Hepatitis Flashcards
Chronic hepatitis
condition lasting more than 6 months
Acute hepatitis
condition lasting less than 6 months
Drugs that cause Hepatitis
Acetaminophen, Isoniazid, Halothane, Phenytoin, Carbamazapine, Ketoconazole
HAV- incubation period
15-45 days
HAV -Prodrome
1-2 weeks
sx: flu-like sx
HAV -Icteric phase
2-6 weeks Dark urine Pale stool Jaundice Itch (Pruritis)
HAV -History
Search for the source of exposure
Exclude other possible causes for acute hepatitis (drug, alcohol, mushroom poisoning)
HAV -liver enzyme and liver function tests
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
HAV -Passive protection
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
HAV -complications
Relapsing hepaitis A
Cholestatic hepatitis
Fulminant hepatitis
HEV -incubation period
15 days to 60 days
HEV -dx
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)
HEV -tx
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
HAV, HEV -prognosis
HAV- low mortality
HEV- mortality rate 10 times HAV
especially high mortality (20%) during pregnancy
HBV -virion (Dane particle)
- 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**
HBV -incubation period
15- 160 days
HBV -Extrahepatic manifestation
During acute phase:
Urticarial rash (Gianotti-Crosti syndrome)
Arthritis
GB syndrome, encephalitis, aseptic meningitis
During chronic phase:
Glomerulonephritis
Polyarteritis nodosa
HBV -Immune comlexes
Formed by HBsAg and specific Ab are responsible for hypersensitivity reactions seen as arthritis, rash, liver damage, vasculitis, or kidney problems
HBV -lab
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
HBV -tx
Lamivudine- acute case -Chronic: Lamivudine, Telbivudine, Adefovir, Tenofovir, Entecavir Interferon alpha Pegylated interferon alpha
HBV -surgical
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***
HBV passive immunization
For infants born to HBV positive mothers and for persons who were accidentally exposed.
HCV -co-infection with HIV-1
increase the risk of both sexual and maternal-fetal transmission of HCV.
HCV -extra-hepatic finding
Porphyria cutanea tarda
Mixed cryoglobulinemia
