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Patho Midterm 1 > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

What is the first largest organ in the body? What is the second?

A
  1. Integument

2. liver

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2
Q

Hepatitis?

A

Inflammation of the liver

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3
Q

Etiology of hepatitis

A
  • infection in the liver by any microbe (usually viral)
  • hepatotoxic drugs -> alcohol
  • autoimmune hepatitis
  • secondary to systemic problems (eg. Epstein-barr virus; cytomegalovirus)
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4
Q

What are the most common viral hepatitis’s?

A

Hepatitis A, B and C

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5
Q

What are the differences in the hepatitis?

A
  • virus
  • mode of transmission
  • incubation period varies
  • severity
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6
Q

Which hepatitis is the most severe?

A

Hepatitis C

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7
Q

Incubation period and average of hepatitis A?

A

I: 15-50 days
A: 30 days
(homologous)

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8
Q

Incubation period and average of hepatitis B?

A

I: 28-160 days
A: 70-80 days
(homologous)

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9
Q

Incubation period and average of hepatitis C?

A

I: 15-160 days
A: 50 days

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10
Q

List the virus involved for:

  1. Hep A
  2. Hep B
  3. Hep C
A
  1. hepatitis A virus
  2. hepatitis B virus
  3. hepatitis C virus
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11
Q

Which hepatitis is the least severe?

A

Hepatitis A

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12
Q

What is the severity of hepatitis A?

A

Mild, acute

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13
Q

Which hepatitis is self-limiting?

A

Hep A and B

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14
Q

Mode of transmission for hep A?

A

Oral-fecal transmission (eg. outbreak in fast food restaurants, water+ ice in developing countries)

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15
Q

What is measured in Hep A when testing?

A

Hep A virus antibodies are measured (increased levels of IgM, first Ab to appear after exposure to an antigen)

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16
Q

Severity of Hep B?

A

More severe than Hepatitis A, can be acute or chronic (10-15%)

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17
Q

Mode of transmission for Hepatitis B?

A

Blood, mostly fluids, oral, sexual

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18
Q

What is present in Hep B?

A

3 antibodies. Anti-Hepatitis B antibodies

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19
Q

What are the 3 antibodies present in Hep B?

A
  1. Anti-HBs
  2. Anti-HBc
  3. Anti-HBe
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20
Q

Anti-HBs?

A

s= antigen sits on the surface of the virus

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21
Q

Anti-HBc?

A

c= antigen sits on the core of the virus

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22
Q

Anti-HBe?

A

e= antigen sis on surface and immediately surrounding the core

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23
Q

What is the severity of Hep C?

A

most severe; chronic

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24
Q

What can chronic hep C cause?

A

cirrhosis and hepatocellular carcinoma

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25
Which hepatitis has a carrier state and what does this mean?
- Hep B and C | - If either of these are chronic, the pt can harbour the virus and pass it on even if the hepatitis is not active
26
Hep C is the most severe, can it be cured?
Yes
27
Mode of transmission of Hepatitis C?
Infected blood, organs
28
Who is at higher risk of developing hepatitis C?
It is common in IV drug users and those engaging in high risk sex practices
29
Describe the patho behind viral hepatitis (2 mechanisms).
1. Virus invades the host cell, replicates, and lyses the cell - this can occur with any viral infection in the body - viral damage leads to necrosis of the cell - in hepatitis, virus targets hepatocytes causing compromised liver function 2. Inflammation induced by the viral injury - with this mechanism it is not only the hepatocytes that are affected, but also the surrounding cells including: - vessels -> damaged -> ischemia -> further necrosis - ducts -> GI dysfunction bc it cannot transport bile
30
How long does recovery take for viral hepatitis?
~4 months
31
What are the 3 stages of presentation for viral hepatitis (MNFTS)?
1. Prodromal 2. Clinical 3. Recovery
32
What are the manifestations that occur in the prodromal stages?
It ranges from insidious to symptomatic: - Myalgia - Nausea and vomiting - Fever d/t infection - anorexia - abdominal pain
33
Why does myalgia occur in the prodromal stage?
liver produces metabolites for other cells -> less ATP production -> muscle weakness
34
Why does N&V occur in the prodromal stage?
It is related to the liver being an accessory organ to the GI tract
35
When does the clinical phase occur?
post-prodromal; 5-10 days later
36
What are the manifestations that occur in the clinical phase?
manifestations worsen. - liver is tender and swollen - jaundice - pruritus - hepatomegaly
37
Why does pruritus occur in the clinical phase?
Because bile salts accumulate and deposit in the skin
38
When do acute manifestations subset typically?
~3 weeks (depending on the type)
39
How do you determine full recovery?
you need to go back to normal lab results
40
How do you diagnosis viral hepatitis in a patient?
- you want to ensure you are working with a liver problem so you would run basic labs - serology (detecting antibodies to virus) - viral testing
41
How would you treat a pt with viral hepatitis?
1. Hep A & B are generally self-limiting so monitor pt and let it run its course 2. Decrease workload of the liver : - bedrest (decrease energy requirements) - smaller, high calorie meals - no alcohol or hepatotoxic drugs (damages liver) - symptomatic management - vaccines for Hep A and B - Direct acting antivirals for Hep C [targets specific stages of the life cycle of Hep C; requires monitoring; up to 95% cure rate] - Interferon
42
Why would a patient with viral hepatitis be on a smaller, high calorie diet?
higher calories means more proteins, less fat (less fat decreases demand for bile production/secretion from the liver -> decreases hepatic workload)
43
Interferon?
Our body produces interferon, a protein that facilitates defence against the infection
44
What is the severity of Autoimmune Hepatitis?
Chronic, severe
45
What is the etiology of autoimmune hepatitis?
- Complex trait etiology - environmental trigger -> viral & chemical trigger (eg. hepatotoxic drugs) - HLA on chromosome 6 & MHC genes -> loss of self-tolerance =classic autoimmunity
46
Is autoimmune hepatitis classic autoimmunity?
Yes
47
What are types of autoimmune hepatitis?
Type 1 and Type 2
48
Which type of autoimmune hepatitis is more common?
Type 1
49
Who does type 1 autoimmune hepatitis tend to affect?
It occurs more in women (80%) more than men - > 30% of the women are under 40 yrs old - > 30% have other autoimmune problems as well
50
What kind of antibodies are found in type 1 autoimmune hepatitis?
- ANA's (anti-nuclear antibodies) and smooth muscle antibodies
51
Anti-Nuclear antibodies?
Responsible for targeting nuclear components in hepatocytes [widespread targeting]
52
Anti-smooth muscle antibodies?
responsible for targeting smooth muscles in the blood vessels and ducts in the liver
53
Who does type 2 autoimmune hepatitis tend to affect?
kids aged 2-14 yrs old
54
Is type 1 or 2 autoimmune hepatitis class autoimmunity?
type 2
55
What do antibodies target in type 2 autoimmune hepatitis?
Cytosol and microbes
56
Cytosol?
targets everything within the plasma membrane of a cell including the nucleus
57
Microbes?
Small vesicles pinching off the endoplasmic reticulum, full of protein
58
Manifestations of autoimmune hepatitis?
Range from asymptomatic to those of hepatic failure | - inflammation in the liver due to autoimmune targeting
59
How would you diagnose a patient with autoimmune hepatitis?
The workup is complex. - look for antibodies and exclude viral hepatitis - test for ANA -> (however, other autoimmune disorders test + for ANA's as we'll such as Lupus so this will not definitely define autoimmune hepatitis) - excess gamma globulins (Abs produced by the liver) - liver biopsy -> invasive so only if necessary
60
What are the treatment options for autoimmune hepatitis?
- Immunosuppressant drugs (such as steroids) | - Liver transplant

Patho Midterm 1 (18 decks)

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