Hepatitis Flashcards
Viral Hepatitis
general
Common condition characterized by diffuse liver inflammation caused by specific hepatotropic viruses
Etiology:
Hepatitis A (HAV)
Hepatitis B (HBV)
Hepatitis C (HCV)
Hepatitis D (HDV)
Hepatitis E (HEV)
Other viruses can also cause an acute presentation of hepatitis (Epstein-Barr virus, Cytomegalovirus)
HEP
Patho
Pathophysiology:
Cytotoxic killing of the hepatocytes by CD8 T-cells which leads to cell apoptosis and liver damage
HEP A
Genral
Most common cause of acute viral hepatitis
Enterically transmitted RNA virus(fecal-oral route)
Produces typical S/S of hepatitis: anorexia, malaise, jaundice, fever, RUQ abdominal pain, hepatomegaly
Fulminant hepatitis and death are rare; increased risk in patients with chronic hepatitis C infection
Chronic hepatitis does not occur
HEP
typical S/Sx
Produces typical S/S of hepatitis: anorexia, malaise, jaundice, fever, RUQ abdominal pain, hepatomegaly
HEP A
Dx
Diagnosis is by antibody testing
IgM anti-HAV: detectable from 1–2 weeks after infection; remain for up to 6 months
IgG anti-HAV: evidence of past infection or vaccination
IGM is acute, IGG is either from past infection or immunization
HEP A
Tx and prevention
Treatment is supportive
Vaccination and previous infection are protective
Hepatitis B
general
Parenterally transmitted DNA virus
Coinfection with hepatitis D may occur
Produces typical S/S of hepatitis: anorexia, malaise, jaundice, fever, RUQ abdominal pain, hepatomegaly
Fulminant hepatitis and death may occur
Chronic infection can occur → cirrhosis and/or hepatocellular carcinoma
parentally : Sex, mother to baby, IVDU
Hep B
Dx
Diagnosis is by serologic testing: antigens and antibodies (surface, core, envelop)
HEP B
Tx
Treatment is supportive; antivirals for severe disease
Hep B
Prevention/protection
Vaccination is protective
Postexposure use of hepatitis Bimmune globulin (HBIG) may prevent or attenuate clinical disease
HBIGcontains antibodiestohepatitis B
Gives rapid, but short lived protection
Who should receive HBIG?
A baby born to a mother with hepatitis B; needle stick injury
Hepatitis B infection
serology
HBsAg positive- (surface antigen)
1st evidence of infection
Elevation >6 months → chronic infection
IgM Anti-HBc positive (acute infection)
Anti-HBs negative
IgG Anti-HBc positive (chronic infection)
HBV-vaccination
serology
HBsAg negative
IgM Anti-HBc negative
IgG Anti-HBc negative
Anti-HBs positive
c=core protein, should alsways be negative for vaccinated
Hep B
vaccination series
HBVvaccine:
Active immunity; leads to long-term immunity
For infants:
3-dose series, administered at 0, 1, and 6 months
For adults:
2-dose series (1 month apart)
Hepatitis A+ B combinationvaccine is also available as 3-dose series
Hepatitis B Screening
CDC issued new guidelinesrecommending expansion of hepatitis B screening to everyone
Under the new guideline,all adults 18 and older should be screened for hepatitis B at least once in their lifetime
Screening should be done using a triple panel test which includes HBsAg, anti-HBs, and anti-HBc
If the test is negative and no new risk factors are identified, people don’t need to be screened again
People considered at increased risk for HBV should still get periodic repeat testing
All pregnant people should be tested for HBsAg during each pregnancy regardless of vaccination status or history of testing
Hep B
The CDCidentifies these groupsto be at increased risk:
Currently or formerly incarcerated persons
Persons with current or past STIs or multiple sex partners
Persons with current or past hepatitis C virus infection
Persons born in regions with an HBV prevalence 2% or greater
US-born persons whose parents were born in regions of high HBV prevalence (>8%) and who were not vaccinated as infants
Persons with HIV infection
Persons with current or past injection drug use
Men who have sex with men
Infants born to people who are HBsAg-positive
Household contacts of persons with HBV infection
Needle-sharing or sexual contacts of persons with known HBV infection
Patients on dialysis
Persons with elevated ALT or AST levels of unclear etiology
Persons who request HBV testing (may be due to reluctance to disclose risk factors)
dont memeorize
HCV
General
Parenterally transmitted RNA virus
< 50% due to IV drug use
Sometimes causes typical S/S of hepatitis: anorexia, malaise, and jaundice, but may be asymptomatic
Fulminant hepatitis and death rarely occur
Chronic hepatitis develops in ~80% of patients → cirrhosis and rarely hepatocellular carcinoma
HCV
Dx
Diagnosis is by serologic testing:
Anti-HCV → HCV RNA (confirmatory testing)
HCV
Tx
Treatment is based on the genotype and presence of cirrhosis → combination of direct-acting antivirals
HCV
prevention/protection
No vaccine is available
Previous infection is not protective to later infection with the same or different genotypes of the virus
Hepatitis D
general
Defective RNA virus (delta agent) that can replicate only in the presence of hepatitis B virus
Parenterally transmitted
Produces typical S/S of hepatitis: anorexia, malaise, jaundice, fever, RUQ abdominal pain, hepatomegaly
Occurs as a coinfection with acute hepatitis B or as a superinfection in chronic hepatitis B
HDV–HBV coinfection/superinfection is the most severe form of chronic viral hepatitis → rapid progression toward hepatocellular carcinoma (HCC) and liver-related death
HDV
Dx
Diagnosis is by serologic testing:
HBsAg
Anti-HDV IgM (early) or IgG (late)
HDV RNA
HDV
Tx and prevention
Treatment is supportive
VaccinationagainstHBV is the most effective way to prevent HDV
Hepatitis E
general
Enterically transmitted RNA virus(fecal-oral route)
Produces typical S/S of hepatitis: anorexia, malaise, jaundice, fever, RUQ abdominal pain, hepatomegaly
Fulminant hepatitis and death are rare, except during pregnancy
HEV
Dx
Diagnosis is by serologic testing:
Anti-HEV IgM (acute infection)
Anti-HEV IgG (previous infection)
HEV RNA
HEV
Tx and prevention
Treatment is supportive
A vaccine for hepatitis Eis available in China, but is not available in the United States
Hepatitis
phases of infection (4)
- incubation
- prodromal (pre-icteric)
- icteric
- recovery
hepatitis
Prodromal (pre-icteric) phase:
Hep B?
- Nonspecific symptoms
- Profound symptoms: anorexia, malaise, nausea and vomiting, fever, RUQ abdominal pain
- Urticaria and arthralgias occur occasional and are most associated with HBV infection
Icteric phase:
- Occurs ~3-10 days after the prodromal phase
- Urine darkens, followed by jaundice
- Systemic symptoms often regress, and patients feel better despite worsening jaundice; jaundice peaks ~1-2 weeks
- Liver is usually enlarged (hepatomegaly) and tender
check spleen too
Recovery phase:
During this 2- to 4-week period, jaundice fades
hepatitis
Liver lab tests
Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) elevated (> 1000 IU/L)
ALT > AST
ALT is the slowest to return to baseline (recovery phase)
ALT and AST will be elevated out of proportion to alkaline phosphatase
Hyperbilirubinemia (conjugated and unconjugated)
Fractionation of bilirubin is of no clinical value
Urinary bilirubin usually precedes jaundice
hepatitis
Prothrombin/international normalized ratio (PT/INR)
measurement to access liver function
can be elevated
hepatitis
Tx
Supportive care
Avoid alcohol and hepatotoxic drugs
Treatment of acute hepatitis C – prevent transmission
Cases of viral hepatitis should be reported to the local and states health department
hepatitis
prevention
universal precautions/ Immunoprophylaxis
Good personal hygiene
Universal precautions:
Barrier protection when handling blood and other body fluids from patients with acute HBV and HCV; stool from patients with acute HAV
Immunoprophylaxis:
Antibody-containing preparations to provide a susceptible individual with immunologic protection against a specific disease
Vaccines for hepatitis A and hepatitis B are available in the United States
