Hepatits Flashcards
Which hepatitis are mostly co infections?
B and D
Hepatitis E is worst in…. And found mainly in which part of the world?
Pregnancy
East asia
Which hepatitis can be acquired perinatally?
B, C, D (sex, blood, mom)
Which hepatitis can you acquire with consuming water or food?
A and E
Which hepatitis rarely presents in acute form?
C
Sx of hepatitis
Jaundice, fever, weight loss, fatigue, dark urine, hepatosplenomegaly, abdo pain
What does the lab look like in viral hepatitis?
Increased direct bili, increased ALT>AST (viraL), increased alkaline phosphatase, aplastic anemia is a rare complication
What test in hepatitis correlates with increased mortality?
Prothrombin time: 70-80% of the liver is dead if prothrombin time is up (all coag factors are made in liver except 8 and VWF)
Best initial test for hepatitis A, C, D and E?
IgM antibody: acute infection
IgG antibody: resolution of infection
Hepatitis C disease activity measured with
PCR RNA level : amount of active viral replication
If PCR rises it shows treatment failure
Serologic pattern for hep B
Surface antigen: indicates presence of virus; + in acute or chronic infections, - in resolved infection
E antigen: degree of viral replication
Surface antibody if + could be vaccine, so look at core (vaccine gives no core), if core + then it means resolved, past infection if IgG, acute or chronic if IgM or IgG
Serology hep B window period
Surface antigen, e antigen and surface antibody negatives
Core antigen positive IgM then IgG
Which serologic marker becomes abnormal first in hep B?
Surface antigen
Which serologic marker in hep B correlates directly with the amount of viral replication?
E antigen
Which serologic marker in hepatitis B shows the infection is on the way to resolution?
Anti hep B e antibody
The best serologic marker in hep B that indicates that a woman can transmit the disease to her baby is?
E antigen 90% chances!
A carrier of hep B would have which serology?
Surface antigen + and that is it
Which markers in hep B would indicate that you cannot transmit the infection
No surface antigen found
Which is the best indication of the need for treatment in chronic hepatitis B?
E antigen
What is the treatment for hep A?
Resolves spontaneously over weeks, almost always benign
What is the treatment for hep E?
Resolves spontaneously over weeks, almost always benign
What is the percentage of hep B that becomes chronic?
10%
What is the treatment for acute hep B?
None
What is the treatment for acute hep C?
Interferon, ribavirin and either telaprevir or boceprevir, decreases likelihood of developping chronic infection
Chronic hepatitis B is dx when
Surface antigen is positive for longer than 6 months
When to treat for chronic hep B?
Both surface antigen + (more than 6 months) and e antigen +
What is the tx for hep B?
(one drug!)
Entecavir or adefovir or tenofovir or lamivudine or telbivudine or interferon (but has lots of adverse effects and no greater efficacy - flu like sx, plus it is injectable)
Adverse effects of interferon?
Arthralgia, myalgia, leukopenia, thrombocytopenia, depression and flu like sx
Goal of hep B therapy?
Convert e antigen in e antibody
What test determines if you treat hep C?
PCR-RNA viral load elevated : treat with 3 drugs interferon ribavirin and either telaprevir or boceprevir
What are side effects of ribavirin?
Anemia
