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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
Q

Which hepatitis has a carrier state and what does this mean?

A
  • 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
Q

Hep C is the most severe, can it be cured?

A

Yes

27
Q

Mode of transmission of Hepatitis C?

A

Infected blood, organs

28
Q

Who is at higher risk of developing hepatitis C?

A

It is common in IV drug users and those engaging in high risk sex practices

29
Q

Describe the patho behind viral hepatitis (2 mechanisms).

A
  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
Q

How long does recovery take for viral hepatitis?

A

~4 months

31
Q

What are the 3 stages of presentation for viral hepatitis (MNFTS)?

A
  1. Prodromal
  2. Clinical
  3. Recovery
32
Q

What are the manifestations that occur in the prodromal stages?

A

It ranges from insidious to symptomatic:

  • Myalgia
  • Nausea and vomiting
  • Fever d/t infection
  • anorexia
  • abdominal pain
33
Q

Why does myalgia occur in the prodromal stage?

A

liver produces metabolites for other cells -> less ATP production -> muscle weakness

34
Q

Why does N&V occur in the prodromal stage?

A

It is related to the liver being an accessory organ to the GI tract

35
Q

When does the clinical phase occur?

A

post-prodromal; 5-10 days later

36
Q

What are the manifestations that occur in the clinical phase?

A

manifestations worsen.

  • liver is tender and swollen
  • jaundice
  • pruritus
  • hepatomegaly
37
Q

Why does pruritus occur in the clinical phase?

A

Because bile salts accumulate and deposit in the skin

38
Q

When do acute manifestations subset typically?

A

~3 weeks (depending on the type)

39
Q

How do you determine full recovery?

A

you need to go back to normal lab results

40
Q

How do you diagnosis viral hepatitis in a patient?

A
  • 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
Q

How would you treat a pt with viral hepatitis?

A
  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
Q

Why would a patient with viral hepatitis be on a smaller, high calorie diet?

A

higher calories means more proteins, less fat (less fat decreases demand for bile production/secretion from the liver -> decreases hepatic workload)

43
Q

Interferon?

A

Our body produces interferon, a protein that facilitates defence against the infection

44
Q

What is the severity of Autoimmune Hepatitis?

A

Chronic, severe

45
Q

What is the etiology of autoimmune hepatitis?

A
  • Complex trait etiology - environmental trigger -> viral & chemical trigger (eg. hepatotoxic drugs)
  • HLA on chromosome 6 & MHC genes -> loss of self-tolerance =classic autoimmunity
46
Q

Is autoimmune hepatitis classic autoimmunity?

A

Yes

47
Q

What are types of autoimmune hepatitis?

A

Type 1 and Type 2

48
Q

Which type of autoimmune hepatitis is more common?

A

Type 1

49
Q

Who does type 1 autoimmune hepatitis tend to affect?

A

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
Q

What kind of antibodies are found in type 1 autoimmune hepatitis?

A
  • ANA’s (anti-nuclear antibodies) and smooth muscle antibodies
51
Q

Anti-Nuclear antibodies?

A

Responsible for targeting nuclear components in hepatocytes [widespread targeting]

52
Q

Anti-smooth muscle antibodies?

A

responsible for targeting smooth muscles in the blood vessels and ducts in the liver

53
Q

Who does type 2 autoimmune hepatitis tend to affect?

A

kids aged 2-14 yrs old

54
Q

Is type 1 or 2 autoimmune hepatitis class autoimmunity?

A

type 2

55
Q

What do antibodies target in type 2 autoimmune hepatitis?

A

Cytosol and microbes

56
Q

Cytosol?

A

targets everything within the plasma membrane of a cell including the nucleus

57
Q

Microbes?

A

Small vesicles pinching off the endoplasmic reticulum, full of protein

58
Q

Manifestations of autoimmune hepatitis?

A

Range from asymptomatic to those of hepatic failure

- inflammation in the liver due to autoimmune targeting

59
Q

How would you diagnose a patient with autoimmune hepatitis?

A

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
Q

What are the treatment options for autoimmune hepatitis?

A
  • Immunosuppressant drugs (such as steroids)

- Liver transplant

Patho Midterm 1 (18 decks)

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