ICL 10.3: Acute Hepatitis

Question 1

how do you know if someone has a HepB infection?

Answer 1

HepB patients lose their taste for cigarettes?

Question 2

what are the symptoms of viral hepatitis?

Answer 2

they younger you are, the few symptoms you have

1. fatigue
2. jaundice
3. anorexia
4. RUQ pain
5. pruritus
6. dark urine / light stool
   .

Question 3

which viruses can cause acute hepatitis?

Answer 3

1. HAV
2. HBC
3. HCV
4. HDV
5. HEV
6. others

Question 4

what is HepA? how is it transmitted?

Answer 4

fecal-oral transmission

usually people go to endemic regions like Mexico and have water or fruit that’s been washed in water – it’s big in the drug community now too!!

symptoms are related to age; they’re worse the older you are

Question 5

is there a vaccine for HepA?

Answer 5

yes; everyone is recommended they get it now at 0 and 6 months

you can also give it for post-exposure prophylaxis

Question 6

what are the characteristics of the HepA virus?

Answer 6

1. incubation = 30 days but it can be 15-50 days
2. no chronic seuqalae!!
3. labs show anti-HAV IgG antibodies

no treatment….you’re gonna get better always – if you have acute liver failure either you get a transplant or you get better

Question 7

45 y/o male returns from trip to Mexico involving significant time spent outside of resort areas. Developed fatigue, anorexia 21 days afterwards, then jaundice. The probable cause is what?

Answer 7

HAV causing acute liver failure

HBC and HBC are usually from drugs

alcoholic hepatitis is possible but unless it’s 7 bottles of tequila probably not….

Question 8

23 y/o male with h/o IVDU presents with fatigue, anorexia, jaundice, encephalopathy. Most likely cause is what?

Answer 8

HepA

acute HepC isn’t common

Question 9

how can you get HepB?

Answer 9

percutanous aka if you’re a drug user you’re at higher risk

environmental; aka you can get it from surfaces!

it’s rampant in the inuit community in Alaska and Greenland

Question 10

what are the characteristics of HepB?

Answer 10

1. chronic sequelae; it’s the leading cause of hepatocellular carcinoma and cirrhosis worldwide
2. acute failure possible when you pick it up or later on
3. can be reactivated, especially in immunosuppressed patients; it’s a DNA virus!
4. vaccine available
5. incubation = 60-90 days; 45-180

acute fatality rate is 1%; chronic infection rate depends on age

premature mortality from chronic disease = 15-25%

Question 11

what are the lab results from HepB infection?

Answer 11

1. HBV PCR

2 .HBsAg

3. HBsAb
4. HBV core antibody
5. HBV e antigen
6. HBV e antibody

Question 12

how do you treat HepB?

Answer 12

1. acute = nothing; you’ll get over it, especially if you’re an adult
2. chronic = variety of oral agents like interferon and long-term treatment

can get cirrhosis and hepatocellular carcinoma

if someone is going to get immunosuppression treatment, treat them for HepB prophylaxis

Question 13

23 y/o male, history of IVDU, acute onset anorexia / jaundice. Most likely cause is what?

Answer 13

HepB (could also be HepA)

Question 14

50 y/o female undergoes chemo, develops jaundice post-treatment. Most likely cause is what?

Answer 14

it could be medications or metastatic disease

it’s probably HepB

Question 15

how do you get HepC?

Answer 15

percutaneous exposure; it’s really hard to get from normal contacts with other people

endemic in Egypt and argentina and russia but it’s not that endemic ; eventually it’s gonna go away

Question 16

what are the characteristics of HepC?

Answer 16

1. chronic sequelae is very common
2. cirrhosis; 20% of chronic patients are at risk for this
3. no vaccine
4. incubation is 6-7 weeks

fatality rate is low

Question 17

how do you treat HepC?

Answer 17

oral agents; there a ton of them!!!

there is no post-exposure prophylaxis!! so if you have needle stick with someone with HepC there’s nothing we can give you

Question 18

what are the lab tests in someone with HepB?

Answer 18

1. antibodies

2. PCR

Question 19

55 y/o male presents with elevated liver enzymes, no symptoms. Prior history of blood transfusion 1980. Most likely cause is what?

Answer 19

HepC

Question 20

what are the characteristics of HepD?

Answer 20

it’s a defective virus! it requires HepB to reproduce so you can’t get HepD without having HepB – you can get them at the same time or you can get HepD after having HepB

Question 21

how is HepE transmitted?

Answer 21

fecal-oral transmission

if you’re young you’re fine unless you’re pregnant…up to a 20% chance of death actually if you have it

it causes chronic disease in transplant patients specifically and it’s a problem in pig farmers in France….everyone else is fine weirdly

Question 22

what are the lab tests with HepE?

Answer 22

antibodies

Question 23

how do you treat HepE?

Answer 23

we can’t treat

you just get over it unless you’re pregnant which isn’t good

acute prognosis is good but chronic isn’t as good

Question 24

what other viruses can cause liver disease?

Answer 24

1. adenovirus
2. HSV in pregnancy
3. EBV
4. CMV

kinda uncommon unless it’s immunocompromised patients

Question 25

what kinds of liver accesses can you have?

Answer 25

1. intrahepatic; some pain
2. sub-diaphragmatic; lots of pain

can be caused by amebas but in the US it’s caused by diverticulitis

Question 26

what are the bacterial causes of liver abscesses?

Answer 26

1. biliary issues
2. diverticulae
3. hematogenous

Question 27

what are the amebic causes of liver abscesses?

Answer 27

1. entamoeba histolytica

2. diarrhea

Question 28

how do you diagnose a liver abscess?

Answer 28

1. symptoms
2. pulmonary symptoms
3. blood culutres
4. scan
5. aspiration

Question 29

how do you treat liver abscesses?

Answer 29

1. aspiration

2. antibiotics