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D&T 4, Exam 3 (Liver) > Limjoco - Hepatitis > Flashcards

Limjoco - Hepatitis Flashcards

1
Q

Hepatotropic viruses (A, B, C, D, E, G) have an affinity for the liver.

Name 5 other viruses (systemic) that can cause Viral Hepatitis?

A
  1. EBV (infectious mononucleosis)
  2. CMV
  3. HSV
  4. Adenovirus (neonates, immunosuppressed)
  5. Yellow Fever
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2
Q

Mnemonics for Viral Hepatitis

AcutE Hepatitis: A and E (never chronic)
*Note: HEV is bad in immunocompromised hosts, pregnant women

Consonants B, C, D: can cause Chronic Disease

Hepatitis B can be transmitted by Blood, Birthing and Bonking.

A
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3
Q

Which Hepatitis?

80% or more develop chronic hepatitis and 20% of these people develop cirrhosis

A

Hep C (Chronic and Cirrhosis)

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4
Q

Typical Course for What Condition?

Incubation period: asymptomatic

Symptomatic Pre-icteric period: malaise, fatigue, anorexia, nausea, fever
*2 weeks post-exposure

A

Acute Viral Hepatitis

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5
Q

Typical Course for What Condition?

Icteric Phase (1-2 weeks after prodrome, last up to 6 weeks)

jaundice, dark urine, clay-colored stools, hepatomegaly

Convalescence (6-8 weeks post-exposure): dinminishing jaundice

A

Acute Hepatitis

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6
Q

When is an individual with Viral Hepatitis most infectious?

A

Last asymptomatic days of Incubation Period

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7
Q

What do lab results look like for Viral Hepatitis?

  1. Liver Enzymes?
  2. ________bilirubinemia (hyper/hypo)
  3. Viral Serology; also RNA or DNA detection by PCR
A

High Levels of ALT, AST (>1000 U/L)

Hyperbilirubinemia

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8
Q

After how many months of infection, do you have chronic hepatitis?

A

6 months

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9
Q

Definition (Viral Hepatitis).

  • harbors orgs without signs & symptoms
  • either no liver damage or with liver damage –> reservoirs for future infection
A

Carrier State

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10
Q

During a Viral Hepatitis Infection, hepatocellular damage is due to the host’s ________ immune response to viral protein expressed by infected cells.

It is not due to direct viral cytopathic effect.

What immune cells are activated and what damage ensues?

A

adaptive

T Cells

  • ->Necroinflammatory activity
  • ->Apoptosis (“cell suicide” - elimination of infected/damaged cell)
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11
Q

Which Hepatitis?

  • Family: Picornavirus
  • Genus: Hepatovirus
  • Small, naked +SS RNA
  • Benign, self-limited course, rare relapse
  • NO chronic or carrier state
  • history of travel to endemic areas*
A

Hep A

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12
Q

Which Hepatitis?

  • fecal-oral route
  • ingested through contaminated water and food
  • contaminated undercooked shellfish concentrates virus
  • endemic in countries with poor sanitation
  • in developed countries, better hygience but NO herd immunity
  • older age group will be more symptomatic an severe
A

Hepatitis A

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13
Q

Serology for Hepatitis A.

_____ (what Ab): rises with onset of symptoms; marker of ACUTE infection

_____ (what Ab): rises on decline of IgM after months, persists
confers LIFELONG IMMUNITY AGAINST REINFECTIONS WITH
ALL STRAINS

NOTE: there is no direct detection for IgG. It is derived from [Total Ig - IgM]

A

IgM

IgG

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14
Q

Total Anti-HAV Antibody = Ig____ + Ig_____

A

IgM + IgG

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15
Q

How is HAV spread rapidly?

Fecal shedding of HAV Virus occurs _____ weeks before and ____ week after the start of jaundice.

A

2-3 weeks before

1 week after

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16
Q

Which Hepatitis?

  • more sporadic than HAV
  • **India, Asia, Africa, ME, China, mexico
  • Developed world: pig farms
  • High mortality rate in Pregnant Women
A

Hep E

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17
Q

Which Hepatitis?

Genus: Hepevirus

  • naked +SS RNA
  • virions shed during acute illness
  • RNA and Virions detectable in stool/serum prior to symptoms appearing

CLINICAL: Inc. AST/ALT
Inc. IgM

-self-limited, resolves in 4-6 weeks

A

Hep E

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18
Q

Which Hepatitis?

Family: Flavivirus

  • small +SS RNA virus
  • RNA codes only for 1 polyprotein, processed into functional proteins
  • RNA polymerase, poor fidelity in copying (Antigenic variation)
A

Hep C

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19
Q

Hepatitis C

_____ envelope glycoprotein (target of anti-HCV antibodies) is the MOST VARIABLE region of the genome.

New virus strains can escape neutralizing antibodies.

A

E2

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20
Q

Why no vaccine for Hep C?

Anti-HCV Ig____ produced after infection does NOT confer immunity –> HIGH RATE OF CHRONICITY

A

genomic instability, antigenic variation (Exonuclease lacks proofreading capacity in the 3’-5’ so the RNA is prone to frequent mutations)

IgG

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21
Q

What are the top 3 Risk factors for contracting Hep C?

A
  1. IV Drug use
  2. Multiple sex partners
  3. Undergoing surgery in the last 6 months

Others: Needle Sticks, Multiple contacts w/HCV-infected person, Work in medical/dental field, perinatal infections

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22
Q

True or False.

There is a higher risk for HCV than HIV by needle stick.

A

True!

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23
Q

Which Hepatitis?

Incubation period: 4-26 weeks (1-6 months)

Majority Asymptomatic

Best Diagnostic method: PCR to detect RNA in blood together with elevated AST, ALT levels

-milder clinical course than HBV

A

Hep C

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24
Q

Fact. Hepatitis C - Acute and Chronic Infection Serum HCV RNA Levels

A
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25
Q

Hepatitis C

  • majority develop chronic hepatitis –> up to 20% develop __________.
  • despite Ab production, HCV _____ remains in the blood
  • _____________ remain elevated (inc or dec but never normalize)
  • *Need close follow-up*
A

cirrhosis

RNA

Transaminases

26
Q

FACT: Drugs for Hep C

Pegylated INF-alpha, Ribavirin

Newer Drugs with Better Response: ABT-450
Ombitavir
Dasabuvir (+/- Ribavirin)

Response Depends on:
HCV Genotype: 2,3 best response
Host Genotype: IL28B gene (encodes IF-lambda)

27
Q

____________ is the primary reason for liver transplantation.

A

HCV-related Cirrhosis

28
Q

True or False.

HCV infection recurs in transplants.

Cirrhosis recurs in 20-30% of transplants.

29
Q

Which Hepatitis?

-Family: Hepadnavirus

-Circular, Double-Shelled (enveloped)

-partially DS DNA virus

-resistant to extreme temps/humidity

-it’s own Polymerase Complex (Reverse transcriptase, DNA polymerase)
so replication DNA –> RNA –> DNA

30
Q

Name the Antigen for Hepatitis B Virus (HBV)

Nucleocapsid CORE: ______

Envelope Glycoprotein: _______

Lipid envelope glycoproteins (surface): __________

A

HBcAg

HBeAg

HBsAg

31
Q

What is the name of the particle that is the complete virion for Hepatitis B and is infectious?

A

Dane Particle

32
Q

What antigen of the Hepatitis B Virus aggregates to form subviral particles that are non-infectious small spheres and filaments?

33
Q

What Serological markers are present during the Acute Stage of Hep B Infection?

A

HBsAg

HBeAG

HBV DNA

HBcAB: IgM

34
Q

IgM is replaced by ______ anti-HGcAb after several months of Hep B Infection.

35
Q

What Serological markers are present during the Chronic Stage of Hepatitis B Infection?

A

HBsAg

HBeAg

HBV DNA

HBcAb: IgG

36
Q

Summary of Hepatitis B Antigens and Antibodies.

37
Q

Modes of Tranmission for Hepatitis B?

  1. ____________: high prevalence regions
  2. ____________: intermediate prevalence regions
  3. ____________: low prevalence regions
A
  1. Childbirth/vertical
  2. Horizontal
  3. Sexual/IV Drug
38
Q

Fact: Potentital Outcomes of Hep B Infection

39
Q

Fact: Hepatitis B

  • Most Self-Limited
  • Small % may progress to cirrhosis and/or develop HCC
  • AGE at time of infection predicts chronicity
  • -> Younger: more likely becomes chronic
  • -> Vertical Transmission (mom-to-baby)
40
Q

Why is it hard to achieve complete cure in chronic cases of Hepatitis B?

A

Virus inserts itself in to the host DNA. Thus, host cannot mount effective response via production of HBsAb and virus persists.

41
Q

What is the treatment for Hepatitis B?

A

Slow down progress of disease and Limit damage to liver (prevent cirrhosis or HCC).

42
Q

The outcome of Hepatitis B Infection depends on Host Immune Response.

Early Stage: ______________ (natural killer T cells, interferon) protects the individual

If CD4+ and CD8+ produce INF-y, etc. and clear infected cells –> _____________ (result?)

If weak immune response, some infected cells not killed/cleared –> ____________ (result?)

A

Innate Immune Response

resolution

chronicity

43
Q

What antigen of the Hep B virus is incorporated in to the HDV envelope, needed for assembly of HDV virion.

44
Q

Which Hepatitis?

  • very small molecule
  • Circular, -RNA, enveloped
  • uses host’s RNA polymerase to replicate through RNA-directed RNA synthesis
  • delta antigen (HDAg) protein produced by virus
45
Q

Hepatitis D

Absolute requirement for ________ (which hepatitis?) for replication –> needs HBsAg in envelope.

Delta agent, defective virus, is directly cytopathic to cells.

46
Q

Self-limited infection for Hep B & D EXCEPT FOR ___________ –> leads to acute liver failure.

A

IV Drug abusers

47
Q

Two possible scenarios of Infection by Hepatitis D Virus

  1. ____________: simulataneous infection with HBV, HDV –> Acute, self-limited; rarely chronic
  2. ____________: when HBV carrier gets HDV 30-50 days later –> Severe acute hepatitis. Worsens the Hep B Infection (likely bc of direct viral toxicity of HDV)
A
  1. Coinfection
  2. Superinfection
48
Q

Fact: Histopathologic changes in hepatitis are essentially similar in all viral, autoimmune and drug-induced hepatitides.

49
Q

Fact: Liver Biopsy - Why Do It?

  • Confirm the clinical diagnosis
  • Exclude simultaneous conditions
  • Grade extent of inflammation and injury
  • Stage the degree of fibrosis
  • Monitor treatment effectiveness
50
Q

Interpret the Lab Results:

HBsAg: negative

anti-HBc: negative

anti-HBs: negative

A

Susceptible (no protective immunity exists - HBsAB: IgG)

51
Q

Interpret the Lab Results:

HBsAg: negative

anti-HBc: positive

anti-HBs: positive

A

Immune due to natural infection (protective IgG - HBsAB)

52
Q

Interpret the Lab Results:

HBsAg: negative

anti-HBc: negative

anti-HBs: positive

A

Immune due to Hep B Vaccination (no antibodies against the core antigen, only antibodies against surface antigen - protective IgG)

53
Q

Interpret the Lab Results:

HBsAg: positive

anti-HBc: positive

IgM anti-HBc: positive

anti-HBs: negative

A

Acutely Infected (no IgG antibody - HBsAg)

54
Q

Interpret the Lab Results:

HBsAg: positive

anti-HBc: positive

IgM anti-HBc: negative

anti-HBs: negative

A

Chronically Infected (HBcAB = IgG)

55
Q

Interpret the Lab Results:

HBsAg: negative

anti-HBc: positive

anti-HBs: negative

A

Interpretation unclear; 4 possibilities:

  1. Resolved infection (MOST COMMON)
  2. False-positive anti-HBc; thus susceptible
  3. “Low level” chronic infection
  4. Resolving acute infection
56
Q

What do you see?

A

Spotty/Lytic Necrosis

57
Q

What do you see?

A

Interface hepatitis (AKA “piecemeal necrosis” in older literature)

58
Q

What do you see?

A

Hallmark of Hepatitis B-infected cells: “ground-glass” cells

Large cells with pale, finely granular cytoplasm with peripheral halo = surface antigens in endoplasmic reticulum

59
Q

What do you see?

A

Inflamed portal tract (bile ductule at arrow) with lymphoid follicle = typical of Hepatitis C infection

60
Q

What do you see?

A

See picture.

61
Q

What do you see?

A

Systemic infection with herpes simplex virus (HSV)

(non-hepatotropic virus): infected hepatocytes with Cowdry bodies

Apoptotic or acidophil bodies seen in various hepatitides

D&T 4, Exam 3 (Liver) (19 decks)

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