Hepatitis

Question 1

Hepatitis

Answer 1

Acute hepatitis is an inflammatory disease of the liver that results in liver injury and necrosis

Acute – lasts less than six months, ends in either complete repair of the injured tissue or ends in liver failure and death

Question 2

Non-Viral Causes

Answer 2

Drugs (alcohol)
Chemicals
Autoimmune liver disease

Question 3

Hepatitis A

Answer 3

Oral fecal route: 
Present in blood only briefly
Crowded conditions (day care centers)
Poor personal hygiene
Contaminated food, water, milk, shellfish
Infected food handlers
Persons with subclinical infections

Question 4

Hepatitis B

Answer 4

Transmitted by percutaneous or permucosal exposure to infectious blood, blood products, or other body fluids
Transmission occurs when infected blood or other body fluids enter the body of a person who is not immune to the virus
Can live on a dry surface for at least 7 days
Much more infectious than HIV

Question 5

Hepatitis C

Answer 5

Transmitted percutaneously
Transmitted via blood and blood products
Previously called posttransfusion non A, non B hepatitis
Infection occurs 1-2 weeks before symptoms occur and continues during clinical course of illness
75-85% of patients go on to develop chronic hepatitis
Major indication for liver transplant

Question 6

Hepatitis D

Answer 6

AKA “Delta virus”
Cannot live on its own
Requires helper function of HBV to replicate
Patients with HBV + HDV = supervirus

Question 7

Hepatitis E

Answer 7

Oral fecal route:
Most commonly contaminated water
Occurs primarily in developing countries

Question 8

Hepatitis G

Answer 8

Recently recognized
Found in some blood donors
Transmitted by blood transfusion
Often coexists with other hepatitis viruses

Question 9

Pathophysiology of Hepatitis

Answer 9

During an acute infection:
Liver cell damage results in hepatic cell necrosis
Proliferation and enlargement of Kupffer cells (supporting cells of liver that hepatocytes exist within) takes place
Inflammation of the periportal areas may interrupt bile flow
Liver cells can regenerate in an orderly manner

Question 10

Clinical Manifestations of Hepatitis - 3 Stages

Answer 10

• Pre icteric phase
• Icteric phase
• Post Icteric phase

Question 11

Pre-Icteric Phase

Answer 11

Proceeds jaundice
Lasts from 1-21 days
Period of maximal infectivity for hep A (more likely to be transmitted)

Question 12

Icteric Phase

Answer 12

Lasts 2-4 weeks
Jaundice
Pruritis
Unconjugated bili is irritating skin

Question 13

Post Icteric Phase

Answer 13

Begins as jaundice is disappearing
Lasts weeks to months
Malaise
Easily fatigued

Question 14

Fulminant Hepatitis

Answer 14

Clinical syndrome
Results in severe impairment or necrosis of liver cells and potential liver failure
Hep A & B are the most common viral causes
Tylenol may also precipitate it
Results in severe liver dysfunction and encephalopathy

Question 15

Diagnostic Studies for Hepatitis

Answer 15

Transaminases (ALT, AST) (elevated)
Alkaline phosphatase 
Serum proteins (low)
Serum bilirubin (elevated)
Urinary bilirubin 
Prothrombin time (elevated)
Biopsy
Physical assessment: enlarged spleen, palpable liver