubin
- HEV RNA
- antiHEV IgM 
- antiHEV IgG
Liver biopsy
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19
Q

What will you see on liver biopsy in a hepatitis E infection?

A

Patchy necrosis

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20
Q

Which group is most at risk for fulminant hepatitis in hepatitis E infection?

A

Pregnant women (incr mortality of both mother and fetus)

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21
Q

Do affected hepatitis E patients become carriers?

A

No

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22
Q

Which hepatitides can have chronic sequelae?

A

HBV
HCV
HDV

Consonants = chronic

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23
Q

Discuss the treatment of hepatitis E infection

A

Self-limiting

Supportive care

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24
Q

Which hepatitides have vaccinations available?

A

HAV

HBV

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25
Q

What family does the hepatitis B virus belong to?

A

Hepadnaviridae

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26
Q

What is the structure of the hepatitis B virus?

A

Enveloped, circular, partially ds DNA

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27
Q

What is the route of hepatitis B transmission?

A

Parenteral
Sexual
MTC

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28
Q

Which groups are at risk of parenteral hepatitis B transmission?

A 
IVDUs
HCWs
Hemodialysis patients
Blood transfusion recipient 
Organ transplant recipient
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29
Q

What is the replication cycle of HBV?

A
  1. After entering the host cell’s nucleus, reverse transcriptase completes the positive strand of the virus’s partially double-stranded relaxed circular DNA (rcDNA).
  2. The rcDNA is converted to covalently closed circular DNA
  3. The cccDNA is then transcribed into viral mRNA by host RNA polymerase.
  4. The viral mRNA leaves the nucleus and is translated into HBV core proteins and new reverse transcriptase in the cytoplasm.
  5. Viral mRNA and reverse transcriptase are packaged into a capsid, where viral mRNA is then reverse-transcribed into viral rcDNA.
  6. New viral DNA genomes are enveloped and leave the cell as progeny virions.
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30
Q

What is the pathophysiology of hepatocyte destruction in acute HBV infection?

A

HBV-derived peptides on HBV infected hepatocytes are detected by lymphocytes which activate CD8+ T cells that attack the hepatocytes

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31
Q

What is the pathophysiology of hepatocellular carcinoma in chronic HBV infection?

A

Persistent inflammation

HBV DNA integration into the host genome

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32
Q

What is the course of hepatitis B infection?

A
  1. Incubation (1-6m)
  2. Clinical course varies significantly
    - serum sickness-like syndrome
    - subclinical hepatitis
    - symptomatic hepatitis
    - fulminant hepatitis
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33
Q

When can serum sickness-like syndrome in acute HBV infection develop?

A

1-2w post infection

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34
Q

What are the clinical features of serum sickness-like syndrome in acute HBV infection?

A

Rash
Myalgia
Arthalgia
Fever

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35
Q

What are the clinical features of symptomatic hepatitis in acute HBV infection?

A 
Fever
Myalgia
Arthalgia
Skin rash
Fatigue
Anorexia
Nausea
RUQ pain
Jaundice
36
Q

When does hepatitis B infection become chronic?

A

If the infection persists for more than 6 months with the detection of HBsAg

37
Q

Which HBV antigen is the first evidence of infection?

A

HBsAg

38
Q

Which HBV antigen indicates carrier state?

A

Continued HBsAg after 6mo

39
Q

Which HBV antigen indicates active viral replicatoin?

A

HBeAg

40
Q

Which HBV antibody indicates resolved infection or immunity?

A

Anti-HBsAg (with no HBsAg present)

41
Q

Which HBV antibody indicates recent HBV infection

A

Anti-HBcAg IgM

42
Q

Which HBV antibody indicates chronic HBV infection?

A

Anti-HBcAg IgG

43
Q

Which HBV antibody indicates long-term clearance of HBV?

A

Anti-HBeAg

44
Q

How do you screen for HBV infection and how do you confirm HBV infection?

A

Screen - HBsAg, anti-HBcAg IgM

Confirm - HBV DNA, HBeAg

45
Q

What additional laboratory studies should you perform in a patient with confirmed HBV infection?

A 
Transaminases
Ferritin
Bilirubin
Albumin
INR 
Cholinesterase
46
Q

What will you see on liver biopsy in an acute hepatitis B infection?

A

Councilman bodies

Bridging necrosis

47
Q

What will you see on liver biopsy in a chronic hepatitis B infection?

A

Periportal infiltrates
Piecemeal necrosis
Ground glass hepatocytes

48
Q

Which histology finding is pathognomic for chronic HBV?

A

Ground glass hepatocytes

49
Q

What are extrahepatic manifestations of hepatitis B infection?

A

Polyarteritis nodosa
Glomerulonephritis
Aplastic anemia

50
Q

Discuss your management of hepatitis B infection

A 
Lifestyle changes (weight, alcohol, medications)
Acute 
- supportive care
Chronic
- nucleoside/nucleotide analogues (tenofovir)
- pegylated interferon alpha
End-stage liver disease
- transplant
51
Q

Name contraindications for tenofovir

A 
Kidney disease (AKI, CKD)
Bone disease (osteomalacia, osteoporosis)
Fanconi syndrome
52
Q

Name contraindications for pegylated interferon alpha

A

Decompensated cirrhosis
Psychiatric conditions
Pregnancy

53
Q

What is the structure of hepatitis D virus?

A

Defective ss RNA

54
Q

What does the hepatitis D virus require to enter host cells?

A

HBsAg coat of HBV

55
Q

What is the incubation period of HDV coinfection?

A

1-6mo

56
Q

What is the incubation period of HDV super infection?

A

2-8w

57
Q

Define acute liver failure

A

Rapidly worsening liver function resulting in coagulopathy and hepatic encephalopathy in individual without preexisting liver disease or cirrhosis

58
Q

Name causes of acute liver failure

A

Viral hepatitis
Substances (acetominophen, halothane)
Toxins (aflatoxin)

59
Q

What investigations should you perform in acute liver failure?

A 
Transaminases
Bilirubin
Coagulopathy studies
FBC (platelets)
Viral serology
Toxicology screening
60
Q

Discuss your management of acute liver failure

A

Address underlying cause

Early transfer to a transplant center

61
Q

Name complications of HBV infection

A 
Short-term
- HDV infection
- acute liver failure
Long-term
- liver cirrhosis
- hepatocellular carcinoma
- extrahepatic manifestations
- post-hepatitis syndrome
62
Q

Which glomerulonephritis is more common as a extrahepatic manifestation of HBV infection?

A

Membranous glomerulonephritis

Membranoproliferative type I is less common

63
Q

Define acute hepatitis C infection

A

HCV infection that develops during the first 6 months following the exposure

64
Q

Define chronic hepatitis C infection

A

HCV infection that persists beyond the first 6 months following the exposure

65
Q

Do the majority of HCV infections resolve or progress?

A

85% become chronic - majority of acute infections are asymptomatic

66
Q

What family does the hepatitis C virus belong to?

A

Flaviviridae

67
Q

What is the structure of the hepatitis C virus?

A

Enveloped,+ sense ss RNA

68
Q

What is the route of hepatitis C transmission?

A

Parenteral
Sexual
Perinatal

69
Q

What is the incubation period for hepatitis C infection?

A

2w-6mo

70
Q

What is the clinical presentation of acute hepatitis C infection?

A

Asymptomatic
Symptomatic
- same as other acute viral hepatitis

71
Q

What is the clinical presentation of chronic hepatitis C infection?

A

Liver cirrhosis

72
Q

What are the extrahepatic manifestations of chronic hepatitis C infection?

A
  1. Hematological
    - mixed cryoglobulinemia
    - B cell non-Hodgkin lymphoma
    - ITP
    - autoimmune hemolytic anemia
  2. Renal
    - membranoproliferative glomerulonephritis
    - membranous glomerulonephritis
  3. Dermatological
    - porphyria cutanea tarda
    - lichen planus
  4. Endocrine
    - DM
    - autoimmune thyroiditis
  5. Vascular
    - leukocytoclastic vasculitis
73
Q

How do you diagnose HCV infection?

A

ELISA (antibodies) and confirm with PCR (HCV RNA)

74
Q

Discuss the management of HCV infection

A

2 x DAA (ledipasvir + sofosbuvir)

Interferon + ribavirin

75
Q

What are the adverse effects of interferon and ribavirin combination?

A 
Arthalgia
Thrombocytopenia
Leukopenia
Anemia
Depression
Teratogenic
76
Q

Can pregnant women with HBV/HCV deliver vaginally and/or breastfeed?

A

Yes

77
Q

Which sex does autoimmune hepatitis affect predominantly?

A

Females

78
Q

Name the clinical features of autoimmune hepatitis

A

Fatigue
Abdominal pain
Weight loss
Jaundice (if acute liver failure)

79
Q

How do you diagnose autoimmune hepatitis?

A

ANA
ASMA
Liver biopsy

80
Q

Give a differential diagnosis for autoimmune hepatitis

A

Viral hepatitis
Primary sclerosing cholangitis
Primary biliary cirrhosis
Alcohol-related hepatotoxicity

81
Q

Discuss the management of autoimmune hepatitis

A

Azathioprine

Prednisone

82
Q

What are the 3 stages of alcoholic liver disease?

A

Alcoholic fatty liver
Alcoholic hepatitis
Alcohol-related cirrhosis

83
Q

What are the laboratory findings in alcoholic fatty liver disease?

A

AST>ALT
Incr GGT
Incr CDT
Macrocytic anemia

84
Q

What are the laboratory findings in alcoholic hepatitis?

A 
AST:ALT>2
Macrocytic anemia
Thrombocytosis
Incr GGT
Incr ALP
85
Q

Which histological finding is associated with alcoholic liver disease?

A

Mallory bodies

86
Q

What is the etiology of NAFLD and NASH?

A

DM II

Obesity

Internal medicine (16 decks)

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