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GI Final > Hepatitis- Jenkins > Flashcards

Hepatitis- Jenkins Flashcards

1
Q

What can cause an elevated alkaline phosphatase?

A

biliary disease

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2
Q

***What are the differentials in AST/ALT elevation? (6) What labs should be ordered to rule these differentials in or out?

A
  • Hepatitis C: Viral count
  • Hepatitis B: Viral count
  • Hepatitis A: Serology (antibodies)
  • NAFLD/NASH
  • Autoimmune Hepatitis: ANA
  • Hemochromatosis: Ferritin
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3
Q

***What are the primary causes of chronic liver disease?

A
  • Hepatitis C (26%)

- Alcohol (24%)

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4
Q

How did a lot of people contract Hepatits C?

A

Blood transfusions before 1990 (were not regulated)

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5
Q

***What is the leading cause of liver transplantation?

A

Hepatitis C

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6
Q

***What is Hepatitis C? How many genotypes are there? What are the most common? Is it curable?

A
  • Small , enveloped, icosahedral positive-sense RNA virus.
  • 6 genotypes
  • most common: 1a, 1b, 2a and 2b

*NOW curable!

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7
Q

***What are the most common HCV genotypes in the US?

A

1-3

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8
Q

Who is at risk for HCV?

A
  • persons in contact with non sterile needles (IVDA, tattoos before 1990, piercings, accupunctures, needlesticks)
  • persons who snort cocaine and share snorting straws
  • exposure to HCV
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9
Q

What do many pts with HCV present with?

A
  • most with chronic HCV are asymptomatic or have mild, nonspecific symptoms
  • only 20-30% of acute illnesses have symptoms (fever, fatigue, dark urine, clay-colored stool, abd pain, loss of appetite, n/v, joint pain, jaundice)
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10
Q

***What is the screening test for HCV? What is the confirmatory test? What is the timeline that will produce a + result?

A
  • screen: anti-HCV antibody –> detected within 4-10 weeks after exposure
  • Confirmatory: HCV RNA PCR (viral count) –> in blood as early as 2-3 weeks after infection
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11
Q

***How many people with HCV will develop a chronic infection? How many will develop cirrhosis?

A
  • 80% will develop a chronic infection

* 5-20% will develop cirrhosis over 20-30 years (why it’s hard to get insurance to pay for tx)

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12
Q

***What is the curative treatment for Hepatitis C (Genotype 1)? How much does this cost?

A

1 pill for 90 days (each pill=$1100) ==> about $100, 000

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13
Q

What are some characteristics of HBV?

A
  • Member of Hepadnavirus family
  • Partially double stranded circular DNA virus with reverse transcriptase replication
  • Virion consist of outer lipid envelope and icosahedral nucleocapsid core composed of protein.
  • Four known genes encoded by the genome:
  • Gene C codes for core protein (HBcAg)
  • Gene P codes for DNA polymerase
  • Gene S codes for the surface antigen (HsAg)
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14
Q

***What percentage of adults with HBV will become chronically infected? What about infants?

A
  • 95% of adults will recover completely and NOT become chronically infected.
  • 90% of infants will become chronically infected
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15
Q

How is HBV transmitted?

A
  • 50-100X more infectious than HIV*
  • through percutaneous or mucosal contact with infectious blood or body fluids (SEX, IVDA, birth to an infected mother, contact with open sores, sharing razors or toothbrushes)
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16
Q

What are the signs and symptoms of decompensated cirrhosis?

A
  • Jaundice
  • Splenomegaly
  • Ascites
  • peripheral edema
  • encephalopathy
17
Q

***What does the presence of HBsAg indicate? What should be done next?

A

acute or chronic active infection

–> do a viral count

18
Q

***What does anti-HBs or HBsAb indicate?

A

recovery and immunity for HBV infection (either through recovery from infection or vaccine)

19
Q

What does anti-HBc IgG indicate? How long will this persist?

A

previous infection with HBV

appears at recovery from acute Hep B and persists for life

20
Q

What does IgM anti-HBc indicate?

A

recent acute infection with HBV (< 6 months)

21
Q

***What does HBV DNA PCR indicate?

A

the viral load–> the higher the number, the more infectious the pt is

22
Q

What do the following labs indicate?
- HBsAg
+anti-HBc
+ anti-HBs

A

Immune due to natural infection

23
Q

What do the following labs indicate?
- HBsAg
- anti-HBc
+ anti-HBs

A

immune due to vaccination

24
Q 
What do the following labs indicate? 
\+ HBsAg 
\+ anti-HBc 
\+ IgM anti-HBc 
- anti-HBs
A

acutely infected

25
Q 
What do the following labs indicate? 
\+ HBsAg 
\+ anti-HBc 
- IgM anti-HBc 
- anti-HBs
A

Chronically infected

26
Q

***What is the treatment for an acute HBV infection? Chronic?

A

Acute: supportive ONLY. no medication is available

Chronic: hard to get a - viral count==> LOTS of meds (I don’t think we have to know them)

27
Q

***What is the highest risk factor for hepatocellular carcinoma?

A

Hepatitis B

28
Q

***Which hepatitis infections can cause cirrhosis?

A

B and C

NOT A*

29
Q

What are some characteristics of HAV?

A
  • A Picornavirus
  • Non-enveloped, single-stranded RNA virus
  • Only one serotype of the virus, but multiple genotypes exist.
  • humans=only reservoir for this virus
30
Q

***How is Hep A spread? When is the period of greatest HAV shedding and transmission?

A
  • Fecal-oral, person-to-person or consumption of contaminated food/water (resistant to detergent, acid, solvents and temps up to 60C) (NOT blood)
  • greatest shedding and transmission during the anicteric prodrome (2 weeks before –> 1 week after onset of illness)
31
Q

What are the serologic tests for HAV?

A

Anti-HAV IgM is + at the time of onset (sensitive and specific and remains + for 3-6 months after primary infection)

Anti-HAV IgG appears soon after IgM and persists for many years

32
Q

What does anti-HAV IgG in the absence of IgM indicate?

A

past infection or vaccination and immunity

33
Q

What are the symptoms of HAV? How does this change with age?

A

children < 6 yo, 70% are asymptomatic or have unrecognized infection

> 80% of adults have symptoms (nausea, anorexia, fever, abs pain, jaundice)

34
Q

***What is the treatment for HAV? How often does HAV become a chronic infection?

A

treatment=supportive

HAV is NEVER chronic!

35
Q

Who should be given Immune Globulin for HAV?

A
  • Postexposure prophylaxis (within 2 weeks of exposure),
  • Travelers < 12 months of age,
  • Travelers who are departing in less than 2 weeks who are all previously unimmunized.
  • For effective short term protection against HAV infection for up to 3 months or postexposure prophylaxis

GI Final (18 decks)

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