Hepatitis Flashcards
List 10 causes of hepatitus
- Alcohol
- Alpha 1 antitrypsin
- Hemachromatosis
- Wilsons
- Celiac
- NASH
- Acetaminophen
- Statins
- Autoimmune
- Hep B
- Hep C
- Hep A
List 10 signs of liver failure
- Spider angiomas
- Ascites
- Atrophy of the testicles
- Bruising
- Clubbing
- Dupuytren’s contracture
- Encephalopathy
- Palmar erythema
- Fetor hepaticus
- Gynecomastia
- Hepatomegaly
- Jaundice
List 10 risk factors for Hepatitis B
- IVDU
- Born to infected mother
- Healthcare workers
- Hx STI
- MSM
- Incarceration
- Tattoos
- Transfusions before 1992
- Unimmunized
- Living in crowded conditions
- Vaccine non responder
- Multiple sexual partners
- Sexual partner with Hep B
Ways to protect yourself against Hepatitus (4) HBV
Vaccination
Avoid unprotected sex
Avoid sharing needles
Avoid sharing toothbrushes
Breastfeeding is okay as long as the skin is intact
What constitutes a diagnosis of non alcoholic steatohepatitis
Non alcoholic fatty liver on ultrasound PLUS increased serum AST and ALT
with outher causes ruled out
What on blood work makes you think of a hepatocellular pattern
Elevation of AST and ALT
What on blood wokr makes you think alcohol
AST:ALT >2
What on blood work makes you think obstructive pattern
Elecated ALP
List 5 non hepatic causes of elevated AST and ALT
Rhabdomyolysis
Cardiac muscle damage
Thyroid disease
Strenuous exercise
Hemolysis
Adrenal insufficiency
Celiac disease
Malignant infiltration
What blood work would you order if you found elevated AST ALT on labs (other than viral hep panel)
Platlets
AST
ALT
ALP
GGT
Total Billi
Albumin
PT
INR
Serum ferritin
ANA
CK
Ceruloplasmin (wilsons)
Anti-TTG with total IG
TSH
Alpha 1 antitrypsin
What do you order to test for the hepatitis viruses
HBsAg (Active infection)
HBsAb (past infection or immunization)-Speaks to immunity
HBcAb (Past or current infection)-Doesn’t speak to immunity
HBeAG (infectivity)
Can also order serum HBV DNA for infectivity
Serum Anti-HCV (only for initial testing, not if they have been positive before)
Serum HCV RNA (active infection)
Can get genotype and sub type
Get HIV as well
General advice/prevention after Hep exposure
Clean wounds
Vaccinate
Consider PEP
Hep A PEP
HAV vaccine (not twinrix)
Consider Hep A immune globulin if immunocopromised, children, over 41, or chronic liver disease
Hep A treatment
Supportive
Hygiene practices
Possible liver transplant
Hep B PEP
Only if not immune based on anti-HBs in the past (>10)
HBIG within 7 days of exposures
Check Anti HBc and HBsAG after 5 months to assess for transmission
Hep A transmission
Fecal oral
Usually through food
Cana be through sexual contact
Symptoms of Hep A
Only acute
Asymptomatic in children
Fever
Jaundice
Malaise
Abdo pain
N/V
Pale stools
Dark urine
Jaundice
Transmission of Hep B
Blood and body fluids, usually through sexual contact
Symptoms of Hep B
Acute usually nausea, fatigue, fever, abdo pain, jaundice, myalgias
Chronic usually asymptomatic until cirrhosis
Treatment for Hep B
Refer to hepatology
Treat if severe, high DNA loads, ALT elevated for >3 months
Treat with Tenofovir (Antiretrovirals)
Entecavir (antiretrovirals)
Interferon
Monitoring after Hep B or Hep C positive
Lab work q6-12 months for DNA, LFTs
Ultrasound Q 6 months
Scope q 1-3 years for varicies
Monitor Alcohol use
FIB 4 score to determine if they need a fibroscan
Whats in a fib 4 (4)
Age
ALT
AST
Platlets
PEP for Hep C
Just monitoring as it may clear spontaneously
What’s the possibility progressions of Hep C
20-45% clear it spontaneously (Will see Anti HCV positive but HCV RNA negative)
Those that are chronic (HCV RNA positive) 80% will remail stable
Why do we treat Hep C if so many are stable or clear it
So people don’t pass it on
How to treat Hep C
Always refer Hep C
Neucleotide inhibitors, NS5A inhibitors
(Sofosbuvir) (ladipasvir)
