Hepatitis Flashcards
What are the key differences between Hepatitis A, B, and C, D and E
Hepatitis A: Fecal-oral, no chronic infection.
Hepatitis B: Blood/body fluids, 15-20% chronic, DNA virus
Hepatitis C: Blood/body fluids, 75-85% chronic. RNA virus
Hepatitis D: Coinfection with Hepatitis B
Hepatitis E: Fecal-oral. No chronic infection.
Clinical features of viral hepatitis
Fever
Anorexia, nausea, vomiting
Right hypochondrial pain (liver area)
Jaundice,
Dark urine, pale stools
Hepatomegaly (enlargement of liver)
What are the general biochemical abnormalities seen in a patient with viral hepatitis?
Leukopenia
Urine urobilin, urobilinogen
Raised serum bilirubin
Raised ALT more than Raised AST
Raised GGT
Specific viral markers for Hepatitis A?
Similarity to Hep D and E?
Anti-HAV IgM in an active infection
Anti-HAV IgG (prior exposure or vaccination)
For hepatitis D and E, change A in HAV to D or E.
Similar concept.
Specific viral markers for Hepatitis C?
How to tell between an active infection and just immunization?
Anti-HCV IgG is present in both cases.
Active infection indicates presence of positive HCV RNA, whereas immunization/prior exposure has negative HCV RNA.
Treatment of chronic Hepatitis B
HBV DNA >2,000 IU/mL + ALT x2 ULN + HBeAg (+) or HBeAg (-)
Anyone with liver cirrhosis with HBV DNA > 2,000 IU/mL
Pharmacological:
Pegylated IFN-alfa or IFN-alfa, for fixed durations.
S/E : bone marrow suppression, flu-like smx, GI s/e, depression, suicidal ideation
or
Nucleostide agents:
Entecavir
tenofovir diprovoxil
tenofovir alafenamide
lamivudine, telbivudine, adefovir
until endpoint is met
Treatment of Chronic Hepatitis C
Direct-acting antiviral therapy used in combination for at least 8 weeks
N3/4A protease inhibitors (grazoprevir)
NS5A inhibitors (ledipasvir)
NS5B polymerase inhibitors (sofosbuvir)
Ribavirin (S/E : fatigue, teratogenic, anemia)
Peg-INF-alfa (immune-suppression, GI, depression, suicide ideation)
