Hepatitis

Question 1

Hep Symptoms

Answer 1

Malaise, N/V/ abd pain

Headache joint pain

Rash itching

Question 2

Hep signs

Answer 2

Jaundice, Fever, spenomegaly , hepatomegaly, liver tenderness on palpation , increased liver enzymes, rash, dark urine, clay colored stool,

Question 3

Hep A Transmission / Vaccine / chronic infection / Post exposure / prevention

Answer 3

Fecal - oral

Yes two dose vaccine (6-12 month apart )

No chronic infection

Post exposure ( within 2 weeks of exposure)
    40 and under = 1 time dose whenever 
     40 and older = 1 vaccine 2 weeks before travel 
      Immunocompromised should get vaccine and immunoglobulin 

Clean water ( heat water), good hygiene

Question 4

Hep A incubation / catagious / labs / s/s

Answer 4

I : 2weeks -2 months
C: 2 weeks prior to symptoms and 1 week after symtpoms
L : increased ALT
S: GI symptoms then jaundice

Question 5

Hep A serology

Answer 5

Anti- HAV
IgM = + during acute phase = miserable
IgG = + will be for life and convalescence phase = long life immunity = G = GONE

Question 6

Hep B transmission , incubation, chronic infection, vaccine , PEP

Answer 6

Blood Bourne percutaneous or permuscosal

Incubation = 6 weeks to 6 months

Yes for vaccine ( 2 dose or 3 dose ) 2 dose = 4 weeks apart 3dose = 0,1,6month

Chronic infection - Yes ( 85 % clear ) at risk for hepatocellular carcinoma

PEP : 1 dose of vaccine within 24 hours of exposure

Question 7

HB HBsAg

Answer 7

Surface = tells us if they have infection ( acute or chronic )

Question 8

HB HBsAB

Answer 8

Tell us if pt has immunity ( disease or vaccine

Question 9

HB HBcAB

Answer 9

Tells us if the immunity is from disease or vaccine
+ = disease
- = vaccination

Question 10

HB HBcAB

Answer 10

Tells us who has a acute verse chronic infection

\+ = acute 
- = Chronic

Question 11

HB HBeAG

Answer 11

indicates HBV replication
High infectious
If present beyond 3 months = more likely to have chronic infection

Question 12

HB HBeAB

Answer 12

Antibiody that does not provide protection but is a good sign the earlier it occurs = less infectivity

Question 13

HB treatment

Answer 13

Supportive , refer to GI or ID

Chronic Hep B = antivirals for long period of time 48 weeks

Question 14

Hep C Transmission, incubation , vaccine, chronic infection, risk groups

Answer 14

Blood Bourne

I : 2 weeks -24 weeks

No vaccine

Chronic disease YES if untreated 85 % develop chronic disease , slow to develop at risk for hepatocellular carcinoma

Risk groups: IVDU, HIV, blood product recipants before 1992, birth mother had hep C, people born 1945-1965

Question 15

HC serology

Answer 15

Anti HVC - not always + during acute illness ( may take 4-10 weeks)

If anti HVC + = follow up will Hep C RNA

Hep C RNA - = if they clear infection

Question 16

Hep C treatment

Answer 16

Biggest barrier is cost
Liver biopsy for genotyping ( type 1 most common)
NO ETOH
Immunize for other hep

Long course of antivirals ( 24-28 weeks )

Question 17

Hep C factors that promote progression of disease

Answer 17

Increased ETOH
age >40 at time of infection
HIV co - infection

Male gender

Question 18

Hep D transmission, risks, vaccine, chronic vaccination

Answer 18

Blood Bourne

Risks Hep B

No vaccine but protection by immunizing for hep B

Chronic : yes

Question 19

Hep E transmission, risks, vaccine , chronic

Answer 19

Oral fecal

Risk : developing world, contaminated water supplies

No vaccine

Poor outcome in pregnant women

Question 20

AST vs ALT

Answer 20

AST = increased with statin and ETOH
AST rises fast and clears quickly
- found in heart muscle / brain / kidney

Question 21

ALT > AST

Answer 21

In hepatitis and liver disorders
More specific to liver than AST
Elevation persists longer than AST

Question 22

Bilirubin

Answer 22

Elevated in hepatits and will aslso be detected in the urine , patient will be jaundice when over 2.5