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ID Boards > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

Complications of HAV

A
  • Usually improves w/o sequelae w/in 2mos
  • relapsing hepatitis - 1 in 7
    • during 6mos after acute infection
  • prolonged cholestatic hepatitis >12wks
    • <5%, resolves spontaneously
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2
Q

hepatitis in pregnancy a/w guillain-barre

A

HEV

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3
Q

Most effective therapies for tx cHBV

A

tenofovir (esp HIV)

entecavir

lamivudine - used in HIV, but has high rate of R development (30%)

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4
Q

Important complication of tx of HCV

A

HBV reactivation w/ flares of hepatitis, occasionally severe enough to require liver transplant or result in death

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5
Q

Who to screen for HCC in chronic HBV infection

A
  • all pts w/ cirrhosis
  • Asian M >40yo; Asian F >50yo
  • African >20yo
  • FH of HCC
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6
Q

Frequent extrahepatic manifestations of HCV

A
  • AI thyroiditis
  • B-cell NHL
  • lichen planus
  • porphyria cutanea tarda
  • cryoglobulinemia: vasculitis, glomerulonephritis
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7
Q

Genotypes of HEV

A
  • Genotype 1,2 - Asia, N Africa
    • no animal reservoir
  • Genotype - endemic in swine - butchers and farmers

Endemic in most of the developing world

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8
Q

Infectious related causes of hepatic parenchymal disease

A
  • ART toxicity: ABC, nevirapine (classically). Can be seen with almost all ART
  • Malignancy: KS, HCC
  • Biliary disease: AIDS cholangiopathy
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9
Q

Common cause of hepatitis in children

worsened liver failure w/ chronic HBV/HCV

A

think parvovirus B19

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10
Q

exposure: contaminated water

jaundice, abd pn, + fever/HA/myalgias

A

consider lepto

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11
Q

Travel to SA or Africa

range from mild febrile illness to fulminant liver failure

A

consider yellow fever

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12
Q

Persons w/ isolated HBcAb+ in high-risk groups (BMT, SOT, ritux, HDS)

A

represents occult HBV most commonly

  • need vaccination
  • (note: if HBsAg+ –> need ppx always)
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13
Q

Tx HBV if…

  • GFR 30-60
  • GFR 10-30
  • GFR <10 (no RRT)
  • RRT
A
  • GFR 30-60: TAF
  • GFR 10-30: TAF or entecavir
  • GFR <10 (no RRT): entecavir
  • RRT: TDF or TAF or entecavir (anything)
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14
Q

When to tx pregnant women with HBV

A

*rec all pregnant women have HBV DNA

Tx if DNA >200k

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15
Q

The 4 preferred tx for chronic HBV

A
  • Entevacir
  • TAF
  • TDF
  • Peg-IFN
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16
Q

When to tx HBV

A

when high replication plus disease (ie liver damage) - phases 2 and 4 of natural history

  • w/ HBeAg positive disease: limits are ALT >2xULN and DNA >20k
  • w/ HBeAg negative disease: limits are ALT>2xULN and DNA >2k
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17
Q

HBV Disease Phase:

HBsAg negative

HBeAg-

HBV DNA <10

ALT normal

Liver disease none

A

resolved HBV infection (HBsAg-/anti-HBc Ab+)

(Phase 5)

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18
Q

HBV Disease Phase:

HBsAg - intermediate

HBeAg -

HBV DNA >2k

ALT elevated

Liver disease mod/sev

A

HBeAg- chronic HBV

(Phase 4)

*req tx

19
Q

HBV Disease Phase:

HBsAg low

HBeAg -

HBV DNA <2k

ALT normal

Liver disease none

A

chronic HBC infection - inactive carrier

(Phase 3)

*latent/nonreplicative phase

20
Q

HBV Disease Phase:

HBsAg high/intermediate

HBeAg +

HBV DNA 10^4-10^7

ALT elevated

Liver disease mod/sev

A

chronic HBV - immune reactive (Phase 2)

*req tx

21
Q

HBV Disease Phase:

HBsAg high

HBeAg +

HBV DNA >10^7

ALT normal

Liver disease none/minimal

A

Chronic HBV infection - immune tolerant

(Phase 1)

22
Q

Essential evaluation with chronic HBV

A

eAg, HBV DNA, HDV, genotype

HIV

stage (LFT, elastrography or bx)

renal status

u/s to r/o HCC (Asian, M>40yo, F>50yo, AA>25-30yo)

23
Q

Which HCV regimen to avoid in pts with HIV on PI

A

grazoprevir (an HCV PI)

PIs interact (similarly, boosters will effect levels)

24
Q

Which HCV regimens have concern with tenofovir?

A

sofosbuvir (TDF can increase sofosbuvir)

25
Q

Which HCV regimens are safe with ESRD?

A

all are

26
Q

Which HCV regimens are pangenotypic?

A
  • glecaprevir/pibrentasvir
  • sofosbuvir/velpatasvir
27
Q

Usual answers for tx-naive HCV 1a

A
  • *sofosbuvir/velpatasivir x12 weeks
  • glecaprevir/pibrentasivir x8wk
28
Q

Equation that could be helpful in determining likelihood of cirrhosis in HCV

A

FIB 4

= age (yrs) x AST (U/L) / plt count x ALT^1/2

(FIB4>fibrosure - though fibrosure still tends to be used for insurance purposes)

29
Q

Accepted staging methods for HCV

A

liver bx

blood markers

elastography

or any combo of the above

30
Q

HBsAg+

anti-HCV negative

A

polyarteritis nodosa

31
Q

HCV

palpable purpura (often on LEs)

A

cryoglobulin vasculitis

32
Q

HCV

pruritic rash

A

lichen planus

33
Q

HCV

blister in sun-exposed areas

A

porphyria cutanea tarda

34
Q

Hepatitis in pregnancy

A
  1. Rule out viral hepatitis (including HSV, as, though 50% will have MC lesions, hepatitis can occasionally be only presenting symptom)
  2. R/o meds
  3. HELLP
  4. AFLP - severe + low glucose, low fibrinogen
35
Q

Hepatitis with Travel to Developing Country

A
36
Q

Bacterial causes of hepatitis

A

Cholestatic

  • coxiella burnetti
  • spirochetes (syphilis, lepto)

bacterial sepsis, liver abscess

Brucellosis

TB

Typhus

37
Q

low platelets, leukopenia

often hepatitis

exposure

A

Rickettsia/Ehrlicia

38
Q
  • acute hepatitis (bili>LFTs - cholestatic)
  • multiorgan: kidney, eyes, skin, muscle, lungs
  • exposure to fresh water (rafting in Hawaii or Costa Rica) OR rats (homeless or cabins)
A

leptospirosis

39
Q

IDU, HIV + MSM

with acute elevated LFTs

A

think HCV

(most likely cause of acute hepatitis in these populations)

40
Q

fulminant hepatitis in someone with either acute or chronic HBV

A

HDV

41
Q

HAV post-exp ppx

A
  • vaccinate and possibly IG
    • unless >40yo or immunocompromised - then maybe just IG)
    • all close exposures (not casual exposures)
42
Q

MCC of acute hepatitis in the US

A

HAV

43
Q

extrahepatic complications of HEV

A

GBS and other neuro manifestations

pancreatitis

44
Q

Outbreaks - contaminated water Asia/Africa

Sporadic - undercooked meat (BOAR, deer)

**Overseas travel typical

A

Hep E

ID Boards (24 decks)

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