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Clin Med 2 > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

Which Hepatitis can be chronic?

A

B, C, D

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2
Q

What else can cause viral hepatitis?

A

EBV, CMV, HSV, MMR, Varicella, Yellow fever, adenovirus, coxsackie viruses (make up about 15% of acute hepatitis)

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3
Q

What will you see clinically for a asymptomatic pt with acute hepatitis?

A

elevated liver enzymes and serologic markers

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4
Q

What is the hepatitis prodrome?

A 
malaise
joint pains
myalgias
fatigue
anorexia
N/V
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5
Q

What is the most common cause of viral hepatitis?

A

Hep A

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6
Q

How is Hep A transmitted?

A

ingested of contaminated food and water or through direct contact with an infectious person (fecal-oral route)

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7
Q

What is the incubation period for Hep A?

A

15-50 days (mean 30 day)

excreted in stool for 1-2 weeks before onset

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8
Q

When do sxs resolve for Hep A?

A

in the 3rd week typically

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9
Q

What will the physical exam reveal for a Hep A pt?

A 
flu like sxs 
fatigue 
dark urine 
pale feces
scleral icterus, jaundice
enlarged liver
does NOT lead to chronic hepatitis
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10
Q

What labs will you do for HAV?

A 
ALT > AST 
bilirubin 
dx - serology 
HAV IgM (early Ab) 
HAV IgG (late Ab) persists for years (indicated immunity)
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11
Q

What is the treatment for HAV?

A

supportive, disease is self-limited in the vast majority of cases

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12
Q

Who gets the HAV vaccine?

A

children > 1 y/o

travelers

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13
Q

Is there a vaccine for Hep E?

A

No (well there is on approved in China)

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14
Q

Is there a vaccine for Hep A?

A

Yes (active and passive)

passive is for POST exposure (if given <2weeks)

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15
Q

Where is Hep E most common?

A

mexico, asia, northern africa

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16
Q

What is the transmission of HEV?

A

fecal oral route (contaminated drinking water)
undercooked pork or wild game
blood or blood products

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17
Q

What is the incubation period for HEV?

A

15-45 days

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18
Q

How do you dx HEV?

A

HEV IgM antibody

for most pts you suspect of having Hepatitis, you will order all hep IgMs to see which one they have

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19
Q

What is the treatment for HEV?

A

supportive, self-limited

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20
Q

Why can’t Hep B be cured?

A

the bastard virus gets into the nuclei of your cells

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21
Q

What defines chronic hepatitis?

A

> 6months

can be from virus (B,C,D)
EtOH
cirrhosis
autoimmune

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22
Q

What is the leading cause of chronic hepatitis?

A

HBV

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23
Q

Where is HBV most common?

A

southeast asia

africa

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24
Q

Which age group, if infected, is at greater risk of having chronic HBV?

A

neonates

90% change of having chronic hep

while if an adult is infected they have a 5% risk of chronic

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25
How is HBV transmitted?
sexual transmission or blood vertical transmission (mother to child)
26
If mother is HBsAG+/HBeAg+ she has ____% of passing it to her child
90
27
If mother is HBsAG+/HBeAg- she has a ___% risk of passing it to her child
10
28
What is the second most common cause of hepatitis?
Hep B
29
What is the incubation of HBV?
1-4 months
30
What are prodromal sxs of HBV?
malaise, fever, rash, arthralgia/arthritis anorexia N/V abdominal pain
31
Which hepatitis accounts for 50% of all HCC (hepatocellular carcinoma)?
HBV
32
How often is the screening for HCC in HBV pts?
every 6 months since it grows so quickly
33
What are the pre and post exposure vaccines for HBV?
pre: HBsAG in yeast post: HBIG babies get vaccinated right away (in the hospital post birth)
34
What is the most common HBV treatment?
Tenofovir always screen for HIV
35
HDV
needs HBV to infect globally 10% of HBV pts have HDV
36
Where is HDV most common?
in IVDU North Africa South America Mediterranean basin
37
Which route/timing of infection is LESS likely to cause chronic hepatitis, HBV-HDV coinfection of superinfection?
coinfection
38
Which hepatitis can commonly get transmitted during dialysis?
HCV
39
What are the good prognostic factors protecting you from cirrhosis with HCV?
female sex younger age ``` bad: male sex older age (longer infection) excessive EtOH coinfection with HBV, HIV (similar risk factors for HCC progression from HCV) ```
40
What is the fastest cause of cancer related death in the US?
Hepatocellular Carcinoma (HCC)
41
What is the difference between HBV and HCV in relation to HCC?
for HCV if you are treated and never get to cirrhosis then you will likely not get HCC for HBV you can get HCC whether or no you have cirrhosis
42
What is the HCV treatment?
3 months for sofosbuvir/ledipasvir (Harvoni) | always use two agents
43
HAV IgM
early AB
44
HAV IgG
late AB - persists for years, confers immunity
45
Active vs passive immunization for HAV
active - formalin inactivated viral particles - children > 1 years old - travelers passive - pooled immunoglobin (IG) - given as soon as possible AFTER exposure but no later than 2 weeks - given to household and sexual contacts of pts
46
What are long term complications of chronic hepatitis?
cirrhosis hepatocellular CA portal HTN
47
HBcAg
hepatitis B core antigen
48
HBeAg
hepatitis B core antigen (envelope)
49
HBsAg
hep B surface antigen if positive after 20 weeks (~6 months) then it will likely remain positive forever and thus is CHRONIC
50
HBV transmission
cutaneous and mucosal exposure to infectious blood and body fluids Vertical transmission - if mother HBsAg+/HBeAg+ >90% transmission - if mother HBsAg+/HBeAg- <10% transmission
51
Which serology test will be positive for HBV before sxs even start?
HBsAg (suface antigen) if this is still present after 6 months without antiHBS then chronic infection
52
Which HBV drugs are the best?
Tenofovir and Entecavir because they have low 5 year resistance rates
53
HBIG
post exposure immunization | prevention of mother to child transmission
54
HBsAg particles in yeast
pre-exposure immunization
55
What is the main indication of liver transplant in the US?
HCV
56
How many HIV pts also have HCV?
30% globally
57
HCV risk factors
``` IVDU blood transfusion/solid organ transplant before July 1992 chronic hemodialysis pt HIV infection high life time number of sexual partners vertical transmission ```
58
HCV + HCC occurs mainly in those who____
have advanced fibrosis or cirrhosis
59
HCV RNA vs HCV antibody
HCV RNA more sensitive HCV IgG antibody doesnt distinguish between acute and chronic many false positives
60
For an asymptomatic pt you suspect having hepatitis, what do you screen for?
HBsAg and HBsAb antiHCV (if + get HCV RNA) antiHAV
61
For an symptomatic pt you suspect having hepatitis, what do you screen for?
HBsAg and HBsAb AntiHAV AntiHCV LFTs
62
What are the guidelines for HCC screening in pts with Hepatitis?
HBV pts should be screened for HCC every 6 months | Since HBV has no cure
63
If a pt was infected with HBV but does not have a chronic infection what would you expect to see on labs?
HBsAg - negative anti HBs - positive Anti-HBc - positive basically the surface antigen has cleared and your body has the antibody to it AND they have antibody to the core antigen present in the serum which would not be seen in someone who just had an immunization to it
64
If someone has never been infected with HBV but have had the vaccine, what would you expect to see on labs?
AntiHBs - positive everything else would be negative basically they have antibody to the surface antigen but dont have core antibodies and no present antigens

Clin Med 2 (13 decks)

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