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Exam 4-DWB > Hepatitis B, C, D, E > Flashcards

Hepatitis B, C, D, E Flashcards

1
Q

Hepatitis B transmission

A
  1. blood borne
  2. sexually transmitted
  3. can live on environmental surfaces for up to 7 days
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2
Q

Which body fluids have high viral concentration

A
  1. blood
  2. serum
  3. wound exudates
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3
Q

Which body fluids have moderate viral concentrations

A
  1. semen
  2. vaginal fluid
  3. saliva
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4
Q

Which body fluids have low/not detectable

A
  1. urine
  2. feces
  3. sweat
  4. tears
  5. breast milk
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5
Q

Worldwide at-risk population for hepatitis B

A
  1. endemic countries such as asia, sub-saharan africa
  2. children of HBV-positive mothers
  3. travelers to endemic areas
  4. sexual contacts
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6
Q

US at-risk population for hepatitis B

A
  1. sexual contacts
  2. household contacts
  3. IV drug users
  4. health care workers
  5. people working with /receiving blood products or dialysis
  6. residents/staff of facilities for developmentally disabled persons
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7
Q

There is an increased prevalence of Hepatitis B in what populations

A
  1. HIV + persons
  2. IV drug users
  3. men having sex with men
  4. sexual/household contacts of HBsAg + persons
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8
Q

Who should get tested for hepatitis B

A
  1. anyone with acute presentation of liver disease

2. anyone in risk groups

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9
Q

acute hepatitis B infection: incubation

A

30-180 days, mean 60-90

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10
Q

HPI/ROS of acute hepatitis B infection

A
  1. General: fatigue, low-grade fever
  2. Skin: erythematous rash, urticaria
  3. HEENT: jaundice at day 10
  4. GI: nausea, bloated feeling
  5. MS: arthralgias
  6. VS: fever
  7. Skin: rash, jaundice
  8. HEENT: posterior cervical lymph nodes, icteric sclera
  9. GI: tender, palpable liver edge {70%}
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11
Q

Surface antigen and antibody for hepatitis B

A

Antigen- HBsAg

Antibody- anti-HBs

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12
Q

Core antigen and antibody for hepatitis B

A

Antigen- HBcAg

Antibody - anti-HBc

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13
Q

e=nucleocapsid protein {similar to C}

A

Antigen: HBeAg
Antibody: anti-HBe

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14
Q

Polymerase chain reaction test for viral load of hepatitis B

A
  1. DNA amplification technique able to detect as few as copies/mL
  2. very expensive
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15
Q

Indications of viral load test

A
  1. treatment decisions
  2. response to treatment
  3. chronic infection
  4. unusual presentation
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16
Q

Prevalence of chronic HBV

A
  1. two billion people have incidence of infection
  2. 800,000 - 1.4 million infected in US
  3. ninth leading cause of death worldwide
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17
Q

What percent of children and adults with chronic hepatitis B infections will develop cirrhosis or liver cancer

A

25% of childhood

15% of adults

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18
Q

Antigens and antibodies for chronic Hepatitis B infection

A
  1. HBsAg positive for > 6 months;
  2. total anti-HBc positive;
  3. HBeAg may have significance in long-term clinical course;
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19
Q

Hepatitis D infection always requires what other infection and why

A

HBV infection because it uses HBV protein shell;

** can occur acutely as a co-infection with HBV or as a superinfection after HBV

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20
Q

What is the most common blood-borne infection in the US

A

Hepatitis C

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21
Q

How is hepatitis C spread

A

parenteral route

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22
Q

What percent of patients with hepatitis C develop chronic liver disease

A

40-60%

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23
Q

Risk groups for hepatitis C

A
  1. current/former injection drug user
  2. pre 1987 clotting factor recipients
  3. pre-1992 transfusion/organ recipient
  4. dialysis patient
  5. person with known HCV exposure
  6. person with HIV/HBV
  7. children born to HCV + mother
  8. persons born between age of 1945-1965
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24
Q

Clinical course for hepatitis C

A
  1. incubates over 6-7 months
  2. 25% of people develop jaundice
  3. 1% mortality rate in acute infection
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25
Q

symptoms of hepatitis C

A

typically asymptomatic, indolent, prolonged course until advanced liver disease develops

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26
Q

Who should get tested for hepatitis C

A
  1. ever injected illegal drugs
  2. infected with HIV/HBV
  3. unexplained abnormal ALT/liver disease
  4. born to HCV + mother
  5. ever on hemodialysis
  6. needlestick
  7. sexual partner to HCV + person
  8. received clotting factors made before 1987 or blood/organs before 1992
  9. born between 1945-1965
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27
Q

Lab testing for hepatitis C

A
  1. screens for HCV antibodies
  2. detects antibodies 28-90 days after exposure
  3. does not distinguish acute from chronic
  4. misses approximately 10% of positives
  5. may see ALT fluctuate wildly and does not predict the extent of liver damage
  6. follow positive screening result with confirmatory testing
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28
Q

hepatitis C viral load

A

PCR: HCV RNA+ one to two weeks after infection
Indication: acute infection suspected
anti-HCV ambiguous or unconfirmed, infection suspected with normal LFTs
- repeat if negative with high suspicion of infection
- no sure correlation between high titer and disease severity

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29
Q

Genotyping testing for HCV

A
  1. informs treatment decisions
  2. type 1 HCV most common in US
  3. type 2 and 3 most likely to respond to treatment {24 weeks};
  4. type 1 more resistant to treatment {48 weeks}
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30
Q

Cofactors for hepatitis C disease severity

A
  1. alcohol
  2. age over 40 at time of infection
  3. HIV coinfection
  4. male
  5. other coinfection
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31
Q

Out of every 100 people infected how many with hepatitis C will develop chronic infection

A

75-80

32
Q

Out of every 100 people infected how many with hepatitis C will develop chronic liver disease

A

60-70

33
Q

Out of every 100 people infected how many with hepatitis C will develop cirrhosis over 20-30 years

A

5-20

34
Q

Out of every 100 people infected how many with hepatitis C will die from infection consequences

A

1-5

35
Q

What are the extrahepatic manifestations of hepatitis C

A
  1. lymphoma
  2. diabetes
  3. glomerulonephritis
  4. porphyria cutanea tarda
  5. lichen planus
36
Q

Chronic HBV treatment is based on

A
  1. ALT abnormality
  2. viral load
  3. positive/negative E antigen
  4. abnormal liver biopsy
37
Q

Chronic HBV treatment is aimed at

A

viral replication;

  1. pegylated interferon and ribavirin
  2. protease inhibitors:
    a. adefovir,
    b. entecavir,
    c. telbivudine,
    d. tenofovir;
    e. lamivudine {virus may become resistant
38
Q

E antigen-negative treatment for Hepatitis B when normal ALT, viral lode under 10^5

A
  1. no treatment

2. follow with LFTs, alpha fetoprotein every 6 months

39
Q

E antigen-negative treatment for Hepatitis B when abnormal ALT, viral load > 10^5

A

GI referral for treatment consideration

40
Q

Chronic HCV treatment

A
  1. Ribavirin
  2. pegylated interferon
  3. telaprevir
  4. boceprevir
  5. simeprevir
  6. sofosbuvir
41
Q

What is the duration for chronic HCV treatment

A

6-12 months

42
Q

Duration for chronic HCV treatment depends on

A
  1. genotype
  2. viral load
  3. liver biopsy results
43
Q

Side effects of chronic HCV treatments

A
  1. nausea
  2. fatigue
  3. irritability
  4. hair loss
  5. anemia
  6. neutropenia
44
Q

interactions of chronic HCV treatments

A

multiple drug-to-drug interactions because of cytochrome P450

45
Q

hepatocellular carcinoma is associated with

A

HBV and HCV

46
Q

testing with hepatocellular carcinoma

A

alpha fetoprotein, liver US every 6 months

47
Q

Liver transplant and HBV re-infection treatments

A
  1. HBIG: improved outcomes but expensive
  2. Famciclovir: less promising
  3. Lamivudine: greater resistance
  4. Combination therapy: HBIG, vaccine
48
Q

Liver transplant and HCV reinfection treatments

A
  1. recurrent infection almost universal
  2. graft damage related to degree of immune suppression
  3. viral activity continues with immunosuppressants
49
Q

Education/Prevention plan for Hepatitis

A
  1. safe sex
  2. clean needles
  3. universal precautions
  4. health promotion in those infected
  5. avoid alcohol/unnecessary medications/infection
50
Q

Screening for hepatitis C should be done

A
  1. high risk groups

2. baby boomers 1945-1965

51
Q

Vaccinations for HAV/HBV should be done for

A
  1. risk groups: STD clinics, HIV counseling/testing sites;
  2. correctional facilities;
  3. drug treatment clinics
  4. sexual and household contacts
  5. healthcare workers/first responders
  6. diabetics
52
Q

HAV vaccine candidates

A
  1. all children 12-23 months
  2. unvaccinated adolescents, young adults
  3. IV drug users
  4. men who have sex with men
  5. travelers
  6. persons with any other chronic hepatitis
  7. clotting factor recipients
  8. persons who work with primates
53
Q

Hepatitis A vaccines

A

different formulas for:
1. pediatric {12 months-18 years}
2. adult > 18 years
100% immunogenic

54
Q

Common side effects for hepatitis A vaccine

A
  1. soreness at injection site

2. headache

55
Q

Where is the hepatitis A vaccine given

A

deltoid injections for adults/adolescents;

for child: vastus lateralus

56
Q

Hepatitis A vaccine and other vaccines

A

safe to give with other immunizations but use separate site

57
Q

Hepatitis A vaccine dosing for travelers

A
  1. four weeks before travel give 1 dose
  2. less than 4 weeks before travel: dose one plus 0.02mg/kg immune globulin (Ig) IM at different site;
  3. give second dose 6-12 months after dose one for long-term protection
58
Q

Do you test first before giving hepatitis A vaccine for traveling

A

yes if adult is > 40 born in or with history of travel to HAV-endemic areas

59
Q

Postexposure prophylaxis for hepatitis A is given when

A

within 2 weeks of exposure

60
Q

To whom do you give Postexposure prophylaxis for hepatitis A

A

if 40 +,health problems: immune globulin for passive protection;

61
Q

What hepatitis A vaccine do you give to high risk groups

A

both vaccine and immune globulin

62
Q

Candidates for HBV vaccine

A
  1. infants at birth
  2. catch up all others < 19
  3. multiple sex partners, MSM, STDs, HIV, HCV, chronic HBV+ sexual partners;
  4. healthcare workers
  5. IV drug users
  6. dialysis patients
  7. diabetes age 19-59 {higher incidence/poorer outcomes}
  8. travelers
63
Q

Do you test first for HBV vaccine

A
  1. consider prevalence in pt population {high risk sex, IVDU, immigrant};
  2. consider cost of testing {HBsAg} including visit and vaccine
64
Q

When do you do HBV testing after HBV vaccine

A
  1. ongoing risk of exposure
  2. healthcare worker
  3. high risk sex
  4. IVDU
  5. infected household
  6. obese
  7. in 4-8 weeks after 3rd vaccine dose
  8. anti-HBs
  9. full series vaccine for nonresponders
  10. copy of antibody titer lab results to patients
65
Q

When do you not do HBV testing after HBV vaccine

A

infant, child, adolescent

66
Q

HBV booster doses are recommended

A

only for hemodialysis patients

  1. test annually for anti-HBs
  2. administer booster if level < 10
67
Q

HBV booster for immunocompromised patients

A

undetermined need but consider annual anti-HBs testing and booster if level < 10

68
Q

HBV booster is not recommended for

A

vaccinated persons with normal immunity, low exposure risk

69
Q

Post-exposure prophylaxis for known HBsAG + source

A
  1. as soon as possible, ideally within 24 hours
70
Q

Post-exposure prophylaxis for known HBsAG + source booster dose

A

persons with written documentation of complete HBV vaccine series but no postvaccination testing

71
Q

Post-exposure prophylaxis for known HBsAG + sourceHBIG and finish vaccine series on normal schedule

A

persons in vaccination process

72
Q

Post-exposure prophylaxis for known HBsAG + source vaccine and HBIG

A

unvaccinated persons

  1. simultaneous administration, separate injection site
  2. vaccine series according to age-appropriate dose/schedule
73
Q

Post-exposure prophylaxis for unknown HBsAG: no treatment

A

persons with written documentation of completed HBV vaccination series

74
Q

Post-exposure prophylaxis for unknown HBsAG: vaccine series continued to completion

A

persons not fully vaccinated

75
Q

Post-exposure prophylaxis for unknown HBsAG: vaccine series started as soon as possible

A

unvaccinated persons

Exam 4-DWB (20 decks)

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