Hepatitis Pathophys Flashcards
What is the sequence of events in viral hepatitis?
1) Acute Hepatitis
2) Acute Liver Failure
3) Chronic Hepatitis
Once you get chronic hepatitis what happens
you get cirrhosis, liver failure, and/or hepatocellular carcinoma
Hepatitis A and E mostly cause what
Acute hepatitis
HBV mostly causes what
Acute hepatitis like A and E. The difference is that there is a greater chance that B can lead to fulminant liver failure.
A small percentage of HBV causes chronic hepatitis. This is mostly in the presence of Hep D
HCV causes what
chronic hep
hepatits pts will, of course, have an acute rise in liver enzymes (AST and ALT)
ok
Constitutional symptoms of acute hepatitis?
fever, fatigue, abdominal pain
High AST/ALT is what levels?
1,000 - 5,000….usually doesnt exceed 5,000
Most serious complication of acute viral hepatitis
Fulminant liver failure
Presentation of fulminant liver failure
altered mental status in pt with acute hepatitis.
The altered mental status is due to the hepatic encephalopathy
Fulminant liver failure mortality rate is close to 90%
Key test for Hepatitis A diagnosis?
IgM anti-HAV antibody
Key test for HEV
IgM anti-HEV antibody
Chronic HBV represents a vital public health problem for which part of the american population
Asian Americans…HBV is endemic to many parts of Asia
Positive HBsAg means what?
Active infection
Positive HBsAg antibody means what?
resolved infection or prior vaccination
Positive HBc antibody means what?
Definitely have been infected in the past…this does not show up with a vaccination
Positive HBe antigen means what?
Active replication and highly infectious
In patients with chronic HBV, what serological (plasma or serum) markers are detectable for life?
HBsAG and IgG for HBc
When is it appropriate to start treating chronic HBV?
When there is evidence of liver injury….meaning high ALT
What are the treatment goals of chronic HBV tx?
Decrease replication and minimize liver injury.
Reduce the risk of Hepatocellular carcinoma
Unfortunately, chronic HBV can only be cured in approximately 5-10% of pts.
All HIV fts should be tested for HBV. There chance of natural clearance is lower
ok….the good news is that some anti-HIV drugs, like Tenofovir, are also anti-HBV.
HBD is transmitted parenterally or enterically>
Parenterally…Needs the HBsAG to infect
Super-infection
When a person with CHRONIC HBV becomes infected with HDV
Co-infection
Just acute HBV and HDV infection occuring simultaneously
New CDC recommendation for HCV screening?
Anyone born between 1945 and 1965
Regarding HCV serotypes, the most prevalent in the US is
HCV 1
HCV 2 where
Developed countries (US included)
HCV 3
IV drug users
HCV 4
Middle East and North Africa
HCV 5
South Africa
HCV 6
Asia
Goal of HCV tx
Eradicate teh HCV…it is curable with treatment
Hepatocellular carcinoma is actually the most common cancer worldwide.
ok
What are the major risk factors for Hepatocellular carcinoma?
Chronic Hepatitis (either B or C)
Hepatitis C viruse causes cancer only in the setting of
Cirrhosis
Which of the hep viruses can cause HCC without even entering into a stage of cirrhossis?
HBV
Proteinuria of unknown cause calls for
Screen for HCV
CMV hepatitis in mmunocompromised pts. Become suspicious when you see what symptoms
Fever, diarrhea, increase in liver enzymes
Gold standard test for CMV?
Tissue Biopsy
Gold standard treatment for CMV hep
Ganciclovir
Hepatitis E causes what type of infection and is more severe in who?
AcutE, More severe in pregnant women and the elderly…KNOW
Hep A and B vaccines should be given to who
anyone with any type of liver disease
Which genotype of HCV has the lowest cure rate?
1
All HBV pts should be screeened for HCC, whereas HCV pts should only be screened if…
They have Cirrhosis
