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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
Q

How is HBV transmitted?

A

sexual transmission
or blood

vertical transmission (mother to child)

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26
Q

If mother is HBsAG+/HBeAg+ she has ____% of passing it to her child

A

90

27
Q

If mother is HBsAG+/HBeAg- she has a ___% risk of passing it to her child

A

10

28
Q

What is the second most common cause of hepatitis?

A

Hep B

29
Q

What is the incubation of HBV?

A

1-4 months

30
Q

What are prodromal sxs of HBV?

A

malaise, fever, rash, arthralgia/arthritis
anorexia
N/V
abdominal pain

31
Q

Which hepatitis accounts for 50% of all HCC (hepatocellular carcinoma)?

A

HBV

32
Q

How often is the screening for HCC in HBV pts?

A

every 6 months since it grows so quickly

33
Q

What are the pre and post exposure vaccines for HBV?

A

pre:
HBsAG in yeast

post:
HBIG

babies get vaccinated right away (in the hospital post birth)

34
Q

What is the most common HBV treatment?

A

Tenofovir

always screen for HIV

35
Q

HDV

A

needs HBV to infect

globally 10% of HBV pts have HDV

36
Q

Where is HDV most common?

A

in IVDU

North Africa
South America
Mediterranean basin

37
Q

Which route/timing of infection is LESS likely to cause chronic hepatitis, HBV-HDV coinfection of superinfection?

A

coinfection

38
Q

Which hepatitis can commonly get transmitted during dialysis?

A

HCV

39
Q

What are the good prognostic factors protecting you from cirrhosis with HCV?

A

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
Q

What is the fastest cause of cancer related death in the US?

A

Hepatocellular Carcinoma (HCC)

41
Q

What is the difference between HBV and HCV in relation to HCC?

A

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
Q

What is the HCV treatment?

A

3 months for sofosbuvir/ledipasvir (Harvoni)

always use two agents

43
Q

HAV IgM

A

early AB

44
Q

HAV IgG

A

late AB - persists for years, confers immunity

45
Q

Active vs passive immunization for HAV

A

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
Q

What are long term complications of chronic hepatitis?

A

cirrhosis
hepatocellular CA
portal HTN

47
Q

HBcAg

A

hepatitis B core antigen

48
Q

HBeAg

A

hepatitis B core antigen (envelope)

49
Q

HBsAg

A

hep B surface antigen

if positive after 20 weeks (~6 months) then it will likely remain positive forever and thus is CHRONIC

50
Q

HBV transmission

A

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
Q

Which serology test will be positive for HBV before sxs even start?

A

HBsAg (suface antigen)

if this is still present after 6 months without antiHBS then chronic infection

52
Q

Which HBV drugs are the best?

A

Tenofovir and Entecavir because they have low 5 year resistance rates

53
Q

HBIG

A

post exposure immunization

prevention of mother to child transmission

54
Q

HBsAg particles in yeast

A

pre-exposure immunization

55
Q

What is the main indication of liver transplant in the US?

A

HCV

56
Q

How many HIV pts also have HCV?

A

30% globally

57
Q

HCV risk factors

A 
IVDU
blood transfusion/solid organ transplant before July 1992 
chronic hemodialysis pt 
HIV infection 
high life time number of sexual partners
vertical transmission
58
Q

HCV + HCC occurs mainly in those who____

A

have advanced fibrosis or cirrhosis

59
Q

HCV RNA vs HCV antibody

A

HCV RNA more sensitive

HCV IgG antibody doesnt distinguish between acute and chronic
many false positives

60
Q

For an asymptomatic pt you suspect having hepatitis, what do you screen for?

A

HBsAg and HBsAb
antiHCV (if + get HCV RNA)
antiHAV

61
Q

For an symptomatic pt you suspect having hepatitis, what do you screen for?

A

HBsAg and HBsAb
AntiHAV
AntiHCV
LFTs

62
Q

What are the guidelines for HCC screening in pts with Hepatitis?

A

HBV pts should be screened for HCC every 6 months

Since HBV has no cure

63
Q

If a pt was infected with HBV but does not have a chronic infection what would you expect to see on labs?

A

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
Q

If someone has never been infected with HBV but have had the vaccine, what would you expect to see on labs?

A

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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