Hepatitis Lecture - Schoeny Exam 3 Flashcards
Which types of Hepatitis are spread through blood and body fluids? Which are spread through feces?
Blood/body fluids: B, C, D
Feces: A, E
Which types of hep cause chronic infection?
B, C, D
Which types of hep have a immunization?
A, B, D
Symptoms of acute hepatitis?
Nausea, vomiting, abd pain, loss of appetite, fever, diarrhea, light (clay) colored stools, dark urine, jaundice
There are 2 lab tests for hep a, hep A IgG, and hep A IgM. What’s the difference?
IgG tests for immunity from vaccine or previous infection
IgM tests for acute infection
What vaccines are available for hep A?
Havrix for hep A only
Twinrix is hep A/B combo
What is the immunization schedule for Havrix?
Children and adolescents - .5mL dose, 2 shot series given 6 months apart
Adults - 1mL dose, 2 shot series given 6 months apart
What is the immunization schedule for twinrix?
Standard - 3 shot series given at day 0, 1 month, and 6 months
Accelerated - 4 shot series given at day 0, day 7, day 21, and 1 year.
Hepatitis A treatment?
Supportive care
What is the most easily transmissible blood borne pathogen?
Hep B
When is the accelerated schedule for twinrix used?
For adults who are not immunized.
Can hep B be transmitted through breastmilk?
No
Most common hep B modes of transmission?
Sexual
Parenteral (needles)
Perinatal
What percentage of Hep B infections clear naturally?
80%
When Hep B + mothers give birth, what should be given to the baby at birth?
Hep B antibodies and hep b immunization
What patient population has increased risk of poor hep B outcomes?
patients of Asian descent
What are the different hepatitis B labs?
HBsAg Anti-HBs Anti-HBc IgM anti-HBC HBeAg Anti-HBe
What is HBsAg?
Hep B surface antigen.
+ during infection
What is Anti-HBs, what does a + result indicate?
Antibody to HBsAg
Indicates immunity to Hep B. Does not specify if it is from infection or immunization.
What is Anti-HBc, what does a + result indicate?
Antibody to Hep B core antigen.
+ result indicates prior infection.
What is IgM anti-HBc, what does + result indicate?
IgM class antibodies to Hep B core antigen. \+ result indicates infection within past 4-6 months.
HBeAg and Anti-HBe are used for what?
Specialized hep B treatment
What is the first detectable lab abnormality during hep B infection. When does it become postive?
HBsAg - positive 4 weeks after exposure.
Chronic hep B infection would show what lab abnormalities?
HBsAg and Anti-HBc would be positive.
An acute hep B infection would show what lab abnormalities?
+ HBsAg, Anti-HBc, and IgM anti-HBc
A patient immune to Hep B from immunization would have what + lab(s)?
Anti-HBs
What two hep B vaccines are approved in newborns and above?
Engerix and recombivax
Immunization schedule for engerix and recombivax?
3 dose series at 0, 1-2, and 4-6 months
What Hep B vaccine is a 2 dose series is only approved for ages 18 and up? Immunization schedule?
Heplisav-2
given at day 0 and 1 month
What is the leading cause of liver cancer and liver transplant in the US?
Hep C
Is hep C curable?
Yes :)
Is hep C vaccine preventable?
No :(
Average hep C incubation peroid?
6-7 weeks
What are some factors that lead to a worse prognosis in hep C infections?
Alcohol intake Age > 40 at time of infection HIV co-infection Male gender Chronic Hep B co-infection
CDC recommends Hep C testing for people who received clotting factors before 1987 or blood/organs before 1992. Why?
Hep C was not discovered yet, so blood donations could not be screened for it.
What labs are used to test for hep C?
Hep C antibody - screening test
HCV PCR - confirmatory test
How many genotypes of hep C are there?
6
Which hep C genotype is most common in the US?
Genotype 1 (80%)
Hep A treatment
Supportive care
Hep B treatment
Adefovir, entecavir, or tenofivir
There are many hep C treatments. What is “the backbone of what we use today”?
Hep C polymerase inhibitors used with pegylated interferon and ribavirin
List some of the Hep C polymerase inhibitors.
Simeprevir
Sofosbovir
What test needs to be done prior to treating hep C with zepateir?
Test for NS5A resistance in genotype 1a
Most common organism causing infectious esophagitis?
Candida albicans
What are common viral causes of infectious esophagitis?
CMV or herpes virus
Infectious esophagitis is common in _______ patients
Immunosuppressed
Diagnosis of infectious esophagitis is made with ______
endoscopy
Treatment for C albicans infectious esophagitis?
Diflucan
Treatment for CMV infectious esophagitis?
Ganciclovir *** Only use if you are 100% sure its CMV because ganciclovir is toxic.
Treatment for HSV infectious esophagitis?
Acyclovir
Name this bacteria:
Gram negative rod residing in mucous gel coating of epithelial cells of the stomach.
H. pylori
What conditions are H. pylori associated with?
PUD
Gastric adenocarcinoma
MALT cell lymphoma
What tests are available for H pylori?
Stool antigen
Urea Breath test
Endoscopy with biopsy
Treatment for H. pylori?
Clarithromycin, amoxicillin, and PPI
Due to resistance, what substitutions may be made in the typical H pylori treatment?
May substitute either clarithromycin or amoxicillin with doxycycline or metronidazole.
What quadrant is the pain from diverticulitis normally?
LLQ
Treatment of diverticulitis?
Metronidazole and fluoroquinolone
T/F? A botulism infection can be caused by 1 single spore.
true, it is highly virulent
Botulism toxin causes descending flaccid paralysis by what mechanism?
Toxin prevents release of ACh at neuromuscular junction
What food is often associated with botulism?
Home canned products
Does botulism have a rapid or gradual onset?
rapid
Treatment of botulism?
ICU admission
induce vomiting
Antitioxin!!!!! - gotta get it from the CDC
What is tinea soleum?
Pork tapeworm
What infection that lives in water and migrates to the urinary tract is linked to bladder cancer?
Schistosomiasis hematomium
