Hepatitis Lecture Powerpoint

Question 1

Hepatitis A

Answer 1

Single stranded RNA virus, almost exclusively spread fecal oral route most often person to person, incubation 2-6 weeks, increasing age increases symptoms as newborns are usually asymptomatic and anicteric, boiling water/iodine/chlorine are effective for destroying virus, risk highest in developing countries, usually self limiting, prognosis generally excellent without lasting sequelae

Question 2

2 phases of Hep A infection

Answer 2

Prodrome - mild flu like symptoms

Icteric - develop dark urine then pale stools, jaundice

Question 3

If you order a patient a total Hep A antibody panel (IgM + IgG) and they have only IgG, then…

Answer 3

….patient either previously had disease or was vaccinated

Question 4

Hep A treatment

Answer 4

• supportive
• sugarcane in developing countries
• locate primary source to prevent further outbreaks
• post exposure prophylaxis with gammaguard within 2 weeks of exposure for non immunized close contacts

Question 5

Hepatitis B

Answer 5

DNA virus, estimated 1/3 of global population has been infeected, incubation period 1-6 months, transmitted via body fluids (blood/semen/vaginal secretions) including sexual/parenteral/perinatal, anicteric hepatitis has greater tendency to develop chronic hep

Question 6

2 phases of hep B infection

Answer 6

• Acute phase - majority asymptomatic

- Viral prodrome with icteric hepatitis (arthralgias, skin rash, low grade fever, jaundice for 1-3 months)

Question 7

Hepatitis Ig labs

Answer 7

• core IgM indicates acute infection
• core IgG indicates past infection (not from vaccination)
• surface antigen indicates acute or chronic infection
• surface antibody indicates had virus (if core antibody positive) or vaccine (if only positive value then vaccinated)
• E antigen indicates active viral replication and highly contagious
• E antibody indicates a carrier

Question 8

Chronic hep B treatment

Answer 8

Referral to GI

Question 9

Any patient with chronic hep B requires….

Answer 9

….screening regimen for hepatocellular carcinoma (HCC), which is an ultrasound every 6-12 months

Question 10

Hep B 3 treatments

Answer 10

• pegylated interferon alpha
• entecavir
• tenofovir disoproxil fumarate

Question 11

Hepatits C

Answer 11

Single stranded RNA virus, most frequent cause for liver transplant in US, most frequently occurring nonA nonB hepatitis worldwide, 80% will remain viremic and 20% of that will develop cirrhosis, transmitted primarily via iv drug use, transfusion prior to 1990, needle stick, increased risk of transmission if co infection with HIV, incidence rising due to opioid epidemic, good prognosis if treated acutely

Question 12

Who should be screened for hep C (4)

Answer 12

• evidence of liver diz
• HIV infected individuals
• incarcerated
• needle stick injury

Question 13

Acute vs chronic hep C diagnosis

Answer 13

• Acute is clinical suspicion and sometimes HCV PCR

- Chronic most patients are asymptomatic

Question 14

Most common genotype of hep C

Answer 14

1

Question 15

Chronic hep C screening

Answer 15

• HCV antibody test
• if positive, check assays for HCV RNA using PCR
• if not present then cleared, if present then send to GI

Question 16

__ is strongest contributor to accelerated liver disease and cirrhosis

Answer 16

Alcohol

Question 17

Hep C treatment (acute (1)and chronic (2))

Answer 17

• acute, monitor for spontaneous clearing for 6 months

- chronic sofosbuvir (sovaldi) or simeprevir (olysio)

Question 18

Hepatitis D

Answer 18

RNA virus transmitted same modes of hep B, only seen in patients with hep B, uncommon in west, chronic hep B with D progresses more rapidly to cirrhosis, 90% asymptomatic, treated same way as hep B (and vaccine against B is effective against D as well)

Question 19

Hepatitis E

Answer 19

RNA virus transmitted fecal oral from contaminated water in endemic areas, usually self limiting and has many similatrities with hep A, vaccine available

Question 20

Hep is associated with a higher mortality rate in these 2 patient types

Answer 20

• pregnant women

- transplant recipients

Question 21

Fatty liver disease

Answer 21

Accumulation of triglycerides and other fats in liver cells, may have associated hepatic inflammation and liver cell death, need to distinguish nonalcoholic vs alcoholic etiology (alcoholic is reversible, metabolic syndrome is commonly associated with nonalcoholic fatty liver)

Question 22

Fastest growing cause of liver disease in the western world, most common liver disease among US adolescents, predicted to become leading cause of liver transplant in next 10years

Answer 22

Non alcoholic fatty liver disease

Question 23

Non alcoholic fatty liver disease is an independent risk factor for….

Answer 23

….prediabetes

Question 24

Alcoholic liver disease (3)

Answer 24

Catch all for three stages

• alcoholic fatty liver
• alcoholic hep
• alcoholic related cirrhosis

Question 25

Most common cause of severe iron overload

Answer 25

Hemachromatosis (genetic issue with iron deposition in multiple organs including liver)

Question 26

Disease states linked to liver disease (4)

Answer 26

• hemachromatosis
• autoimmune hepatitis
• a1 antitrypsin deficiency
• wilson’s disease