L3: Acute and Chronic Hepatitis Flashcards
What are some diseases that will only cause chronic hepatitis?
- Autoimmune Hepatitis (AIH)
2. Wilson’s Disease
What is the inflammatory cell type of hepatitis?
Lymphocyte
What causes chronic liver damage but is not considered “chronic hepatitis”
alcohol-related liver disease
non-alcoholic fatty liver disease
chronic inflammatory biliary tract diseases (PBC, PSC)
hereditary haemocrhomatosis (HFE)
What are some causes of acute hepatitis?
- Viruses
2. Drugs
What are some viruses that may cause hepatitis?
HAV, HBV, HCV, HEV, EBV, CMV, Rubella, Yellow Fever Virus
What are some causes of chronic hepatitis?
- Viruses
- Drugs
- Auto-immune
- Wilson’s Disease
- Alpha-1-Antitrypsin Deficiency
What are some consequences of chronic hepatitis?
fibrosis - cirrhosis
risk of HCC
What does the core of a hepatitis B virus contain?
- hepatitis B core antigen
- e antigen
- HBV DNA
What is the main role/function of the e antigen in the HBV?
important for viral replication
What is the function of interferon on the immune response?
augments immune response
What is a good marker(s) for active replication and infectivity of hepatitis B?
HBV DNA* or HBeAg
What are the phases of a chronic HBV infection?
- Immune Tolerance
- Immune Clearance
- Inactive HBV Carrier
- Immune Escape = Reactivation of Chronic HBV Hepatitic
What may be some causes of reactivation of a hepatitis B infection?
- mutant strains develop
- immune suppression
Which hepatitis virus is most common in IVDUs?
Hepatitis D
Which genotype of hepatitis C is most common in the US?
Type 1a
Which genotype of hepatitis C is most common in Europe?
Type Ib
What does a polymorphism in the IFNL3/IL28B gene indicate?
predicts the response in type 1 hepatitis C
How long does acute hepatitis last for?
< 6 months
How long does chronic hepatitis last for?
> 6 months
List some of the symptoms and signs of ACUTE hepatitis
< 6 months
- often silent (more common in children)
- vague symptoms (nausea, anorexia, malaise)
- enlarged tender liver
- ± jaundice
What would be the blood test findings for someone with ACUTE hepatitis?
- high AST/ALT
- elevated bilirubin
- lengthened PT (a/w coagulation factors)
- NORMAL albumin
What is the characteristic histological finding of chronic hepatitis?
interface inflammation with piecemeal necrosis
aka interface necrosis
Viral hepatitis may also cause superinfections. List some possible combinations/pairings for a viral hepatitis superinfection
- Hep B + Hep D
2. Hep B ± Hep C ± HIV
What is the significance of the IgG Anti-HAV (antibody)?
gives lifelong immunity to Hepatitis A
What is the significance of the IgM Anti-HAV (antibody)?
indicates acute (recent) infection
If HBsAg is present, what would this indicate?
HBV infected - current infection
Can HBcAg be detected in blood?
No.
If anti-HBs (antibody) is present, what would this indicate?
- recovery from HBV infection
- or response to vaccination
If anti-HBc (antibody) is present, what would this indicate?
the person has been exposed to HBV at some point in their life
If IgM anti-HBc is present, what would this indicate?
recent/acute infection to HBV
If there is HBeAg present in the blood, what would this indicate?
- active viral (HBV) replication
- marker of infectivity
If there is anti-HBe (antibody) present in the blood, what would this indicate?
individual is now an inactive carrier of HBV
An ACUTE HBV infection mainly occurs in which age group?
Adults
A CHRONIC HBV infection mainly occurs in which age group?
Neonates/Children
What occurs in the 1st phase of an HBV chronic infection, the Immune Tolerance phase? What would the blood serology show?
- no immune response
- – therefore, unresponsive to treatments (no immune response to augment)
- reservoir of infection; highly infective
HBsAg +
HBeAg+
High Level Viral DNA
What occurs in the 2nd phase of an HBV chronic infection, the Immune Clearance phase? What would the blood serology show?
- occurs in HBV adult infection or if immune tolerance wanes
- viral replication occurs, but also have immune response and damage
HBsAg+
HBeAg+
elevated ALT
high viral DNA
also considered HBeAg+ Chronic HBV Hepatitis
Which phase of a chronic HBV infection may be considered “HBeAg+ Chronic HBV Hepatitis”?
2nd Phase - Replicative, Immune Clearance
What occurs in the 3rd phase of an HBV chronic infection, the Inactive HBV Carrier phase? What would the blood serology show?
- no/minimal viral replication
- inactive carrier state
- can be reactivated
HBsAg+
HBeAg-
anti-HBe+
What occurs in the 4th phase of an HBV chronic infection, the Reactivation phase? What would the blood serology show?
reactivation either due to:
a) Mutant Strains Develop
b) Immune Suppression
- viral replication resumes
HBsAg+
HBeAg- (most often)
variable viral DNA and ALT
also considered: HBeAg- Chronic HBV Hepatitis
Which phase of a chronic HBV infection may be considered “HBeAg- Chronic HBV Hepatitis”?
4th Phase - Reactivation
Those with cirrhosis, who are pregnant or have a chronic HBV infection may be given treatment for their HBV infection.
List 2 drugs that may be given to treat this condition.
- Pegylated Interferon-Alpha
2. Anti-Virals
How does a Hepatitis C acute or chronic infection present?
- silent
- or with vague symptoms (fatigue, arthralgia…)
If there is HCV RNA present, what would this represent?
current infection
If there is anti-HCV (antibody) present, what would this indicate?
- indicates exposure to HCV
- most with this have an ACTIVE CHRONIC infectin
it is NOT protective
What is the main treatment for a hepatitis C infection?
Direct-Acting Anti-Viral Agents (DAAs)
± Interferon
