ICL 10.3: Acute Hepatitis Flashcards
how do you know if someone has a HepB infection?
HepB patients lose their taste for cigarettes?
what are the symptoms of viral hepatitis?
they younger you are, the few symptoms you have
- fatigue
- jaundice
- anorexia
- RUQ pain
- pruritus
- dark urine / light stool
.
which viruses can cause acute hepatitis?
- HAV
- HBC
- HCV
- HDV
- HEV
- others
what is HepA? how is it transmitted?
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
is there a vaccine for HepA?
yes; everyone is recommended they get it now at 0 and 6 months
you can also give it for post-exposure prophylaxis
what are the characteristics of the HepA virus?
- incubation = 30 days but it can be 15-50 days
- no chronic seuqalae!!
- 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
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?
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….
23 y/o male with h/o IVDU presents with fatigue, anorexia, jaundice, encephalopathy. Most likely cause is what?
HepA
acute HepC isn’t common
how can you get HepB?
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
what are the characteristics of HepB?
- chronic sequelae; it’s the leading cause of hepatocellular carcinoma and cirrhosis worldwide
- acute failure possible when you pick it up or later on
- can be reactivated, especially in immunosuppressed patients; it’s a DNA virus!
- vaccine available
- incubation = 60-90 days; 45-180
acute fatality rate is 1%; chronic infection rate depends on age
premature mortality from chronic disease = 15-25%
what are the lab results from HepB infection?
- HBV PCR
2 .HBsAg
- HBsAb
- HBV core antibody
- HBV e antigen
- HBV e antibody
how do you treat HepB?
- acute = nothing; you’ll get over it, especially if you’re an adult
- 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
23 y/o male, history of IVDU, acute onset anorexia / jaundice. Most likely cause is what?
HepB (could also be HepA)
50 y/o female undergoes chemo, develops jaundice post-treatment. Most likely cause is what?
it could be medications or metastatic disease
it’s probably HepB
how do you get HepC?
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
what are the characteristics of HepC?
- chronic sequelae is very common
- cirrhosis; 20% of chronic patients are at risk for this
- no vaccine
- incubation is 6-7 weeks
fatality rate is low
how do you treat HepC?
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
what are the lab tests in someone with HepB?
- antibodies
2. PCR
55 y/o male presents with elevated liver enzymes, no symptoms. Prior history of blood transfusion 1980. Most likely cause is what?
HepC
what are the characteristics of HepD?
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
how is HepE transmitted?
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
what are the lab tests with HepE?
antibodies
how do you treat HepE?
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
what other viruses can cause liver disease?
- adenovirus
- HSV in pregnancy
- EBV
- CMV
kinda uncommon unless it’s immunocompromised patients
