Lec 19 Hepatitis ABCs Flashcards
What types of hepatitis can become chronic?
Hep B, C, D
How do you diagnose viral hepatitis?
by serology –> liver biopsy does not distinguish between them
What signs/symptoms of viral hepatitis?
- fever
- jaundice
- high ALT/AST
How do you diagnose Hep A?
IgM anti-HAV during acute phase
usually positive w/in 2 weeks of symptom presentation
What is morphology of Hep A? [DNA/RNA, stranded]?
single stranded RNA
What family of virus if hep A?
picornavirus
What does IgG anti-HAV tell you?
tells you the patient previously had Hep A
How is hep A transmitted?
fecal-oral
How does hep A present?
mostly asymptomatic in adults; affects children more
What is treatment for Hep A?
usually self-limited
supportive treatment
What is prophyxlaxis for hep A?
inactivated/killed virus vaccine
What are 3 potential complications of Hep A?
- cholestatic hepatitis
- fulminant hepatic failure
- relapsing Hep A
Which hepatitis is most common cause of acute and chronic liver disease and hepatocellular carcinoma?
Hep B
What is morphology of Hep B [DNA/RNA, stranded]?
double stranded DNA virus
What is hepatitis E antigen?
marker of HBV replication and infectivity = envelope antigen
How long does it take from start of infection to symptom onset in HBV?
60-90 days
What does HBV DNA tell you?
quantitiative marker of replication
What does HBeAg tell you?
marker of Hep B viral replication and infectivity
What does HBsAg tell you? When is it detectable?
first detectable marker upon acute infection
precedes rise in AST/ALT and symptoms
undetectable 1-2 months after onset of jaundice
What does positive anti-HBs antibody tell you?
- received HBV vaccination OR cleared acute HBV infection
Which HBV markers are positive in acute HBV of the following: HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBs, anti-HBC-IgM, anti-HBC-IgG?
- HBsAg
- HBeAg
- anti-HBc IgM
Which HBV markers are positive in window period of the following: HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBs, anti-HBC-IgM, anti-HBC-IgG?
- anti-HBe
- anti-HBC IgM
Which HBV markers are positive in chronic inactive HBV of the following: HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBs, anti-HBC-IgM, anti-HBC-IgG?
- HBsAg
- anti-HBe
- anti-HBC IgG
Which HBV markers are positive after recovery of HBV of the following: HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBs, anti-HBC-IgM, anti-HBC-IgG?
- anti-HBs
- anti-HBe
- anti-HBC IgG
Which HBV markers are positive in an immunized patient of the following: HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBs, anti-HBC-IgM, anti-HBC-IgG?
anti-HBs only
Which HBV markers are positive in chronic active HBV of the following: HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBs, anti-HBC-IgM, anti-HBC-IgG?
- HBsAg
- HBeAg
- anti-HBC IgG
What defines chronic HBV?
persistent HBsAg
Is ALT or AST generally greater in viral hepatitis?
ALT > AST in viral hepatitis
What are escape mutants?
people who have loss of anti-HBs neutralizing activity
have possibility of acquiring infection despite having anti-HBs from vaccination
How is Hep B transmitted?
- perenteral –> blood transfusion, needle stick, IV drug use
- sexual
- maternal-fetal
What is the most common cause of chronic viral hepatitis in Asia and Africa?
Hepatitis B
How is HBV usually acquired in childhood? Symptomatic or subclinical in acute stage?
acquired perinatally or in preschool
infection = subclinical
How is HBV usually acquired in adulthood? Symptomatic or subclinical in acute stage?
acquired by sexual contact, injection drug use, or exposure to blood
infection = symptomatic
From Hep B how many people go on to get chronic infection? neonates vs adults?
neonates –> 90% become chronic
adults –> 90% clear the virus
How do you get HCC without cirrhosis in hep B?
HBV integrates into the host genome and can act as an oncogene
What tumor marker is commonly elevated in pts wtih HCC?
alpha fetoprotein
What is incubation period for Hep C?
1-2 months
What is most sensitive indicator of Hep C infection?
HCV RNA
WHat is most common genotype of hep C in the US?
genotype 1
What family of viruses does HBV belong to?
DNA hepadnavirus
What family of viruses does HCV belong to?
RNA flavivirus
What is the morphology of HCV [DNA/RNA, strandedness]?
positive strand RNA
Are HCV infections usually asymptomatic or symptomatic?
usually asymptomatic
What is the most common cause of chronic viral hepatitis in USA and europe?
Hep C
How is Hep C transmitted?
primarily blood, sexual transmission, perinatal, injection drug use
What percentage of people with hep C go on to chronic disease?
50-70%
What is the best indicator of HCV treatment response?
sustained viral response at > 6 months after end of treatment
What is treatment for HCV [3 drugs together]?
combo protease inhibitor + pegylated interferon + ribavirin
When do you begin to detect HCV antibody?
detected at 1-3 months after acute infection
What is morphology of hepatitis D [DNA/RNA, stranded]?
single stranded RNA virus
What family of virus is hep D?
delta virus
Who gets hep D?
only in people that are infected with HBV –> required HBV for replication and expression
What is hep D superinfection?
acute hep D in presence of chronic Hep B
How do you diagnose hep D?
IgM anti-HDV
How is Hep D transmitted?
parenteral, sexual
Where is hep D endemic?
mediterranean, middle east, south america, africa
What is treatment for Hep D?
interferon
What is incubation period for hep E?
short = 1 month
How is hep E transmitted?
fecal oral
How do you diagnose Hep E virus?
anti-HEV IgM
Who is at risk for serious complications with hep E?
pregnant women –> can lead to fulminant hepatitis and death
