Lecture 20: Viral Hepatitis

Question 1

T/F: Any hepatitis virus can cause viral hepatitis

Answer 1

True

Question 2

Common symptoms of acute vial hepatitis; typical course and bad course?

Answer 2

Malaise, N, abdominal discomfort, jaundice; recovery is usual but fulminant course w/ liver failure is possible

Question 3

Which viral hepatitis cause chronic? Potential complications (2)?

Answer 3

B, C, D; cirrhosis/hepatocellular carcinoma

Question 4

Dx of hepatitis based on ________ evaluation

Answer 4

Serological

Question 5

Hepatitis A: incubation period, infectivity, dx

Answer 5

4 weeks, infectivity decreases w/ jaundice, IgM anti-HAV during acute and IgG anti-HAV during chronic

Question 6

How do you acquire Hep A? Where is it common?

Answer 6

Contact with contaminated feces, contaminated food; common in developing countries

Question 7

Hep A: management

Answer 7

Self-limited, supportive therapy, more serious in older patients, do not require antivirals

Question 8

Three potential complications of Hep A

Answer 8

Relapsing hepatitis, cholestatic hepatitis, fulminant hepatic failure

Question 9

Hep A: prophylaxis

Answer 9

Active immunization for those who may be exposed

Question 10

Hep B: incubation period, type of virus, what’s the only “proof” of active replication?

Answer 10

2-3 months, DNA virus, level of Hep B DNA

Question 11

Hep B: antibodies

Answer 11

Three antibodies tested: anti-HBs (vaccination), anti-HBc IgM (acute) anti-HBc IgG (chronic), anti-HBe (infectivity)

Question 12

How do kids get Hep B? Symptomatic?

Answer 12

Preinatal, preschool, subclinical infection

Question 13

How do adults get Hep B? Symptomatic?

Answer 13

Sexual, injection, blood exposure, symptomatic infection

Question 14

Chronically Hep B infected individuals do not have this Ab, but they often have this antigen (while recovered do not). How many people go on to chronic infection (%)? Complications?

Answer 14

HBsAb; HBeAg; 10% –> hepatocellular carcinoma and cirrhosis

Question 15

Hep B: prophylaxis

Answer 15

Active immunization; + HBIG if exposed (in previously unexposed), boost if immunocompromised

Question 16

Chronic Hep B: clinical features (+ extrahepatic, and end-stage)

Answer 16

Fatigue, high ALT; extra-hepatic: arthralgias, glomerulonephritis, vasculitis; end stage: jaundice, hypoalbuminemia, coagulopathy, AST

Question 17

Chronic Hep B: agents (capitalize the ones currently used)

Answer 17

Lamivudine, adefovir, ENTECAVIR, Peg-IFN, telbivudine, TENOFOVIR +/- emtricitabine

Question 18

Hep C: incubation, most sensitive indicator, how do people get it? Antibody?

Answer 18

1-2 months, HCV RNA, mainly acquire by percutaneous route; antibody is always present after infection but DOES NOT MEAN CHRONIC INFECTION

Question 19

Why don’t we have a Hep C vaccine?

Answer 19

High error-prone rate = quasispecies

Question 20

What is the most common cause of chronic viral hepatitis in the US and Europe? How many people in US are chronically infected? % that become chronic?

Answer 20

Hep C; 3 million; up to 80%

Question 21

Chronic Hep C: Clinical Features

Answer 21

Similar to Hep B with more extrahepatic manifestations

Question 22

Chronic Hep C: tx

Answer 22

Interferon monotherapy, protease inhibitor, ribavirin, NOW: ombitasvir/ritonvavir

Question 23

Hepatitis D: incubation, requirement, antibody

Answer 23

2-3 months; requires HBV for replication (co-inecton or superinfection), IgM anti-HDV (acute)

Question 24

Hepatitis E: incubation, antibody, transmission, risk group

Answer 24

1 month, IgM anti-HEV (acute), fecal-oral, pregnant women are at risk for fulminant hepatitis

Question 25

Hep E looks like…Can it cause chronic liver disease?

Answer 25

Hep A; yes, in certain populations