Hepatitis Flashcards
How many types of viral hepatitis are there
5
A-E
Which types of viral hepatitis can be acute
A-E
Which types of viral hepatitis can be chronic
B,C,D
Which types of hepatitis are reportable diseases
A, B, C
What type of virus is Hep A
RNA
How is hep A spread
fecal- oral route
-contaminated food/water
-person to person contact
-international travel
What is the incubation period with Hep A
2 weeks to 6 months
Is hep A more severe in adults or children
adults
What are the symptoms for hep A
Abrupt/insidious onset
-myalgia & fatigue
-N/V & anorexia
-RUQ / epigastric pain
-URI symptoms
-smoking aversion
What is the presentation of someone with Hep A
Low grade fever
hepatosplennomegaly
lymphadenopathy
+/- jaundice later in illness
If a patient has and acute HAV infection, what will their antibody panel look like
+IgM
- IgG
If a patient has -IgM and +IgG antibodies, what type of HAV infection do they have
prior infection or vaccination
When is the Hep A vaccine recommended
children 12-23 months
up to 18 years old
What is the post exposure prophylaxis for Hep A
Single dose HAV vaccine between ages 1-40
Immunoglobulins is <1 or 40+
What is the treatment for hep A
Self limited in 2-3 weeks
-symptomatic treatment and frequent hand washing
How is Hep E transmitted and where is it usually seen
Fecal-oral (H2O contamination)
Primarily in india, Asia, Africa, Middle East, Central America
What is the incubation person for Hep E
14-60 days
* avg = 5-6 weeks
Which populations of people are at risk for Hep E
Pregnancy
underlying liver disease
HIV
chemo
transplant patients
What are the symptoms for Hep E
Immunocompromised symptoms
+
clay colored stool, Dark urine
What can occur outside of the liver with Hep E
Arthritis
pancreatitis
TTP
Guillain-Barre
Peripheral neuropathy
What is the treatment for Hep E
Prevention (no vaccine)
self limited illness
What type of Virus is Hep E
RNA
What type of virus is Hep B
Ds-DNA
How is Hep B transmitted
Blood borne
-Blood products
-occupational exposure
-IVDU
-Mom to baby during delivery
-Sexual contact
How long does Hep B stay infectious on fomites
7 days
What is the incubation period for Acute Hep B
6 weeks to 6 months
avg = 12-14 weeks
What Hepatitis lab is most sensitive / precise for chronic Hep B
HBV DNA (viral load)
What in Hepatitis labs indicate Hep B viral infection
+HBsAg and HBeAg
What hepatitis markers differentiate between acute, chronic, or carrier Hep B infection
+Anti-HBc (IgM & IgG)
*contact with viral DNA
What does Anti-HBe indicate on hepatitis labs
Cessation of replication
How long does acute illness last with hep B
2-3 weeks
*can be up to 16 weeks
Can anyone have reactivation of Hep B
yes as long as they were exposed to the actual virus (not the vaccine)
How can you prevent hep B
Handwashing
standard precautions
Safer sex practices
PeP
Vaccination
What time frame indicates chronic hep B
Infection persisting longer than 3-6 months
*known. by AST/ALT elevations
What risk factors do those with Hep B have
HIV/HCV coinfection
Hep D coinfection
HCC independant of cirrhosis
What pharmacological treatment can be given for chronic hep B
Entecavir
Tenofovir
*PO admin
When can those with chronic hep B be given an antiviral
Only when actively replicating
*check HBV and HBeAg levels (+)
Why are nucleoside analogues chosen over PEG inf for hepatitis treatment
Most dont tolerate PEG inf
What is the goal of treatment with chronic Hep B
Convert the antigens to antibodies and to bring down the viral load
What is the prognosis with chronic hep B
5 year mortality
What type of virus is Hep D
RNA
How is Hep D transmitted
*only occurs as a coinfection with HBV
blood borne
When is Hep D cleared from the body
When HBsAg is cleared
How do you treat hep D
Treat underlying HBV
What type of virus is Hep C
single stranded RNA
What dictates the type of treatment with Hep C
The type of genotype (there are 7)
What coinfection do many with HCV have
HIV
How is HCV transmitted
Blood borne
What is the incubation period for hep C
2-12 weeks
When is HCV typically diagnosed
with routine labs
*often asymptomatic
Who gets screened for HCV
All US adults at least 1x
pregnant female - each preg
one time screening regardless of age
Which patients get periodic HCV screening
IVDU
Dialysis
High risk comorbidities
What lab confirms HCV infection
HCV RNA
Anti-HCV to screen
What is the natural progression of HCV
Spontaneous resolution in 50%
Progression to chronic HCV in 50%
How do you prevent Hep C
Routine screening for transfusions
no Vaccine
safer sex + standard precautions
HBV and HAV vaccine to help chronic HCV
What is the treatment for acute Hep C
Nothing for acute illness
*can consider PEG +/- ribacvarin if no clearance in 3 months
What is the tx for chronic HCV
Goal is sustained virology response (undetectable 12+ weeks)
first line: Ledipasvir + Sofosbuvir
Which genotypes respond better to chronic HCV tx
1>2>3
When is ribavarin added to HCV therapy
Genotype 3
or
1 and 4 with cirrhosis
How long do those with chronic HCV need to be treated
8 weeks with low viral load
12 weeks with genotype 1
24 weeks if cirrhosis is present
What chronic HCV treatment is better for those with renal impairment
Elbasavir/ Grazoprevie
*types 1 and 4
-type 1 needs resistance testing
What impacts treatment regimens for chronic hcv
Any previous treatment
+/- of cirrhosis
Which HCV treatment cannot be given to those with cirrhosis
Glecaprevir/Pibrentasvir
Which treatment is best for HCV types 2-6
Sofosbuvir/velpatasvir
What is the leading cause of both HCC and liver transplant
HCV
*also increases risk of non-hodgkins lymphoma
