Hepatitis Flashcards
Which Hep Viruses have vaccines available?
A, B and E
List some non-infectious causes of Hepatitis
Rx rxns, Rx interxn, Acetaminophen OD, Ecstasy
What is the transmission of HAV
fecal oral through contaminated drinking water
Hep A virology
picornavirus
What are the risk factors for HAV infection
elderly, preexisting liver disease, recent travel
What is the cause of symptoms in HAV infection
slight hepatotoxicity, mostly immunogenic
Dx Hep A: exam
Jaundice, smokers complain about taste of tobacco, fatigue/fever, N/V, dark urine w/ pale feces, hepatomegaly w/ tenderness
Dx Hep A: history
Vaccinated? travel? daycare? shellfish? institutionalized? MSM? IV drugs?
Dx Hep A: lab
Enzyme Immunoassay
- elevated bili, Asp ATF, alk phos
- ultrasound biopsy if in liver failure
Interpret: positive anti-HepA IgM
acute infection
Interpret: positive anti-HepA IgG
past infection OR vaccination
Hep A prophylaxis
immune serum globulin (gammaguard)
Hep E virology
small, naked, ssRNA virus
how is Hep E transmitted
fecal-oral and waterborne
In which countries/continents is Hep E the most common cause of acute hepatitis
Asia, Africa and Mexico
What are the complications of Hep E in pregnancy
fatal fulminant hepatitis, encephalopathy, DIC
Dx Hep E: exam
Biphasic
Prodrome: fatigue, fever, NV, hepatosplenomegaly w/ tenderness
Icteric: jaundice, dark urine, pale feces
Dx Hep E: lab
Send to the CDC
- high ALT, AST, and bili w/ negative AB tests for other hep viruses
- US to rule out biliary obstruction
Prevent Hep E
when traveling, boil water, cook shellfish, clean/cook produce
Which hepatitis virus is a DNA virus?
Hep B
Hep B virology
hepadnavirus, small enveloped DNA virus
What is unique about hep B’s replication?
even though it is a DNA virus, it uses a reverse transcriptase
How is hep B transmitted
contaminated blood, sexual or birth contact
What is the pathogenesis of cirrhosis in chronic HBV infection
ongoing cytotoxic T cell response against infected hepatocytes
What is the pathogenesis of hepatocellular carcinoma in chronic HBV infection
expression of viral transcriptional transactivators that have been integrated into the host genome
What is the most common presentation of HBV infection in the US
Asian born adult infected vertically as a newborn
Dx acute HBV: exam
Fatigue, jaundice, NV, RUQ pain, myalgia, encephalopathy, sleep disturbance, confusion coma
Dx chronic HBV: exam
gynecomastia, spider angioma, caput medusa, peripheral edema, testicular atrophy
Dx HBV: lab
Serology panel
biopsy if chronic
Prevention of Hep B
Vaccination is best, then antibody prophylaxis after exposure
Treatment of chronic Hep B
1yr of polymerase inhibitors PLUS 4mo of pegylated alpha-interferon
Hep D virology
not a complete virus, ‘viriod’, can’t replicate by itself, can only replicate in cells co-infected w/ HepB
Hep C virology
human restricted flavivirus w/ enveloped RNA genome
How is hepC transmitted
blood, sex
What is a red flag in a patients history suggesting HCV infection
travel to egypt (blood fluke eradication gone wrong)
Extrahepatic signs of HCV
sicca syndrome, paresthesias, sensory loss, arthralgia, myalgia, pruritus
Dx HCV: lab
EIA followed by RIBA, genotyping
Where is there no HCV vaccine
antibodies are not protective
HCV antivirals
Ribavirin (chain terminator), Pegylated-alpha-interferon, HCV protease inhibitors (‘previr’)
