Hepatitis Flashcards
Hepatitis
-inflm of the liver
Hepatitis etiology
- microbes -especially viruses
- hepatotoxic durgs
- autoimmunity (some types are d/t autoimmunity)
Viral hepatitis are the hepatitis________
-hep A, B, C, D, E (virus and infection have same
name)
-differences between these are: -virus & transmission
-incubation period
-severity
-mnfts are similar
Hep A
- mild and acute
- self-limiting (cannot ignore pt, but heals by self)
- oral-fecal transmission
- HAV, antiboides hep A virus antibodies Abs measured used to make a diagnosis)
- no chronic or carrier stage
with Hep A person will have what kind of antibodies and they will be measured for?
Hep A virus antibodies and they will be measured to make a diagnosis
Hep B
- more severe than Hep A
- acute or chronic (10-15%)
- carrier state (harbours virus, doesnt mnfts, can pass it on)
- cirrhosis: end stage liver disease, not very common with hep B may develop
- 3 Abs: anti-HBS (antigen that forms against this sits on the surface of the virus) anti-HBC (antigen that sits at core of virus) anti-HBe(referring to antigen in core & around core)
how is Hep A transmitted
-oral-fecal transmission
how is Hep B transmitted
-blood, most body fluids, oral, sexual
what are the three antibodies with Hep B
anti-HBs (antigen that forms against this sits on the surface of virus)
anti-HBc (antigen that sits at the core of the virus)
anti-HBe (referring to antigen in core and around core)
Hep C
- chronic (80%)- cirrhosis & hepatocellular cancer
- from infected blood
- infected drug use (most common)
- high risk sex practices (2nd)
- Ab & viral tests for diagnosis (antibodies don’t serve as protective only serve for diagnostics)
patho of hepatitis
(similar in all types except auto immune)
- 2 mechanisms in all types:
- Viral injury causing necrosis
- IR (normal immune response mediated injury) causing Inflm & necrosis
- these lead to inflammatory damage and hepatocyte necrosis causing decreased liver function
- liver is richly vascularized undergoing inflm damage d/t Immune res
Mnfts
3 phases Prodromal: -lethargy, myalgia -anorexia, nausea & vomiting -fever, abdm pain (liver has capsule that it is in, inflm causes swelling which stretches capsule which causes pain)
Clinical: (5-10 days later)
- mnfts worsen
- enlarged & tender liver
- jaundice (bilirubin, cells that breakdown heme into bilirubin being damaged)
- pruitits (d/t bile salts, accumulate & deposit in skin cause irritation)
Recovery:
- acute mnfts subside (aprox 3 wks)
- full recovery in approx 16 wk
what are the 3 phases for the manifestations of hepatitis
- prodromal
- clinical
- recovery
Diagnosing hepatitis
- history, physical exam
- measure liver enzymes (ALT & AST)-damaged release enzymes
why will hepatitis cause abdominal pain
-liver in a capsule, inflammation of liver causes swelling which stretches the capsule and causes pain
Treatment of hepatitis
(facilitate self-limitness)
- bed rest (decrease energy requirement of the body)
- smaller meals, increased calories and low fat (hepatic workload decreases)
- no alcohol or hepatoxic drugs
- symptomatic management
- vaccines for Hep A & B (prevent) dont want to give vaccines to infected person
- new direct acting antivirals (DAA) for Hep C only!: target specific stages in life cycel of virus-up to 95% cure rate
- interferon can be used was used in the past: problems with side effects
what are the 2 mechanisms that happen in hepatitis that would happen in any viral infection
- Viral injury-causing necrosis: an aspect of viral infection is always cell damage by virus invading host cell & causing lysis (direct hepatocyte injury by virus)
- IR (normal immune response mediated injury) causing Inflm & necrosis
the liver has enormous _______ so that means
functional reserve that means alot has to happen before it shows it is failing
autoimmune hepatitis is a ________ form
severe, chronic form (no recovery)
Etiology of autoimmune hepatitis
- complex trait: -genetic component + environmental component (usually triggered by bacteria or viral infection)
- Idiopathic (because unclear of viral trigger or chemical trigger and what it will produce
- HLA gene on chr 6 (proteins on cells that allow to differentiate self from foreign)
- viral and chemical triggers
what do the HLA genes on Chr 6 do?
proteins on cells that allow to differentiate self from foreign
Type 1 autoimmune hepatitis
- more common
- 80% in females (about 1/3 are under 40-1/3 of that 1/3 have an autoimmune disorder already)
- ANAs (antinuclear antibodies) & anti-smooth muscle abs
in autoimmunity it is generally
antibodies and t cells damaging self
what are the two antibodies with Type 1 autoimmune hepatitis
-ANAs (antinuclear antibodies) & anti-smooth muscle abs