Hepatitis

Question 1

Diagnosing Hep A?

Answer 1

based on positive IgM antibodies to the hepatitis A virus and symptoms

The presence of IgM antibody to the hepatitis A virus indicates an acute infection.

Question 2

Symptoms of Hep A?

Answer 2

Constitutional. Nausea, vomiting, fever, fatigue

Question 3

Treatment for Hep A

Answer 3

No antiviral treatment exists for the hepatitis A infection.

Treatment is only supportive, and symptoms resolve spontaneously in the majority of patients as the illness is self-limiting. Therefore, the patient should be reassured that his symptoms will most likely resolve spontaneously.

Question 4

Window period?

Answer 4

where they have cleared HBsAg from the blood, but anti-HBs has not yet appeared. This patient can still have hepatitis B infection despite testing negative for HBsAg and anti-HBs.

Question 5

The first antibody to appear after hepatitis B infection is

Answer 5

immunoglobulin M (IgM) antibody to hepatitis B core antigen (HBcAg).

The presence of IgM anti-HBc also means that the patient has an acute hepatitis B virus infection and is required to make the diagnosis. Once the IgM anti-HBc disappears in a few weeks, IgG anti-HBc is detected which usually remains present for life.

Question 6

High-risk groups for HCV infection

Answer 6

IV drug users (especially long-time users)
Hepatitis B virus (HBV) or HIV-positive individuals
Prisoners
Recipients of blood transfusions or organ transplants before 1992 (Testing of donor blood was introduced in 1992)

Question 7

Serology of resolved hepatitis C infection

Answer 7

If the infection has cleared or has been successfully treated, HCV RNA cannot be detected and transaminases return to normal levels. However, anti-HCV IgG antibodies persist indicating previous infection.

Question 8

Chronic hep C treatment goals

Answer 8

Complete cure. Response rates may be as high as 95%, especially in patients without liver cirrhosis.

Eradication of HCV RNA in serum as defined by SVR (sustained virologic response)
SVR is present if no HCV RNA is detectable in the patient’s serum 6 months after completion of antiviral treatment.

Question 9

Chronic Hep C treatment

Answer 9

Chosen based on viral genotype, history of antiviral treatment, and degree of liver fibrosis

Combination of two direct-acting antivirals (DAAs)
Sofosbuvir + velpatasvir for 12 weeks (all 6 genotypes)

Question 10

Acute hepatitis C treatment

Answer 10

Goal: prevent transition to chronic infection!
Treatment: interferon-α or peginterferon-α (PEG-INF) for 6 months

Question 11

Hep C complications

Answer 11

Rarely fulminant hepatitis (liver failure)
Liver cirrhosis
Hepatocellular carcinoma
Secondary hemochromatosis

Question 12

Signs/symptoms of high bilirubin

Answer 12

Yellowing of skin and sclera
Clay-colored stools
Dark urine

Question 13

Hep C transmission

Answer 13

Blood transfusions, IV drug use, rarely sexual

Question 14

Treatment for chronic hep B

Answer 14

Interferon, lamivudine

Question 15

Acute Hep C diagnosis (active)

Answer 15

Anti-Hep C antibody

Positive Hep C RNA assay

Question 16

Chronic hepatitis vs chronic carrier state

Answer 16

Both states show persistence of HBsAg and HBeAg. But chronic infection has elevated serum transaminase levels, while carrier state is normal

Question 17

No prophylaxis for Hep C exposure. T/F?

Answer 17

True

But there is for A and B

Question 18

Evidence of prior Hep B infection vs vaccination

Answer 18

antiHBs antibody positive in both

anti HBc IGg positive vs negative (in vaccination)

Question 19

Hep D confection vs superinfection

Answer 19

Hepatitis D virus infection is diagnosed by checking immunoglobulin M (IgM) and immunoglobulin G IgG) antibody to the hepatitis D virus (anti-HDV). After this, IgM antibody to hepatitis B core antigen (anti-HBc) must be checked to differentiate a coinfection where patient tests positive for IgM anti-HBc and superinfection where patients test negative for IgM anti-HBc.