hepatitis Flashcards
inflammation of the liver leading to hepatocyte damage to the membranes causing leakage of AST and ALT. destruction of hepatocytes causes cell death and liver failure may ensure
hepatitis
possible outcomes of hepatitis (3)
- chronic infection due to a weak or immature host immune response leading to fibrosis
- recovery with a vigorous and immediate host response and the virus is cleared
- fulminant hepatitis with a too vigorous host response leading to widespread cell death and liver failure
clinical acute hepatitis
- incubation period
- prodrome
- acute illness
- recovery
- incubation period- long and asymptomatic
- prodrome- 2-10 days of flu-like symptoms. host very infectious
- acute illness- dark urine before jaundice or icterus is noticed with light colored stools. symptoms last 2-3 weeks
- recovery- stool color returns to normal and the systemic symptoms and jaundice abate
outcome of hep A and E
do not become chronic but may results in either recovery or fulminant
outcome of hep B, D and C
all can become chronic especially C and a superinfection of hep D on hep B
gold standard for assessing liver damage
liver biopsy
in chronic hepatitis are the symptoms resolved from the acute part of the illness?
yep but there is continued viral replication
which virus will have extra-hepatic manifestations?
hep B with skin rash, arthritis, vasculitis, glomerulonephritis, cryoglobulinemia
which hep. virus is jaundice minimal and transaminase elevations are <500- 1000
hep C
most common cause of acute hepatitis
HBV
most common cause of chronic hep
HCV
single stranded RNA virus that is fecal-oral transmission. It has a short incubation period of only 4 weeks but there is no chronic disease. vaccine is >90% efficacious
hep A
single stranded RNA virus that is fecal-oral transmission with a short incubation period of 4 weeks but there is no chronic disease. there is no vaccine. found in pigs
Hep E
acute hepatitis that might lead to fulminant hepatitis in 20% of pregnant women
Hep E
hep B transmission is
blood borne and there is a long incubation period of 2-3 months but it can be up to 6 months
all the hep viruses are RNA viruses except
HBV which is a DNA virus
The presence of _____ in the blood is the main marker for infection of hep B
HBsAg
- marker for active infection and it will remain positive in chronic HBV carriers
who are more likely to get chronic HBV
older age
in recovery what is elevated in hep B
anti-HBs +
which hep virus increases the chance of hepatocellular carcinoma
hep B but hep C also can cause it
HBV has a vaccine?
yep, the vaccine is recombinant HBsAg so a vaccinated person has a protective ab, anti-HBs
mother that have HBsAg (+) what should be given to the child?
HBIg and IBV vaccine
immune tolerant phase HBsAg +
childhood
inactive carrier phase HBsAg +
adult
immune active phase HBsAg +
adult and this is the phase you need to treat!!!!
whats the deal with HDV?
defective RNA virus that needs HBV for infection and replication. it is blood borne and it can be acquired with a co-infection with HBV simultaneously or it can lead to a superinfection of a previous infection of HBV, the later one has a higher chance of forming chronic hepatitis and fulminant hepatitis
**there is no treatment but prevented by HBV vaccination
single stranded RNA virus that is transmitted through blood. it has a long incubation time of 2 months and there is clinically mild infection that causes little jaundice and low ALT elevations. There is a rapid progression to cirrhosis if one either drink alcohol or has HIV
Hep. C
CDC recommendation if you are born between the ages s1945-1965
screen once with HCV antibody
what does IgM mean?
active infection
what does IgG mean?
past infection
when is there a shift between IgM and IgG
around 4 months
anti-HCV is protective?
nope
anti-HBs is protective?
yep
Anti-HAV is a combined capture assay measuring
both IgM and IgG
HBeAg is a marker for
viral replication
the presence of antibodies to hep. B _______ is the earliest host response to HBV antigen
core antigen
duration of protection for HBV
10-15 yr
presence of HBV-DNA
active replication
total anti- HBc in hep B is made up of
IgG
which Ig is present in chronic hep D
both IgM and IgG andti-HDV
treatment of HDV
no specific treatment , control of HDV depends on preventing HBV infection by vaccination
diagnosis of HCV 2 tests
- anti-HCV by EIA
2. HCV-RNA
in acute viral hepatitis what doe we see? histo
portal and lobular mononuclear inflammation
- balloning degeneration, apoptosis (bridging necrosis if severe), macrophage/kupffer cell aggregates, cholestasis but no fibrosis
what do we see in chronic viral hepatitis? histo
portal and periportal predominant inflammation
- development of fibrosis
is there regression of fibrosis after successful treatment?
yep
diffuse fibrosis/scarring with regenerative nodules and altered vascular architecture
cirrhosis
which cell contributes sto hepatic fibrosis
stellate cell
