Lecture 20: Viral Hepatitis Flashcards
T/F: Any hepatitis virus can cause viral hepatitis
True
Common symptoms of acute vial hepatitis; typical course and bad course?
Malaise, N, abdominal discomfort, jaundice; recovery is usual but fulminant course w/ liver failure is possible
Which viral hepatitis cause chronic? Potential complications (2)?
B, C, D; cirrhosis/hepatocellular carcinoma
Dx of hepatitis based on ________ evaluation
Serological
Hepatitis A: incubation period, infectivity, dx
4 weeks, infectivity decreases w/ jaundice, IgM anti-HAV during acute and IgG anti-HAV during chronic
How do you acquire Hep A? Where is it common?
Contact with contaminated feces, contaminated food; common in developing countries
Hep A: management
Self-limited, supportive therapy, more serious in older patients, do not require antivirals
Three potential complications of Hep A
Relapsing hepatitis, cholestatic hepatitis, fulminant hepatic failure
Hep A: prophylaxis
Active immunization for those who may be exposed
Hep B: incubation period, type of virus, what’s the only “proof” of active replication?
2-3 months, DNA virus, level of Hep B DNA
Hep B: antibodies
Three antibodies tested: anti-HBs (vaccination), anti-HBc IgM (acute) anti-HBc IgG (chronic), anti-HBe (infectivity)
How do kids get Hep B? Symptomatic?
Preinatal, preschool, subclinical infection
How do adults get Hep B? Symptomatic?
Sexual, injection, blood exposure, symptomatic infection
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?
HBsAb; HBeAg; 10% –> hepatocellular carcinoma and cirrhosis
Hep B: prophylaxis
Active immunization; + HBIG if exposed (in previously unexposed), boost if immunocompromised
Chronic Hep B: clinical features (+ extrahepatic, and end-stage)
Fatigue, high ALT; extra-hepatic: arthralgias, glomerulonephritis, vasculitis; end stage: jaundice, hypoalbuminemia, coagulopathy, AST
Chronic Hep B: agents (capitalize the ones currently used)
Lamivudine, adefovir, ENTECAVIR, Peg-IFN, telbivudine, TENOFOVIR +/- emtricitabine
Hep C: incubation, most sensitive indicator, how do people get it? Antibody?
1-2 months, HCV RNA, mainly acquire by percutaneous route; antibody is always present after infection but DOES NOT MEAN CHRONIC INFECTION
Why don’t we have a Hep C vaccine?
High error-prone rate = quasispecies
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?
Hep C; 3 million; up to 80%
Chronic Hep C: Clinical Features
Similar to Hep B with more extrahepatic manifestations
Chronic Hep C: tx
Interferon monotherapy, protease inhibitor, ribavirin, NOW: ombitasvir/ritonvavir
Hepatitis D: incubation, requirement, antibody
2-3 months; requires HBV for replication (co-inecton or superinfection), IgM anti-HDV (acute)
Hepatitis E: incubation, antibody, transmission, risk group
1 month, IgM anti-HEV (acute), fecal-oral, pregnant women are at risk for fulminant hepatitis
Hep E looks like…Can it cause chronic liver disease?
Hep A; yes, in certain populations
