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INFECTIOUS DISEASE > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

List 10 causes of hepatitus

A
  1. Alcohol
  2. Alpha 1 antitrypsin
  3. Hemachromatosis
  4. Wilsons
  5. Celiac
  6. NASH
  7. Acetaminophen
  8. Statins
  9. Autoimmune
  10. Hep B
  11. Hep C
  12. Hep A
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2
Q

List 10 signs of liver failure

A
  1. Spider angiomas
  2. Ascites
  3. Atrophy of the testicles
  4. Bruising
  5. Clubbing
  6. Dupuytren’s contracture
  7. Encephalopathy
  8. Palmar erythema
  9. Fetor hepaticus
  10. Gynecomastia
  11. Hepatomegaly
  12. Jaundice
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3
Q

List 10 risk factors for Hepatitis B

A
  1. IVDU
  2. Born to infected mother
  3. Healthcare workers
  4. Hx STI
  5. MSM
  6. Incarceration
  7. Tattoos
  8. Transfusions before 1992
  9. Unimmunized
  10. Living in crowded conditions
  11. Vaccine non responder
  12. Multiple sexual partners
  13. Sexual partner with Hep B
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4
Q

Ways to protect yourself against Hepatitus (4) HBV

A

Vaccination
Avoid unprotected sex
Avoid sharing needles
Avoid sharing toothbrushes
Breastfeeding is okay as long as the skin is intact

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5
Q

What constitutes a diagnosis of non alcoholic steatohepatitis

A

Non alcoholic fatty liver on ultrasound PLUS increased serum AST and ALT
with outher causes ruled out

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6
Q

What on blood work makes you think of a hepatocellular pattern

A

Elevation of AST and ALT

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7
Q

What on blood wokr makes you think alcohol

A

AST:ALT >2

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8
Q

What on blood work makes you think obstructive pattern

A

Elecated ALP

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9
Q

List 5 non hepatic causes of elevated AST and ALT

A

Rhabdomyolysis
Cardiac muscle damage
Thyroid disease
Strenuous exercise
Hemolysis
Adrenal insufficiency
Celiac disease
Malignant infiltration

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10
Q

What blood work would you order if you found elevated AST ALT on labs (other than viral hep panel)

A

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

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11
Q

What do you order to test for the hepatitis viruses

A

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

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12
Q

General advice/prevention after Hep exposure

A

Clean wounds
Vaccinate
Consider PEP

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13
Q

Hep A PEP

A

HAV vaccine (not twinrix)
Consider Hep A immune globulin if immunocopromised, children, over 41, or chronic liver disease

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14
Q

Hep A treatment

A

Supportive
Hygiene practices
Possible liver transplant

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15
Q

Hep B PEP

A

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

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16
Q

Hep A transmission

A

Fecal oral
Usually through food
Cana be through sexual contact

17
Q

Symptoms of Hep A

A

Only acute
Asymptomatic in children
Fever
Jaundice
Malaise
Abdo pain
N/V
Pale stools
Dark urine
Jaundice

18
Q

Transmission of Hep B

A

Blood and body fluids, usually through sexual contact

19
Q

Symptoms of Hep B

A

Acute usually nausea, fatigue, fever, abdo pain, jaundice, myalgias

Chronic usually asymptomatic until cirrhosis

20
Q

Treatment for Hep B

A

Refer to hepatology
Treat if severe, high DNA loads, ALT elevated for >3 months
Treat with Tenofovir (Antiretrovirals)
Entecavir (antiretrovirals)
Interferon

21
Q

Monitoring after Hep B or Hep C positive

A

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

22
Q

Whats in a fib 4 (4)

A

Age
ALT
AST
Platlets

23
Q

PEP for Hep C

A

Just monitoring as it may clear spontaneously

24
Q

What’s the possibility progressions of Hep C

A

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

25
Q

Why do we treat Hep C if so many are stable or clear it

A

So people don’t pass it on

26
Q

How to treat Hep C

A

Always refer Hep C
Neucleotide inhibitors, NS5A inhibitors
(Sofosbuvir) (ladipasvir)

INFECTIOUS DISEASE (10 decks)

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