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Hepatitis Flashcards

0
Q

What are risk factors for hepatitis A?

A

(1) contact with infected person
(2) daycare
(3) IV drug use
(4) recent travel
(5) contaminated food or water

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1
Q

What is the most common viral hepatitis worldwide?

A

Hepatitis A.

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2
Q

How is hepatitis A usually spread?

A

Fecal-to-oral. It is absorbed in the intestine, travels the portal vein, and enters and replicates within hepatocytes.

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3
Q

What is an indication that a hepatitis A patient is no longer contagious?

A

Jaundice has resolved.

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4
Q

Can hepatitis A lead to a chronic infection?

A

No.

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5
Q

How is hepatitis A diagnosed?

A

Presence of HAV IgM antibodies.

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6
Q

When might you worry about a fulminant hepatitis A infection?

A

(1) >40 years
(2) chronic liver disease

Fulminant infections are rare.

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7
Q

How is hepatitis B usually spread?

A

(1) perinatally
(2) blood products
(3) sexually
(4) IV drug use

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8
Q

Which are more likely to develop a chronic hepatitis B infection: adults or children?

A

Children (90% vs 5%).

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9
Q

What is the serology profile for acute HBV infection?

A

+: HBsAg, HBcAb (IgM or IgG), HBV DNA

-: HBsAb

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10
Q

What is the serology profile for chronic HBV infection?

A

+: HBsAg, HBcAb, HBV DNA

-: all else

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11
Q

What is the serology profile for a person vaccinated to HBV?

A

+: HBsAb

-: all else

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12
Q

What is the serology profile of a person with a cleared HBV infection?

A

+: HBsAb, HBcAb

-: all else

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13
Q

How is hepatitis B treated?

A

(1) tenofovir

(2) entecavir

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14
Q

What is done for infants born to mothers that are HBsAg positive?

A

(1) vaccine at birth

(2) HBIG

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15
Q

How is hepatitis D spread?

A

Percutaneous exposure.

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16
Q

Which virus requires HBV for infection?

A

Hepatitis D.

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17
Q

Why is HBV infection necessary for HDV?

A

The HDV virions are coated using HBV products, allowing cell-to-cell spread.

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18
Q

What increases the risk of fulminant hepatitis from acute HBV infection?

A

Co-infection with HDV (34% vs 4%).

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19
Q

Is hepatitis C a DNA or RNA virus?

A

RNA.

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20
Q

How is hepatitis C spread?

A

(1) IV drug use
(2) sexually
(3) blood products

21
Q

What is the probability of developing a chronic HCV infection once infected?

A

80%.

22
Q

Which hepatitis infection has the strongest association with hepatocellular carcinoma?

A

HCV.

23
Q

How is HCV treated?

A

(1) interferon
(2) ribavirin
(3) telaprevir
(4) boceprevir

24
Q

Is hepatitis E a DNA or RNA virus?

A

RNA.

25
Q

How is hepatitis E spread?

A

Fecal-orally.

26
Q

Which group has the greatest risk of fulminant hepatitis in an HEV infection?

A

Pregnant women.

27
Q

How is hepatitis E treated?

A

Ribavirin.

28
Q

Is hepatitis A a DNA or RNA virus?

A

RNA.

29
Q

Is hepatitis B a DNA or RNA virus?

A

DNA.

30
Q

What is the main difference between Type 1 and 2 autoimmune hepatitis?

A

(1) autoantibodies to ANA or SMA

(2) autoantibodies to LKM1

31
Q

Which type of autoimmune hepatitis is more likely to have extrahepatic manifestations?

A

Type 2.

32
Q

How is autoimmune hepatitis treated?

A

(1) prednisone

(2) prednisone & azathioprine

33
Q

What is primary biliary cirrhosis?

A

An ongoing, auto-immune inflammatory destruction of the interlobular and septal bile ducts, leading to chronic cholestasis and biliary cirrhosis. (Not really cirrhosis.)

34
Q

What is the trigger for primary biliary cirrhosis?

A

An immune-mediated response to a foreign or self antigen. Presence of AMA antibodies inevitably leads to PBC.

35
Q

What is the LFT profile of primary biliary cirrhosis?

A

Elevated ALK.

36
Q

What are the histological features of primary biliary cirrhosis?

A

(1) damage to epithelial cells of small bile ducts
(2) ductopenia
(3) non-caseating granulomas

37
Q

How is primary biliary cirrhosis treated?

A

Ursodiol. Prednisone does not work.

38
Q

What is primary sclerosing cholangitis?

A

A chronic cholestatic liver disease of unknown etiology characterized by inflammation and fibrosis of the biliary tree.

39
Q

What is the primary worry with primary sclerosing cholangitis?

A

Development of cholangiocarcinoma.

40
Q

What are the histological features of primary sclerosing cholangitis?

A

Onion skin fibrosis around bile ducts.

41
Q

What other disorder is usually seen in patients with primary sclerosing cholangitis?

A

IBD (80%).

42
Q

What is the primary cause of acute liver failure in the US?

A

Drug-induced liver disease (acetaminophen).

43
Q

What profile is at increased risk of drug-induced liver disease?

A

An aging, obese, alcoholic female that has malnutrition and multiple prescriptions.

44
Q

What are 2 drugs causing intrinsic DILI?

A

(1) acetaminophen

(2) methotrexate

45
Q

What are characteristics of hepatocellular DILI?

A

(1) elevated AST/ALT
(2) acute liver failure
(3) 10% mortality

46
Q

What are characteristics of cholestatic DILI?

A

(1) elevated ALK
(2) jaundice
(3) pruritus

47
Q

What is the reason for acetaminophen toxicity?

A

A buildup of the toxic metabolite, NAPQI, due to an exhaustion of glutathione stores.

48
Q

How is acetaminophen-induced liver disease treated?

A

N-acetylcysteine, which is metabolized to glutathione in the body.

49
Q

What drug class is implicated in the most cases of DILI?

A

Antimicrobials.

GI (39 decks)

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