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Clin med GI > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

How many types of viral hepatitis are there

A

5
A-E

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2
Q

Which types of viral hepatitis can be acute

A

A-E

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3
Q

Which types of viral hepatitis can be chronic

A

B,C,D

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4
Q

Which types of hepatitis are reportable diseases

A

A, B, C

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5
Q

What type of virus is Hep A

A

RNA

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6
Q

How is hep A spread

A

fecal- oral route
-contaminated food/water
-person to person contact
-international travel

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7
Q

What is the incubation period with Hep A

A

2 weeks to 6 months

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8
Q

Is hep A more severe in adults or children

A

adults

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9
Q

What are the symptoms for hep A

A

Abrupt/insidious onset
-myalgia & fatigue
-N/V & anorexia
-RUQ / epigastric pain
-URI symptoms
-smoking aversion

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10
Q

What is the presentation of someone with Hep A

A

Low grade fever
hepatosplennomegaly
lymphadenopathy
+/- jaundice later in illness

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11
Q

If a patient has and acute HAV infection, what will their antibody panel look like

A

+IgM
- IgG

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12
Q

If a patient has -IgM and +IgG antibodies, what type of HAV infection do they have

A

prior infection or vaccination

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13
Q

When is the Hep A vaccine recommended

A

children 12-23 months
up to 18 years old

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14
Q

What is the post exposure prophylaxis for Hep A

A

Single dose HAV vaccine between ages 1-40

Immunoglobulins is <1 or 40+

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15
Q

What is the treatment for hep A

A

Self limited in 2-3 weeks
-symptomatic treatment and frequent hand washing

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16
Q

How is Hep E transmitted and where is it usually seen

A

Fecal-oral (H2O contamination)

Primarily in india, Asia, Africa, Middle East, Central America

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17
Q

What is the incubation person for Hep E

A

14-60 days
* avg = 5-6 weeks

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18
Q

Which populations of people are at risk for Hep E

A

Pregnancy
underlying liver disease
HIV
chemo
transplant patients

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19
Q

What are the symptoms for Hep E

A

Immunocompromised symptoms
+
clay colored stool, Dark urine

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20
Q

What can occur outside of the liver with Hep E

A

Arthritis
pancreatitis
TTP
Guillain-Barre
Peripheral neuropathy

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21
Q

What is the treatment for Hep E

A

Prevention (no vaccine)
self limited illness

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22
Q

What type of Virus is Hep E

A

RNA

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23
Q

What type of virus is Hep B

A

Ds-DNA

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24
Q

How is Hep B transmitted

A

Blood borne
-Blood products
-occupational exposure
-IVDU
-Mom to baby during delivery
-Sexual contact

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25
Q

How long does Hep B stay infectious on fomites

A

7 days

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26
Q

What is the incubation period for Acute Hep B

A

6 weeks to 6 months
avg = 12-14 weeks

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27
Q

What Hepatitis lab is most sensitive / precise for chronic Hep B

A

HBV DNA (viral load)

28
Q

What in Hepatitis labs indicate Hep B viral infection

A

+HBsAg and HBeAg

29
Q

What hepatitis markers differentiate between acute, chronic, or carrier Hep B infection

A

+Anti-HBc (IgM & IgG)
*contact with viral DNA

30
Q

What does Anti-HBe indicate on hepatitis labs

A

Cessation of replication

31
Q

How long does acute illness last with hep B

A

2-3 weeks
*can be up to 16 weeks

32
Q

Can anyone have reactivation of Hep B

A

yes as long as they were exposed to the actual virus (not the vaccine)

33
Q

How can you prevent hep B

A

Handwashing
standard precautions
Safer sex practices
PeP
Vaccination

34
Q

What time frame indicates chronic hep B

A

Infection persisting longer than 3-6 months

*known. by AST/ALT elevations

35
Q

What risk factors do those with Hep B have

A

HIV/HCV coinfection
Hep D coinfection
HCC independant of cirrhosis

36
Q

What pharmacological treatment can be given for chronic hep B

A

Entecavir
Tenofovir
*PO admin

37
Q

When can those with chronic hep B be given an antiviral

A

Only when actively replicating
*check HBV and HBeAg levels (+)

38
Q

Why are nucleoside analogues chosen over PEG inf for hepatitis treatment

A

Most dont tolerate PEG inf

39
Q

What is the goal of treatment with chronic Hep B

A

Convert the antigens to antibodies and to bring down the viral load

40
Q

What is the prognosis with chronic hep B

A

5 year mortality

41
Q

What type of virus is Hep D

A

RNA

42
Q

How is Hep D transmitted

A

*only occurs as a coinfection with HBV

blood borne

43
Q

When is Hep D cleared from the body

A

When HBsAg is cleared

44
Q

How do you treat hep D

A

Treat underlying HBV

45
Q

What type of virus is Hep C

A

single stranded RNA

46
Q

What dictates the type of treatment with Hep C

A

The type of genotype (there are 7)

47
Q

What coinfection do many with HCV have

A

HIV

48
Q

How is HCV transmitted

A

Blood borne

49
Q

What is the incubation period for hep C

A

2-12 weeks

50
Q

When is HCV typically diagnosed

A

with routine labs
*often asymptomatic

51
Q

Who gets screened for HCV

A

All US adults at least 1x
pregnant female - each preg
one time screening regardless of age

52
Q

Which patients get periodic HCV screening

A

IVDU
Dialysis
High risk comorbidities

53
Q

What lab confirms HCV infection

A

HCV RNA

Anti-HCV to screen

54
Q

What is the natural progression of HCV

A

Spontaneous resolution in 50%

Progression to chronic HCV in 50%

55
Q

How do you prevent Hep C

A

Routine screening for transfusions

no Vaccine

safer sex + standard precautions

HBV and HAV vaccine to help chronic HCV

56
Q

What is the treatment for acute Hep C

A

Nothing for acute illness

*can consider PEG +/- ribacvarin if no clearance in 3 months

57
Q

What is the tx for chronic HCV

A

Goal is sustained virology response (undetectable 12+ weeks)

first line: Ledipasvir + Sofosbuvir

58
Q

Which genotypes respond better to chronic HCV tx

A

1>2>3

59
Q

When is ribavarin added to HCV therapy

A

Genotype 3
or
1 and 4 with cirrhosis

60
Q

How long do those with chronic HCV need to be treated

A

8 weeks with low viral load

12 weeks with genotype 1

24 weeks if cirrhosis is present

61
Q

What chronic HCV treatment is better for those with renal impairment

A

Elbasavir/ Grazoprevie

*types 1 and 4
-type 1 needs resistance testing

62
Q

What impacts treatment regimens for chronic hcv

A

Any previous treatment
+/- of cirrhosis

63
Q

Which HCV treatment cannot be given to those with cirrhosis

A

Glecaprevir/Pibrentasvir

64
Q

Which treatment is best for HCV types 2-6

A

Sofosbuvir/velpatasvir

65
Q

What is the leading cause of both HCC and liver transplant

A

HCV

*also increases risk of non-hodgkins lymphoma

Clin med GI (9 decks)

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