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GI > Hepatitis and Hep Treatment > Flashcards

Hepatitis and Hep Treatment Flashcards

1
Q

Most common viral hep worldwide?

A

Hep A

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2
Q

Spread of hep A?

A

Fecal-oral

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3
Q

Does hep A have a vaccine?

A

yes

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4
Q

Life of hep A

A

acute, benign, self limited (<2mo)

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5
Q

How is hep B transmitted?

A

Perinatal, blood, sex IVdrugs

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6
Q

How does hep B look in adults?

A

Unlikely to be chronic

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7
Q

How does hep B look in kids

A

almost always chronic

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8
Q

Serologies if vaccinated for hep B

A

+surface Ab only (only there if cured or immunized)

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9
Q

Serologies if have chronic for hep B

A

+surface Ag
+surface core IgG
elevated DNA

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10
Q

Serologies if acute for hep B

A

+surface Ag
+core (IgM or IgG)
elevated DNA

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11
Q

What is the only DNA hep virus?

A

Hep B….stable DNA so harder to treat

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12
Q

How do you treat hep B

A

Interferon

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13
Q

How do you treat babies whos moms have hep B

A

vaccine at birth

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14
Q

What is e antigen?

A

e antigen is secreted only if virus is replicating. Indicates active virus

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15
Q

What is e antibody

A

e antibody indicates robust immune response dec virus

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16
Q

What does the most injury to liver in hep B?

A

immune response

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17
Q

What will your labs look like with immune tolerance to hep B?

A
  • no ALT
  • High DNA
  • eAg pos/eAb neg
  • ->typical initial phase of perinatal acquired infection
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18
Q

What will your labs look like with chronic hep

A
  • ALT high
  • High DNA
  • eAgpos/eABneg
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19
Q

What will your labs look like with seroconversion to inactive carrier state?

A

ALT transient inc then nl

Low DNA

eAg neg/eAb pos

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20
Q

eAg and chronic hep

A

can be neg or pos

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21
Q

What are the indications for HBV treatment?

A
  • elevated ALT
  • elevated HBV DNA
  • cirrhosis and detectable HBV dna
22
Q

What are the goals of HBV therapy

A
  • dec risk of hepatic decompensation and HCC
  • Normalization of ALT
  • Histological improvement
23
Q

How do most of the HBV drugs work?

A

Viral polymerase inhibitors, oral or interferon

24
Q

What is special about eAg negative patients regarding therapy?

A

They relapse when you go off interferon therapy

25
Q

What are some advantages to interferon therapy?

A
  • no viral resistance (immune activator, doesn’t work on virus)
  • Finite course of therapy
26
Q

What are some disadvantages of interferon?

A
  • Not great with high HBV DNA and low ALT
  • Side effects
  • Cant use with decompensated liver dis
  • High relapse with eAg neg
27
Q

In what setting would you see hep D?

A

Only in setting of hep B infection

28
Q

What does hep D inc risk of?

A

Fulminant liver

29
Q

How is hep D spread?

A

percutaneously

30
Q

What kind of virus is hep C

A

RNA

31
Q

Does genotype of hep C impact severity?

A

No, but it impacts treatment response

32
Q

What constitutes decompensated cirrhosis?

A
  • ascites
  • HE
  • Jaundice
  • Variceal bleeding
33
Q

Who is more likely to have hep C M or F?

A

M

34
Q

What is the gold standard for treatment of hep c?

A

Sustained viral response (SVR)

-absence of detectable HCV in blood 6 mo after end of therapy

35
Q

What is the chance of relapse after SVR is reached?

A

<1%

36
Q

What are the two treatments for hep c?

A

Pegylated interferon alpha (IV) and ribavirin (oral)

37
Q

What are the adverse events of interferon?

A
  • flu - like symp
  • depression
  • pancytopenia (bone marrow supp)
  • immune disease activation
  • wt loss
  • infection
  • worsening of cirrhosis
38
Q

How should ribavirin be administered

A

INEFFECTIVE as monotherapy! Use with interferon

39
Q

What are the adverse events of ribavirin?

A
  • non-immune hemolytic anemia
  • rash
  • dyspnea (difficulty breathing)
  • teratogenic
  • contraindicated in chronic renal failure
40
Q

On old treatment, what was predictive of drug’s success?

A

Rapid decline of viral laod inc likelihood of SVR

41
Q

Can you use monotherapy for hep C drugs?

A

NO! virus will rebound

42
Q

What are DAA agents?

A

Target more specific pathways in virus. Can be used for one strain or all.

end in -vir

43
Q

Describe the peaks in hep C life cycle

A
  • inc HCV then dec
  • Inc ALT after HCV hits peak
  • Inc anti-HCV at around wk 10
44
Q

What % hep is responsive to therapy?

A

85-95%

45
Q

What kind of virus is hep E?

A

RNA

46
Q

What is special about hep E worldwide?

A

most common cause of epidemic enterically transmitted hep

47
Q

How is hep E transmitted?

A

Fecal-Oral, immunosuppressed

48
Q

Who is hep E most dangerous for

A

pregnant women are at higher risk for fulminant hep

49
Q

What rises quickly in hep E?

A

ALT rises with IgM

50
Q

What hep is most likely to give you fulminant hep?

A

hep D

51
Q

Which heps give you chronic infections?

A

hep B in infants mostly and hep C and hep D superinfection (ie get hep D after already had hep B)

GI (12 decks)

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