Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSII Micro Unit 6 > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

which hepatitis viruses are there vaccinations for?

A

A, B, E

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What else can cause the symptoms of heptatits?

A
  • reactions to prescription meds
  • med interactions
  • acetaminophen OD
  • ecstasy
  • rule these out first
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hep A Virology

A
  • human restricted picornavirus (enterovirus 72)
  • fecal oral transmission, similar replication cycle as other enteroviruses
  • if sanitation level is low, contaminated stool reaches drinking water
  • highly environmentally stable
  • only one serotype exists
  • neutralizing antibodies recognize virion proteins 1 and 3
  • IgG is protective against reinfection (vaccine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hep A disease

A
  • US is a low endemic area
  • CDC rec routine vax in 2006 for 1 year olds
  • viral replication often asymptomatic, but alternatively can keep an adult out of work for a month (worst acute hep)
  • predominantly portal and periportal lymphocytic infiltrate and a varying degree of necrosis
  • symptoms are immunogenic
  • over 99% of patients recover completely, no chronic infection
  • rare patients develop fulminant hep, of those, 40% mortality
  • transplant is an option, but most patients don’t need one
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the risk factors for a fulminant hep A infection?

A
  • elderly

- pre-existing liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

hep A on exam

A
  • jaundice
  • smokers don’t like taste of tobacco anymore
  • anorexia
  • nausea/ vomiting
  • tenderness around liver, hepatomegaly
  • dark urine, pale feces
  • leg rash
  • fatigue, some fever
  • severity of symptoms directly correlate with age of patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

questions to ask someone to help you see if its Hep A

A

-vaccinated?
-travel?
-daycare?
-shellfish?
-institutionalization?
-poverty?
MSM?
-IV drugs?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

hepatitis A lab

A
  • Enzyme immunoassay (EIA) for IgM- acute infection
  • IgG- past infection or vax
  • elevated ALT- ongoing damage
  • bili, AST, alkP high during acute phase
  • US or biopsy if concerned about fulminant failure
  • incubation period may be shorter if infecting dose is high
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

hep A treatment

A
  • PREVENTION!
  • handwashing, sanitation, water treatment, vaccine
  • prophylaxis: Ig
  • trt- bed rest, hydration, careful with Tylenol
  • usual prognosis is good. elderly patients can relapse, rare complications do occur, most recover with lasting immunity
  • if transmitted human to human, trace contacts, alert local public health
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hep E virology

A
  • small, naked, +ssRNA virus
  • hepevirus
  • fecal oral transmission (waterborne)
  • not necessarily human restricted; there may be an animal reservoir
  • principal cause of acute hepatitis in Asia/ Africa, Mexico
  • largest epidemic in NW China 1986-88, 120,000 cases and >700 deaths
  • only one serotype
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Hep E Disease

A
  • very similar to A- acute, self limited, complications somewhat more common
  • mortality rate is 4% (>10x HepA)
  • mortality in pregnant women is 20%, fatal fulminant hep, encephalopathy, DIC
  • may also reactivate in liver transplant recipients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hep E exam

A

Biphasic!
Prodrome: anorexia, N/V/D, tender around liver, HSM, fatigue, fever
Icteric phase: Jaundice, dark urine, pale feces, leg rash
-Are they vaccinated? Did they travel?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hep E lab

A
  • serology not widely available, send to CDC
  • high ALT, AST, bili with negative antibodies for other hep
  • US care clarify HSM, rule out biliary obstruction
  • livery Bx not indicated for diagnosis, but if one is performed would see cholestasis, swollen hepatocytes, foam cells, acidophil bodies, IF infiltrate, expanded portal areas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

hep E treatment/prevention

A
  • when traveling, boil water, cook fish, clean/cook produce
  • IgG prophylaxis not available
  • HEV239 vax is new, safe and effective so far
  • no specific treatment
  • light activity is better than bed rest
  • fluid and electrolyte replacement
  • LFT monitoring
  • discontinue alcohol and contraindicated drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hep B virology

A
  • human restricted hepadnavirus
  • small, enveloped, DNA virus, partly double stranded
  • messy virus- 1000x more HBsAg decoys than virions
  • unusually stable for enveloped virus
  • only one serotype, HBsAb protective against reinfections, effective vax available
  • even though its DNA, carries reverse transcriptase and replicates through RNA intermediate
  • replicates in hepatocytes and leaves behind integrated copies of viral DNA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hep B pathogenesis

A
  • transmitted efficiently by injection of contaminated blood, less efficiently by sexual or birth contact
  • 1/3 human population seropositive worldwide
  • in US, 200k new cases annually, 5000 deaths, 5-10% of end stage liver failure, 10-15% of HCC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

HBsAg

A
  • appears early
  • ceases being detectable as surface antibody is produced
  • resumes being detectable in chronic infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

HBsAb

A
  • becomes detectable as surface antigen levels fall

- signifies immunity in vax person

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

HBcAb

A
  • arises later, stays

- IgM for acute, IgG for resolved or chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

HBeAg

A

-detectable when virus is mores transmissible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

four stages of Hep B

A
  1. immune tolerance
  2. immunogenic symptoms
  3. clearing virus
  4. virus cleared
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q
  1. immune tolerance in Hep B
A
  • virus replicates without symptoms
  • 2-4 weeks, decades in newborns
  • DNA and antigens in serum, little antibody
23
Q
  1. immunogenic symptoms of hep B
A
  • ALT rises, Hep B DNA decreases

- 3-4 week symptomatic period- acute or lasts for years, leading to cirrhosis

24
Q
  1. clearing the virus in hep B
A
  • viral replication shuts down
  • HBeAb detected
  • no DNA
  • ALT decreases
  • HBsAg remains
25
Q
  1. virus cleared in hep B
A
  • no antigens

- permanent HBsAb IgG

26
Q

HBV outcomes

A
  • 90% resolution, 1% fulminant hep
  • 9% have HBsAg for >6 mo
  • of those 9%, 50 % resolve or go into asymptomatic carrier
  • some have chronic persistent hep, those can develop extrahepatic PAN or glomerulonephritis
  • some have chronic active hepatitis- they can have extrahepatic disease, or cirrhosis or HCC
27
Q

pathogenesis of chronic Hep B infection

A
  • ongoing cytotoxic T cell response against infected hepatocytes causes permanent cirrhosis
  • accumulation of hep antigen/antibody complex leads to kidney damage and arthritis (membranous glomerulonephritis)
  • virus genome integration, expression of viral transcriptional transactivators, and chronic inflammation lead to cancer (HCC)
28
Q

Hep B presentations

A
  • most common US presentation: Asian born adult infected vertically as a newborn
  • second most common: socioeconomically disadvantaged sexually transmitted
29
Q

Hep B acute non icteric exam

A

-flu like or no symptoms

30
Q

Hep B acute icteric phase

A
  • fatigue, fever, jaundice
  • aversion to food and cigarettes
  • anorexia, nausea, vomiting
  • RUQ pain
  • myalgia
  • hepatomegaly
  • hepatic encephalopathy, sleep disturbances, mental confusion, coma
  • splenomegaly
  • are the vaccinated or an immigrant?
31
Q

hep B chronic phase exam

A
  • spider angioma
  • palmar erythema
  • hepatomegaly
  • jaundice
  • variceal bleeding
  • caput medusae
  • peripheral edema
  • gynecomastia
  • ascites
  • testicular atrophy
32
Q

Hep B lab

A
  • serology panel
  • remember the earth thing–i think its easier than what she has.
  • antigens and antibodies
  • ALT, AST, bili
  • US/CT MRI to rule out bili obstruction
  • PCR can be performed
  • if infection is active chronic- bx
33
Q

active chronic hep B biopsy

A
  • inflammation around portal tracts
  • ground glass cytopathology
  • positive for Hep B antigens
34
Q

hep B treatment

A
  • best option was vaccination, rec for all kids and at risk adults
  • recombinant HBsAg produced in yeast- raises antibody
  • antibody prophylaxis- HBIG admin shortly prior to exposure
  • combo of both given for needle sticks and babies
  • supportive care for acute hep
  • drug if chronic, cure rate is low. 1 year of pol inhibitors (lamivudine, adefovir, entecavir, telbivudine)
  • PLUS 4 mo of PEG-INF
  • transplant may be indicated for late stage if treatment fauls
  • watch LFTs/ mental status
  • patient education- sexually transmitted. CONDOMS
35
Q

interferon

A
  • normally good for us in small amounts as a paracrine signal
  • when all over body, you feel like shit.
36
Q

hep D

A
  • not a complete virus
  • needs B to replicate (B is helper virus)
  • 1700 nucleotide circular -RNA genome only encodes delta antigen
  • exterior looks like B
  • spread by blood and sex
37
Q

is the delta antigen cytotoxic?

A
  • YES!
  • increases incidence in fulminant hep with B
  • affects ~5% of hep B carriers
38
Q

coinfection

A
  • acquired at the same time

- same clearance rate as B alone (90%)

39
Q

superinfection

A
  • B already there and then get D

- pre existing B hepatocytes are weak and permissive to D- much worse outcome

40
Q

Hep D diagnosis

A
  • same as Hep B, some exacerbation of sx if already B+
  • primary screening with EIA for anti deltal antibodies
  • Hep B serum panel with acute results if coinfection or chronic results if superinfection
  • if co infected- wait and watch for spontaneous clearance
  • follow up with RT-PCR for viral RNA
  • if indications of liver failure or chonic active infection, liver bx will resemble hep B with positive delta staining
41
Q

hep D treatment

A
  • prevent B with vax or prophylaxis
  • halt IV drug use, alcohol, treat B
  • after D infection, prog is grim
  • can try 1 year PEG-INF, usually relapses after therapy stopped
  • transplant is an option but graft tends to become infected
42
Q

Hep C virology

A
  • human restricted flavivirus
  • enveloped +RNA genome
  • transmitted efficiently by blood, ineffeciently by sex
  • just discovered in 1989, anyone who received blood before 1994 is at risk
  • 3 million carriers in US, many unaware
  • much higher potential for chronic infection than B, stronger association with HCC
  • no vaccine
43
Q

Hep C pathogenesis

A
  • infects hepatocytes and possible B lymphocytes (both have CD81)
  • highly mutagenic, rdRNAP has no proofreading- generates quasispecies
  • can produce 10 trillion new particles a day
  • less than half of infectees clear it, requires strong cytotoxic T tresponse
44
Q

HCV outcomes

A
  • 15% recovery and clearance
  • 85% persistent infection, leading to chronic hepatitis
  • of those, 6% liver failure, 20% cirrhosis, 4% HCC
45
Q

Hep C exam

A
  • acute symptoms similar to HBV, somewhat milder
  • red flag- travel to Egypt (22% HCV+)
  • new infections in US now usually from IV drugs, but many old ones being uncovered
46
Q

extrahepatic sx of HCV

A
  • sicca syndrome
  • arthralgia
  • myalgia
  • pruritus
  • paresthesias, sensory neuropathy
47
Q

liver failure from HCV on exam

A
  • jaundice
  • vasculitis, autoimmunity
  • palmar erythema
  • ascites
  • HSM
  • kidney faul
  • icteric sclera, enlarged parotid, cyanosis
  • lichen planus
  • variceal bleeding
  • peripheral edema
  • testicular atrophy
48
Q

Hep C lab

A
  • LFTs, autoantibodies, cryglob
  • EIA followed by RIBA
  • if pos, HCV genotyping
  • RT-PCR for viral RNA levels to asses success of therapy
  • liver biopsy not required, can be helpful in judging severity of disease
  • screen for HIV, HBV, drug abuse
49
Q

RIBA for HCV

A
  • confirm exposure
  • HCV antigens on paper- then patients serum on top. then second tagged antibody. if patient has antibodies to HCV, they will light up
50
Q

Hep C treatment

A
  • antibody not protective
  • acute infection- short course of PEG-INF reduces rates of chronic
  • may clear spontaneously without treatment
51
Q

second generation HCV treatment

A

-chronic infection with damage- treat
-ribavarin (antiviral and immunomodulatory)
PLUS
-PEG-INF
PLUS if serotype 1
-protease inhibitors- boceprevire and telaprevire
*virus makes a polyprotein molecule that is cleaved, which is why protease inhibitors work

52
Q

goal of HCV treatment

A
  • sustained viral response (SVR)

- failed treatment may still reduce risk of HCC

53
Q

HCV serotypes and trt

A

-make it hard.
2 and 3 have >50% SVR with 6 mo peg-inf and ribavirin
-1 and 4 require 1-2 years therapy and still have lower recovery rates
-new protease inhibitors for 1 are less effective against 2 and 3
-ask about other meds they’re taking on their own!

54
Q

third generation HCV treatment

A
  • simeprevir- PI “cure” serotype 1
  • sofosbuvir (pol inhib)- SVR if combined with ledipasvir (NS5A inhib)
  • sofosbuvir + ribavirin for genotypes 2 and 3

MSII Micro Unit 6 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions