Internal Medicine - Infectious Diseases - Hepatitis Flashcards
Acute hepatitis is most likely caused by what two etiologies?
Viral hepatitis A or B
What etiology of viral hepatitis is most commonly found as a “silent” infection instead of an acute infection?
Hepatitis C
Which hepatitis viruses are commonly transmitted through sex, blood, or perinatal (parenteral) modes?
Hepatitis B, C, and D
Which hepatitis viruses are commonly transmitted through food or water (enteric modes)?
Hepatitis A and E
What are the three signs to look for in laboratory testing with suspected acute hepatitis?
- Increased direct bilirubin.
- Increased ALT:AST ratio.
- Increased alkaline phosphatase.
Elevation of what lab value commonly seen in acute hepatitis is most indicative of increased mortality?
Prothrombin time; elevated PT increases risk of fulminant hepatic failure and death.
What is the best initial diagnostic test for diagnosing any of the hepatitis A, C, D, and E?
What is the best test to assess for recovery from previous hepatitis A, C, D, and E?
IgM antibody for acute infection
IgG antibody for resolution
What is the best test to track effect of treatment in hepatitis C infection (i.e. how can you tell if the treatment you’re giving is working)?
Hepatitis C PCR for RNA levels; also indicate treatment failure if they rise.
How will the following markers change during an acute or chronic hepatitis B infection?
HBsAg: surface antigen
HBeAg
HBcAb: core antibody
HBsAb: surface antibody
Positive
Positive
Positive IgM or IgG
Negative
How will the following markers change during a resolved, old, or past hepatitis B infection?
HBsAg: surface antigen
HBeAg
HBcAb: core antibody
HBsAb: surface antibody
Negative
Negative
Positive IgG
Positive
How will the following markers change when a person has been vaccinated against hepatitis B?
HBsAg: surface antigen
HBeAg
HBcAb: core antibody
HBsAb: surface antibody
Negative
Negative
Negative
Positive
How will the following markers change during a “window period” of an acute hepatitis B infection?
HBsAg: surface antigen
HBeAg
HBcAb: core antibody
HBsAb: surface antibody
Negative
Negative
Positive IgM, then IgG
Negative
Which serum marker is indication that an acute hepatitis B infection has completely resolved and that there is no longer a risk of transmitting the infection to others?
Surface antigen
Which serum marker is an indication of degree of active viral replication?
E-antigen; the patient with the worst disease (highest DNA polymerase activity, i.e. highest e-antigen levels) will benefit the most from antiviral treatment.
Which serum marker is the best indication of whether a pregnant woman will transmit the infection to her child?
E-antigen (answer option may also say “DNA polymerase”, which basically are the same thing–e-antigen is qualitative and DNA polymerase is quantitative).
Acute hepatitis caused by which hepatitis virus(es) is actively treated with antiviral medication (vs. just symptomatic/supportive treatment)?
What medications would you use for treatment?
Only acute hepatitis C gets medical therapy.
Interferon, ribavirin, and either boceprevir or telaprevir.
How is chronic hepatitis diagnosed?
By persistence of surface antigen for >6 months.
What surface marker do you look for when deciding whether a chronic hepatitis B infection requires treatment?
E-antigen
What is the treatment for chronic hepatitis B (if indicated)?
One of the following: entecavir, adefovir, lamivudine, telbivudine, interferon, or tenofovir.
Note: interferon is an injection and has the most adverse side effects, so it is not first choice.
What are the main side effects of interferon therapy?
- Arthralgia/myalgia
- Leukopenia/thrombocytopenia
- Depression
- Flu-like symptoms
What are the goals of therapy for chronic hepatitis in terms of serum markers?
- Reduce DNA polymerase (e-antigen) to undetectable levels.
2. Convert patients from expressing e-antigen to expressing anti-hepatitis e-antibody.
What finding on liver biopsy is indication for immediate treatment for patients with chronic hepatitis?
Fibrosis
If there is active viral replication, fibrosis WILL progress to cirrhosis.
Chronic hepatitis C infection is often silent. How do you determine whether chronic hepatitis C should be treated?
PCR-RNA viral load
What is the treatment for chronic hepatitis C infection?
Interferon + ribavirin + either boceprevir or telaprevir
What is the most common side effect of ribavirin treatment?
Anemia
What is the goal of treatment for chronic hepatitis C?
Achieve undetectable viral load.
