Hepatitis

Question 1

What are the general signs and symptoms of acute

viral hepatitis?

Answer 1

There is typically a 1-2 week period of mild symptoms such as
fatigue, nausea, fever, and/or vomiting. It may or may not be
accompanied by jaundice.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 709.

Question 2

What forms of viral hepatitis are associated with

fecal-oral contamination of food or water?

Answer 2

Hepatitis A and E, both of which are self-limiting forms of viral
hepatitis
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 189-
190.

Question 3

What forms of viral hepatitis can be transmitted via
blood products or percutaneously through the use of
shared needles?

Answer 3

Hepatitis B, C, and D
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 189-
190.

Question 4

What is the incidence of conversion to chronic

hepatitis for hepatitis A, B, and C?

Answer 4

Hepatitis A does not convert into chronic hepatitis. As many as
10% of patients with hepatitis B will become chronic and up to
40% of patients with hepatitis C will develop chronic hepatitis.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 769.

Question 5

For what forms of viral hepatitis are vaccines

available?

Answer 5

Specific vaccines are available for hepatitis A and B. Because
hepatitis D only coincides with a hepatitis B infection, it is
covered by vaccine as well.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 189.

Question 6

What is the mortality rate for a patient undergoing

surgery who is also in alcohol withdrawal?

Answer 6

The mortality rate for these patients approaches 50%.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 710.

Question 7

How do volatile anesthetics result in hepatitis?

Answer 7

Volatile anesthetic hepatitis is a mild, self-limiting form of
hepatitis that is believed to be due to decreases in oxygen
supply to the liver relative to demand. There is also some
evidence that IgG antibodies form in response to liver proteins
modified by the triflouroacetyl metabolite of halothane which
may contribute as a causative factor.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1302.

Question 8

What is the most common cause of drug-induced
hepatitis? What are some other drugs that can
result in hepatitis?

Answer 8

Alcohol is the most common cause of drug-induced hepatitis.
Other drug-related causes include: acetaminophen, valproic
acid, isoniazid, salicylates, azothioprine, ibuprofen,
erythromycin, nitrofurantoin, methotrexate, tetracycline, and
sulfonamides.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 769-771.

Question 9

What is the least severe form of viral hepatitis?

Answer 9

Hepatitis A
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 190.

Question 10

With what form of viral hepatitis is hepatitis D

associated?

Answer 10

Hepatitis D only occurs as a coinfection with hepatitis B. By
itself, it does not produce hepatitis. The hepatitis B vaccine,
therefore, protects against hepatitis D as well.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 189-
190.

Question 11

What body fluids are known to carry and possibly

transmit the hepatitis B virus?

Answer 11

All body fluids should be considered potential vectors in the
transmission of hepatitis B, including urine, semen, saliva, and
blood.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 190.