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GASTRO > HEPATITIS > Flashcards

HEPATITIS Flashcards

0
Q

What is most common acute viral hepatitis?

A

HAV, it’s self limiting

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1
Q

What is hepatitis?

A

Inflammation of the liver characterized by presence of inflammatory cells.

Can be self limiting (heal on it’s own) or can progress to fibrosis and scarring.

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2
Q

What is most common chronic viral hepatitis?

A

HCV

Self limiting in only 15%

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3
Q

What virus is the most directly oncogenes causing HCC?

A

HBV, yet is still self-limiting in 85%

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4
Q

What are the causative microbes of acute viral hepatitis?

A

HEP ABCDE
EBV CMV
PARVOVIRUS B19, Human Herpes Virus 6 (little known)

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5
Q

What is the Pathophysiology of acute hepatitis?

A

Acute necroinflammation of liver
Damage is done by immune destruction not cytopathic
If potent immune reaction, fulminant hepatic failure may result

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6
Q

Presentation?

A

1) Non-specific prodrome
2) Pre-icterus phase
- vague RUQ pain
- nausea
- immune mediated symptoms: hives, rash, arthralgia
3) Icterus phase (not freq seen?)
- jaundice, dark urine, pale stool (dark urine noticed before jaundice)
- hepatosplenomegaly
+/- FULMINANT HEPATIC FAILURE may ensue at this point
4) post icterus/recovery phase may take up to 6 months.

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7
Q

What happens if there is disease 6 months after an acute episode?

A

Termed Chronic viral hepatitis

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8
Q

HAV

  • incubation?
  • transmission?
  • RF?
  • Ix?
  • Rx?
A 
Incubation 15-45 days
Transmission 
- usually faecal-oral (ingestion of contaminated food or water) 
- can be via blood transfusion 
RF
- travelling to developif country
- children in child are or elderly in NH
- homosexual men
- IVDU 
Ix 
- anti-HAV IgM
Rx 
- self-limiting, supportive treatment
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9
Q

HBV

  • incubation
  • transmission
  • RF
A 
Incubation 30-150days
Transmission 
- sexual 
- vertical 
- percutaneous: blood, blood products, IVDU, tattooing 
RF
- multiple sex partners 
- parents from endemic areas
- immigrants
- IVDU
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10
Q

Serological markers for HBV?

A

HBsAg (hepatitis B surface antigen): hallmark for current infection, acute or chronic
Anti-Hbs (hepatitis B surface antibodies) indicates immunity
Anti-Hbc (hepatitis B core antibodies): IgM (acute infection) and IgG (chronic infection or immunity)
HBeAg (hepatitis B e antigen) is a marker of HBV replication
- high viral load and infect ivory
- not necessary for diagnosis
Acute HBV = HBsAg + anti-HBc IgM

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11
Q

Management of HBV?

A

HBV just self-limited, but may progress to fulminant hepatitis
No evidence behind lamivudine (antiviral)
Although if fulminant, early antiviral may reduce need for transplant

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12
Q

HEV

  • incubation
  • transmission
  • Ix
  • Rx
A

15-60days
Faecal oral - contaminated food/water
Ix - anti-HEV IgM
Rx - HEV self limiting, though can become fulminant

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13
Q

S + S of chronic viral hepatitis?

A 
Can be asymptomatic.
Often picked up on LFTs 
Non-specific 
- fatigue
- sleep disorders
RUQ pain 
Sx of cirrhosis 
- liver insufficiency 
- portal HTN
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14
Q

What is chronic HBV infection rarely associated with?

A

Glomerulonephritis in children’s

Polyarteries nodusa in adults

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15
Q

Ix?

A 
ALT > AST (opposite to alcoholic), 
ALP GGT mildly elevated 
Anti-HCV 
HCV viral load 
HCV genotype
16
Q

Radiology Ix for chronic hepatitis?

A 
Liver US to assess size and texture 
Fibroscan to assess liver stiffness 
Liver biopsy 
- balloon degeneration in periportal area 
- fibrosis in periportal areas
17
Q

How do you stage and grade chronic hepatitis?

A

Liver biopsy, Scheur grading system
Grade - portal inflammation -> necrosis
Lobular activity - inflammation -> bridging necrosis
Stage - fibrosis

18
Q

Pathology of chronic HCV?

A

Immune destruction of infected hepatocytes -> chronic inflammation -> fibrosis

19
Q

RF for rapid progression chronic HCV?

A 
Continuing IVDU 
ALCOHOL 
OBESITY
CO-INFECTION OF HIV + HBV 
LOW CD4+ count
20
Q

S + S of acute hepatitis C

A

Asymptomatic and undiagnosed lol

21
Q

Rx of chronic HCV?

A

Non-pharm

  • avoid IVDU
  • avoid alcohol
  • HAV vaccination

Antiviral depends on the genotype

  • pegylated IFN-a
  • ribavirin
  • protease inhibitors: boceprevir, telaprevir
22
Q

When would you delay treatment of Chronic hepatitis C?

A

Minimal inflammation or no fibrosis
Persistently normal ALT
Liver cirrhosis and signs of decompensation: low albumin, high INR, high bilirubin, ascites, jaundice -> LIVER TRANSPLANT NOT INTERFERON

23
Q

What is sustained virological response?

A

Equivalent to cure 99% negative HCV RNA long term.
Absence of HCV RNA by PCR 6 months AFTER stopping treatment

SVR = reduction in mortality

24
Q

What if antiviral combination fails SVR?

A

Try again with protease inhibitors

25
Q

What are predictors of SVR in HCV?

A 
HCV genotype - 2 and 3 better
Baseline viral load < 600,000 - 800,000
Treatment adherence 
Race - best in Asians
Insulin and obesity -ve predictors
26
Q

Why is monitoring chronic HCV treatment important and how is it done?

A

Adverse effects can cause pts to quit
Review
- monthly LFTs, CBE
- 3 monthly TFT (2% disease)

27
Q

Chronic HBV is defined by what?

A

HBsAg carriage > 6 months after acute episode

28
Q

What is the biggest risk for chronic HBV?

A

Vertical transmission -> 95% risk of chronic HBV

29
Q

What are the phases of chronic HBV?

A

Immune tolerant - host tolerates HBV, no inflammation

  • HbeAg +ve
  • HBV viral load very high
  • normal liver enzymes

Immune elimination - inflammatory response -> necroinflammatory lesions -> fibrogenesis

  • HBV viral laid low fluctuating
  • ALT and AST are increased

Inactive - successful immune elimination -> HBe seroconversion

  • anti-HBe positive
  • ALT AST normalize
  • HBV viral load very low or undetectable
  • normalizing liver histology
30
Q

Rx for Chronic HBV?

A

Reliable indicator for liver damage is viral load unlike in chronic HCV

antiviral but can’t eradicate

  • pegylated IFN-a
  • nucleoside analogues (lamividune, tenofovir)

Prevent deterioration

  • HAV Vaccination
  • avoid alcohol
31
Q

When to treat chronic HBV?

A

Indications for antiviral therapy?

  • HBV DNA levels > 2000
  • ALT normal
  • liver biopsy shows necroinflammation and fibrosis
  • decompressed cirrhosis requires urgent treatment

GASTRO (16 decks)

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