Hepatitis

Question 0

Chronic hepatitis

Answer 0

condition lasting more than 6 months

Question 1

Acute hepatitis

Answer 1

condition lasting less than 6 months

Question 2

Drugs that cause Hepatitis

Answer 2

Acetaminophen, Isoniazid, Halothane, Phenytoin, Carbamazapine, Ketoconazole

Question 3

HAV- incubation period

Answer 3

15-45 days

Question 4

HAV -Prodrome

Answer 4

1-2 weeks

sx: flu-like sx

Question 5

HAV -Icteric phase

Answer 5

2-6 weeks
Dark urine
Pale stool
Jaundice
Itch (Pruritis)

Question 6

HAV -History

Answer 6

Search for the source of exposure

Exclude other possible causes for acute hepatitis (drug, alcohol, mushroom poisoning)

Question 7

HAV -liver enzyme and liver function tests

Answer 7

AST and ALT: >10,000 U/mL (ALT>AST)
Alkaline phosphatase: rise in acute disease and may progress during the cholestatic phase of the illness
Bilirubin
Serum Albumin levels decreased
PT may be prolonged

Question 8

HAV -Passive protection

Answer 8

for individuals traveling to areas of high endemicity who have less than 2 weeks before departure
-single dose of Ig is recommended if travel is less than 3 months

Question 9

HAV -complications

Answer 9

Relapsing hepaitis A
Cholestatic hepatitis
Fulminant hepatitis

Question 10

HEV -incubation period

Answer 10

15 days to 60 days

Question 11

HEV -dx

Answer 11

Serological tests- IgM, IgG
viral RNA- can be detected just before the onset of clinical sx in both blood and stool samples
Liver function tests

sx: massive hepatic necrosis is possible (NO in HAV)

Question 12

HEV -tx

Answer 12

No immunoprophylaxis is available in US.
Preventive- clean drinking water good sanitation, and hygiene
Ribavarin and pegylated interferon alpha has shown efficacy in some trials

Question 13

HAV, HEV -prognosis

Answer 13

HAV- low mortality
HEV- mortality rate 10 times HAV
especially high mortality (20%) during pregnancy

Question 14

HBV -virion (Dane particle)

Answer 14

• HBsAg (surface antigen/ Australia antigen)
• HBcAg (core antigen/ dna polymerase)
• HBeAg (early antigen)
• HBV X-protein: play a major role in formation of Hepatocellular carcinoma**

Question 15

HBV -incubation period

Answer 15

15- 160 days

Question 16

HBV -Extrahepatic manifestation

Answer 16

During acute phase:
Urticarial rash (Gianotti-Crosti syndrome)
Arthritis
GB syndrome, encephalitis, aseptic meningitis
During chronic phase:
Glomerulonephritis
Polyarteritis nodosa

Question 17

HBV -Immune comlexes

Answer 17

Formed by HBsAg and specific Ab are responsible for hypersensitivity reactions seen as arthritis, rash, liver damage, vasculitis, or kidney problems

Question 18

HBV -lab

Answer 18

Increased ALT, AST (ALT>AST)
Alkaline phosphatase may be increased
PTT may be prolonged
Serum alumin levels decreased
Leukopenia and lymphocytosis: preicteric phase
In chronic infection, mild to moderate increase in ALT and AST

Question 19

HBV -tx

Answer 19

Lamivudine- acute case
-Chronic:
Lamivudine, Telbivudine, Adefovir, Tenofovir, Entecavir
Interferon alpha
Pegylated interferon alpha

Question 20

HBV -surgical

Answer 20

Liver transplantation!
Hep B immunoglobulin (HBIG) during and post- transplantation period, and lamivudine or adefovir in the pre-transplantation period and post- transplantation period, dramatically reduces the recurrence rate of HBV infection***

Question 21

HBV passive immunization

Answer 21

For infants born to HBV positive mothers and for persons who were accidentally exposed.

Question 22

HCV -co-infection with HIV-1

Answer 22

increase the risk of both sexual and maternal-fetal transmission of HCV.

Question 23

HCV -extra-hepatic finding

Answer 23

Porphyria cutanea tarda

Mixed cryoglobulinemia

Question 24

HCV -lab

Answer 24

Anti HCV- EIA (enzyme immunoassays)
Recombinant immunoblot assay
HCV RNA- RT-PCR*
Elevated liver enzyme

Question 25

HCV -tx

Answer 25

GOLD STANDARD: Interferon alpha (pegylated/ long acting) + Ribavirin.

also: Protease inhibitors
- Treatment duration is 6-12 months

Question 26

HDV -incubation period

Answer 26

1-6 months

Question 27

HDV -co-infection

Answer 27

acute disease and then recover

Question 28

HDV -super-infection

Answer 28

develop chronic HDV infection with cirrhosis

Question 29

HDV -dx of chronic case

Answer 29

presence of Ab to Liver-kidney microsomes (LKM-3) is characteristic**

Question 30

Alcoholic Hep -lab

Answer 30

AST 2-7 fold more than ALT
Hypertriglyceridemia
Carbohydrate deficient transferrin
Gamma Glutamyl Transpeptidase (increased in all forms of fatty liver)

Question 31

Alcoholic Hep -tx

Answer 31

stop alcohol
Diet and nutritional supplements
Methyl prednisolone
Pentoxiifylline- inhibits TNF

Question 32

Autoimmune hep

Answer 32

Type 1 and Type 3: more common in older females

Type 2: more common in Juveniles

Question 33

AIH -dx

Answer 33

Hypergammaglobulinemia
AIH-1: ASMA and ANA
AIH-2: Anti-LKM-1 antibody
AIH-3: Antibodies to soluble liver antigen (anti-SLA)

Question 34

AIH -tx

Answer 34

Prednisolone

Azathioprine

Question 35

Drug induced Hep -lab

Answer 35

LKM-2 may be increased

Question 36

Fulminant hepatic failure (FHF)

Answer 36

Onset of encephalopathy within 8 weeks of onset of jaundice.

**HBV accounts for >50% of all cases of FHF.

Question 37

FHF -tx

Answer 37

Encephalopathy- Lactulose, oral ampicillin***
Cerebral edema- head elevation, hyperventilation, Mannitol
Bleeding- vitK and Fresh frozen plasma
Prophylactic Ab to tx and prevent
Liver transplant is last option.