Hepatitis & Liver Diseases

Question 0

Jaundice

Answer 0

• It is general condition that results from abnormal
metabolism or retention of bilirubin.

• It causes yellow discoloration of the skin, mucus
membranes and sclera.

Question 1

Liver Disorders

Answer 1

• Jaundice 
• Hepatitis 
• Drug induced hepatic damage 
• Liver cirrhosis 
• Alpha1-antitrypsin deficiency 
• Liver tumors 
• Congenital deficiency syndromes with altered liver 
function: 

Porphyrias
Wilson’s disease
hemochromatosis

Question 2

Types of jaundice:

Answer 2

1. Prehepatic jaundice: results from acute or chronic
   hemolytic anemia
2. Hepatic jaundice: results from disorders of bilirubin
   metabolism and transport.
3. Posthepatic jaundice: results from a compromised
   ability of the liver to excrete bilirubin.

Question 3

Bilirubin metabolism

Answer 3

Bilirubin conjugation:
• Bilirubin conjugation takes place in the liver.

• Free bilirubin (lipid-soluble, unconjugated) enters the liver
carried with albumin.

• The enzyme glucuronyl transferase converts unconjugated
bilirubin to a a water soluble form or conjugated bilirubin.

Question 4

Hepatitis

Answer 4

• Inflammation of the liver

• Etiologic agents 
– viral infections 
– toxic agents 
– drugs 
– autoimmune response 
– Wilson's disease 
– Hemochromatosis

Question 5

Types of Secondary Hepatitis: viral / bacterial

Answer 5

• Yellow Fever
• Epstien Barr virus (EBV)
• Cytomegalovirus (CMV)

• Parasites and bacteria, can cause hepatitis
as a secondary effect.

Question 6

Viral Hepatitis

Answer 6

Hepatitis A through E

Question 7

Hepatitis A

Answer 7

fecal-oral spread: hygiene, drug use, travelers, day care,
food

vaccine-preventable

Incubation 1-2 months

Blood detection of anti-hav

Question 8

Hepatitis B

Answer 8

sexually transmitted – 100x more infectious than HIV

blood-borne (sex, injection drug use, mother-child, and
health care)

vaccine-preventable

Incubation 2-3 months

Blood detection of HBsAg

Question 9

Hepatitis C

Answer 9

blood borne (injection drug use primarily)

4-5 times more common than HIV

NOT vaccine-preventable!

Incubation 2-3 months

Blood detection anti-HCV

Question 10

Hepatitis D

Answer 10

Contact with infected blood and body fluids

Infected mother to fetus

Must have hepatitis B to be infected with hepatitis D
(Coinfection or Superinfection)

Incubation 2-3 months

No Vaccine

Blood detection anti-HDV

Question 11

Hepatitis E

Answer 11

Fecal to oral from another infected person

Incubation 1-2 months

No vaccine

Question 12

Acute Hepatitis – Clinical Symptoms

Answer 12

Asymptomatic > Symptomatic > Fulminant Liver Failure >
Death

Symptoms (if present) are the same, regardless of cause
(e.g., A, B, C, other viruses, toxins)

– Nausea, vomiting 
– Abdominal pain 
– Loss of appetite 
– Fever 
– Diarrhea 
– Light (clay) colored stools 
– Dark urine 
– Jaundice (yellowing of eyes, skin)

Question 13

Hepatitis A (HAV)

Treatment & Prevention

Answer 13

Treatment

• Supportive (rest, nutritious diet)
• Avoid ETOH, acetaminophen, other hepatotoxins

Prevention

• Careful hand washing
• Segregation
• Cleaning of laundry and personal items
• Immunization

Question 14

Hepatitis B (HBV)

Risk Factors

Answer 14

• Health care settings (3%)
• Transfusions and dialysis (1%)
• Acupuncture
• Tattooing
• Extended overseas travel

Question 15

Hepatitis B (HBV)

Treatment

Answer 15

Treatment

• Supportive
– Most nonfulminant infections resolve spontaneously
– About 5% progress to chronic infection

• Aggressive treatment in fulminant hepatitis for
coagulopathy, encephalopathy, cerebral edema, and
other manifestations

• Liver transplant

Question 16

Hepatitis B (HBV)
Prevention

Answer 16

Prevention

• Immunizations (HBV)
– Doses given at 0, 1, and 6 months
– 95% response rate

• Administration of HBIG postinoculation

– Given within 7 days of exposure
– Indications
• Neonates born to HBsAg-positive mothers
• Prophylaxis after needlestick or sexual exposure in
nonimmune persons

Question 17

Hepatitis C (HCV)

Cont.

Answer 17

• “Non A, non B hepatitis” until identification of the
causative agent in 1989.

• Leading cause of end-stage liver disease with cirrhosis
in U.S.

• Most common in U.S. but lower response rate to
treatment

• An important feature of the virus is the relative mutability
of its genome
– which in turn is probably related to the high propensity (80%) of
inducing chronic infection.

• HCV clustered into several distinct genotypes which
may be important in determining the severity of the
disease and the response to treatment.

Question 18

Hepatitis C (HCV)

Treatment

Answer 18

Treatment
• Supportive and expectant
– Unless complications or subacute hepatic failure

• Chronic infection
– Assessed by a viral load and viral genotype
– Liver biopsy to stage disease activity

Question 19

Hepatitis D (HDV)

Cont.

Answer 19

• Fulminant hepatitis (HDV)

• Incomplete viral organism that requires presence of HBV
for replication

• Occurs coincident with or subsequent to initial infection
with Hep B

• Diagnosis
– Anti-HDV IgM