Hepatitis

Question 1

Which Hep Viruses have vaccines available?

Answer 1

A, B and E

Question 2

List some non-infectious causes of Hepatitis

Answer 2

Rx rxns, Rx interxn, Acetaminophen OD, Ecstasy

Question 3

What is the transmission of HAV

Answer 3

fecal oral through contaminated drinking water

Question 4

Hep A virology

Answer 4

picornavirus

Question 5

What are the risk factors for HAV infection

Answer 5

elderly, preexisting liver disease, recent travel

Question 6

What is the cause of symptoms in HAV infection

Answer 6

slight hepatotoxicity, mostly immunogenic

Question 7

Dx Hep A: exam

Answer 7

Jaundice, smokers complain about taste of tobacco, fatigue/fever, N/V, dark urine w/ pale feces, hepatomegaly w/ tenderness

Question 8

Dx Hep A: history

Answer 8

Vaccinated? travel? daycare? shellfish? institutionalized? MSM? IV drugs?

Question 9

Dx Hep A: lab

Answer 9

Enzyme Immunoassay

• elevated bili, Asp ATF, alk phos
• ultrasound biopsy if in liver failure

Question 10

Interpret: positive anti-HepA IgM

Answer 10

acute infection

Question 11

Interpret: positive anti-HepA IgG

Answer 11

past infection OR vaccination

Question 12

Hep A prophylaxis

Answer 12

immune serum globulin (gammaguard)

Question 13

Hep E virology

Answer 13

small, naked, ssRNA virus

Question 14

how is Hep E transmitted

Answer 14

fecal-oral and waterborne

Question 15

In which countries/continents is Hep E the most common cause of acute hepatitis

Answer 15

Asia, Africa and Mexico

Question 16

What are the complications of Hep E in pregnancy

Answer 16

fatal fulminant hepatitis, encephalopathy, DIC

Question 17

Dx Hep E: exam

Answer 17

Biphasic
Prodrome: fatigue, fever, NV, hepatosplenomegaly w/ tenderness
Icteric: jaundice, dark urine, pale feces

Question 18

Dx Hep E: lab

Answer 18

Send to the CDC

• high ALT, AST, and bili w/ negative AB tests for other hep viruses
• US to rule out biliary obstruction

Question 19

Prevent Hep E

Answer 19

when traveling, boil water, cook shellfish, clean/cook produce

Question 20

Which hepatitis virus is a DNA virus?

Answer 20

Hep B

Question 21

Hep B virology

Answer 21

hepadnavirus, small enveloped DNA virus

Question 22

What is unique about hep B’s replication?

Answer 22

even though it is a DNA virus, it uses a reverse transcriptase

Question 23

How is hep B transmitted

Answer 23

contaminated blood, sexual or birth contact

Question 24

What is the pathogenesis of cirrhosis in chronic HBV infection

Answer 24

ongoing cytotoxic T cell response against infected hepatocytes

Question 25

What is the pathogenesis of hepatocellular carcinoma in chronic HBV infection

Answer 25

expression of viral transcriptional transactivators that have been integrated into the host genome

Question 26

What is the most common presentation of HBV infection in the US

Answer 26

Asian born adult infected vertically as a newborn

Question 27

Dx acute HBV: exam

Answer 27

Fatigue, jaundice, NV, RUQ pain, myalgia, encephalopathy, sleep disturbance, confusion coma

Question 28

Dx chronic HBV: exam

Answer 28

gynecomastia, spider angioma, caput medusa, peripheral edema, testicular atrophy

Question 29

Dx HBV: lab

Answer 29

Serology panel | biopsy if chronic

Question 30

Prevention of Hep B

Answer 30

Vaccination is best, then antibody prophylaxis after exposure

Question 31

Treatment of chronic Hep B

Answer 31

1yr of polymerase inhibitors PLUS 4mo of pegylated alpha-interferon

Question 32

Hep D virology

Answer 32

not a complete virus, 'viriod', can't replicate by itself, can only replicate in cells co-infected w/ HepB

Question 33

Hep C virology

Answer 33

human restricted flavivirus w/ enveloped RNA genome

Question 34

How is hepC transmitted

Answer 34

blood, sex

Question 35

What is a red flag in a patients history suggesting HCV infection

Answer 35

travel to egypt (blood fluke eradication gone wrong)

Question 36

Extrahepatic signs of HCV

Answer 36

sicca syndrome, paresthesias, sensory loss, arthralgia, myalgia, pruritus

Question 37

Dx HCV: lab

Answer 37

EIA followed by RIBA, genotyping

Question 38

Where is there no HCV vaccine

Answer 38

antibodies are not protective

Question 39

HCV antivirals

Answer 39

Ribavirin (chain terminator), Pegylated-alpha-interferon, HCV protease inhibitors ('previr')