Hepatitis

Question 1

What is hepatitis?

What are the common etiologies?

Answer 1

inflm of the liver

• Microbes
• Drugs (hepato toxic drugs)
• Autoimmunity

Question 2

What microbes can cause hepatitis?

What is the most common?

Answer 2

Could be bact, viral, parasite, fungal

• Most d/t viral infection

Question 3

What viruses might cause Hepatitis?

Answer 3

• Hepatitis A, B, C, D, E
o F and G exist but are not currently a concern
o Other viruses may cause hepatitis
(EX. Epstein Barr)

NOTE D (like Bad B), E (like bad A in pregnant women)

Question 4

What virus causes hepatitis A

Answer 4

Hepatitis A

Virus is named same as the disease

Question 5

What characteristics differentiate the hepatitis viruses? (3)

Answer 5

o Virus and transmission
o Incubation period
o Severity
(EX. Hep C serious, Hep A mild)

*NOTE*
• Refer to DAY 1214 Table 40-4 for comparison
FOCUS ON:
o	Incubation period (chronic vs acute)
o	Mode of transmission
o	Carrier state

Question 6

Hep A in Brief

Answer 6

• Mild, Acute w/ recovery, No carrier state, no inc in liver risk (cirrhosis, cancer, failure)
• Transmission- oral/fecal route, poor sanitation, water/food borne
• Incubation- ~15-50 days. Largely self limiting, considered an acute form

SandS- flu like (headache, malaise, fever,) Icteric phase- dark urine, jaundice

Question 7

Hep B in Brief

Answer 7

• Can be severe, 10% -15% are chronic, includes a carrier state, inc risk to liver
• Transmission- Parenterally, saliva and serum

Incubation- 28-160 days

SandS- may be w/o symptoms, rash and arthralgias

Question 8

Hep C in Brief

Answer 8

• 80% are chronic, high inc liver risk, includes a carrier state, remissions and exacerbations common, often leads to cirrhosis
• Transmission- through blood and blood products, sex

Incubation- 15-160days

Outcomes- frequent chronic liver disease

Question 9

Is the pathology the same for all viral hepatitis

Answer 9

Basically Yes

Question 10

What are the two mechanisms of injury in hepatitis?

Answer 10

o IR -> inflm and necrosis

o Viral injury -> necrosis

Question 11

What is targeted, what is damaged?

Answer 11

viruses target hepatic cells specifically but inflm can damage vessels as well.

Vascular damage common

Question 12

What is a simple measure of hepatocyte necrosis?

Answer 12

serum markers for liver damage- AST and ALT are released with hepatocyte necrosis

Question 13

What is the central MFNTS and how long will until healing can occur?

Answer 13

Decrease in Liver Function

Healing in 4 months

Question 14

3 stages to MNFTS of Hepatitis

Answer 14

Prodromal, Clinical, Recovery

Question 15

Discuss MNFTS of the Prodromal Phase

Answer 15

• lethargy, myalgia
• fever and abd pain
 Pain r/t liver enlargement and stretching liver capsule
• Anorexia, nausea, vomiting (r/t to GI impacts)

Question 16

Discuss MNFTS of CLINICAL Phase

Answer 16

Appear 5-10 days later

• Mnfts worsen
• Jaundice (bilirubin is normally processed by liver, heme break down, inc bilirubin in blood and gets deposited)
• Pruritus (caused by bile salts deposition in the skin)
• Enlarged liver (hepatomegely)

Question 17

What is Jaundice

Answer 17

Bilirubin, formed from the break down of heme, is normally processed by liver, Dec liver Fx ->, inc bilirubin in blood and gets deposited in tissue

Oh ya… it’s yellow

Question 18

How do MNFTS regress in Recovery phase

Answer 18

QUICKLY
• Acute MNFTS subside ~3weeks
• Full recovery within ~16weeks

Question 19

Tx- Why is rest important?

Answer 19

Decrease workload of liver

To allow recovery you want to Dec Energy requirement of body. (Liver will have to process less)

Question 20

Tx what sort of Diet would you encourage

Answer 20

Small meals, High in calorie (like Carbs) but…. Reduced fat content, as liver needs to produce bile to break down fats

Question 21

Tx- What offending agents to you want to completely remove

Answer 21

No alcohol and all other hepatotoxic drugs or chemicals

Question 22

Other basic hepatitis symptom tx

Answer 22

• Symptomatic relief (pain, relief from pruritus)
• Post exposure prophylaxis
o Improve hygiene

Question 23

Pharmacologically what is the difference in tx between Hep A, B and C

Answer 23

• Hep A +B – vaccine and gamma globulins available

* Hep C- No vaccine, antiviral drugs may be used

Question 24

Is autoimmune hepatitis a chronic or Acute Disease?

Answer 24

There is both severe and chronic form

Question 25

Etiology of Autoimmune Hepatitis

Answer 25

o Idiopathic (but not really)
o Complex trait
• HLA genes on Chr 6
• + Enviro factor (virus or chemical agents)

Question 26

Discuss Type One autoimmune Hepatitis

Answer 26

o More common
o 30% of Auto Hepatitis is in women under 40yrs

o The associated Antibodies in immune response

ANA’s (anti-nuclear antibodies) AND
Anti-smooth muscle Abs (smooth muscle in walls of vessels)

Question 27

Discuss Type Two autoimmune hepatitis

Answer 27

o 2-14yrs

o Abs target cytosol (is the cytoplasm less the organelles) and microsomes (vesicles from endoplasmic Reticulum)

Question 28

Range of MNFTS of Autoimmune Hepatitis

Answer 28

•Range from asymptomatic to MNFTS of liver failure (leans to severe)

Question 29

Dx of Autoimmune Hepatitis

Answer 29

• By Exclusion
o Viral hepatitis
o Other liver diseases\

• You can measure Increase in gamma globulins (Abs)

Question 30

Tx for autoimmune hepatitis

Answer 30

• Immunosuppressant drugs

* Liver transplant? (chronic and serious disease)