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GK F3 E3 > Liver 2 > Flashcards

Liver 2 Flashcards

1
Q

HBV is transmitted via what 2 routes?

A

percutaneous and permucosal routes

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2
Q

T/F: Hep B can be a sexually transmitted disease

A

true

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3
Q

When is self-limited HBV infection MC? What patient population is most likely to have HBV result in chronic infection/

A

Self limited MC in adults

Chronic infection: perinatally, early childhood

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4
Q

What are the 2 areas where Hep B is of high prevalence

A

West Africa

South Sudan

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5
Q

There is an increased frequency of liver failure caused by HEV when?

A

3rd trimester of pregnancy

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6
Q

What serves as a marker for active replication of HBV?

A

HBeAg

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7
Q

A majority of neonates infected with HBV become what?

A

asymptomatic chronic HBV carriers

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8
Q

HBV infection in adults or children?

70% are asymptomatic and self- limited

A

Adults

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9
Q

Primary infections with HBV in children or adults?

30% may have symptomatic icteric hepatitis

A

Adults

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10
Q

Which 2 patient populations are at high risk for developing cirrhosis from chronic HBV?

A
  • elderly
  • Patients coinfected w/ HCV, HDV or HIV
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11
Q

Pathophys of HBV:

Most of the liver injury occurs due to what?

A

host immune response to HBV, a cell-mediated response against HBcAg

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12
Q

What are the 8 strong risk factors for Hepatitis B?

A
  1. Perinatal exposure- HBV infected mother

2. Multiple sexual partners

3. MSM

4. IVDU

5. Asian

  1. FHx of HVB/chronic liver dz
  2. FHx Hepatocellular carcinoma
  3. Household contact w/ HBV
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13
Q

Why is diagnosis of HBV often difficult

A
  • 70% of patients with acute HBV are asymptomatic w/ normal physical exam
  • Need an elevated clinical suspicion w/ at risk individuals
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14
Q

70% of pts w/ acute HBV are asymptomatic, but if they do have sxs what are they?

A
  • Insidious onset of prodromal sxs
  • Serum sickness like syndrom in 10%- F/chills, malaise, maculopapular/urticarial rash, NV, arthralgias
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15
Q

Is HEV abrupt or insidious onset of prodromal sxs?

A

abrupt

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16
Q

What will you see on labs in HBV infection

A
  • Positive HBsAg
  • Positive HBeAg
  • HBV DNA
  • Elevated ALT (450ish)
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17
Q

What 2 laboratory findings are seen to make an acute diagnosis of HBV (2wks to 6mo after exposure)

A

HBsAg and IgM Anti-HBc

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18
Q

What do the following laboratory findings suggest?

  • Normal ALT
  • No HBV DNA
  • Seroconversion of HBeAg to Anti-HBe
  • Seroconversion of HBsAG to Anti-HBs
  • IgM to IgG Anti-HBc
A

Resolution of acute HBV

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19
Q

The following lab results indicates what?

  • Anti-HBs
  • IgG Anti-HBc
  • Anti-HBe
A

Prior HBV infection

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20
Q

The following lab results indicate what?

  • HBsAg >6mo
  • Persistence of HBeAg
  • Persistence of HBV DNA
A

Chronic HBV

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21
Q

What are the treatment options for Acute HBV? Fulminant HBV?

A

Acute= self limiting- supportive care

Fulminant= liver transplant

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22
Q

Why is it important to obtain a liver biopsy in a patient with chronic HBV

A

Helps determine if you treat or observe

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23
Q

How do you treat Chronic HBV (2 options)

A

antiviral therapy:

  • Peginterferon
  • OR
  • Nucleoside analogues- Entecavir and Tenofovir
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24
Q

What is the goal of treatment for chronic HBV

A

primary- sustained low or undetectable HBV DNA

Secondary- Seroconvert HBeAg and HBsAg and normalize ALT

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25
Q

How do you prevent HBV

A

Hepatitis B vaccine

(universal infant immunization)

26
Q

What should be given for postexposure prophylaxis for casual sexual partners of patients with HBV

A

Passive immunization- Hepatitis B immune globin

followed by HBV vaccine series

27
Q

What should be given to newborns of HBsAg-positive mothers

A

Hepatitis B immune globulin (HBIG) + HBV vaccine–> given immediately after birth

28
Q

All people with chronic HBV that are not immune to Hep A should be given what

A

Hep A vaccine

29
Q

Patients with chronic HBV should be advised to avoid what due to it being an additional risk factor for the rapid progression to cirrhosis

A

avoid heavy alcohol use

30
Q

T/F: someone with HBV can go straight to Hepatocellular carcinoma without going through end stage liver disease first

A

true

31
Q

Most people with HBV are asymptomatic, however, some will present with what 4 complications

A
  1. Cirrhosis
  2. Hepatocellular carcinoma
  3. Liver failure
32
Q

HDV requires presence of what

A

HBV

33
Q

What 3 instances would make you suspect HDV?

A
  1. Fulminant HBV infection
  2. Acute HBV that improves and then relapses
  3. Progressive chronic HBV without active HBV replication
34
Q

T/F: Acute HBV-HDV coinfection is usu. self limited

A

True

35
Q

If you have a patient with chronic HBV who contracts actue HDV have what? This patient is at increased risk for what

A

superinfection

Higher risk for cirrhosis

36
Q

HDV infection:

IgM Anti-HBc= coinfection or HDV superinfection

A

coinfection

37
Q

IgG Anti-HBc= coinfection or HDV superinfection

A

HDV superinfection

38
Q

How do you treat HDV?

A

High dose interferon alpha and PEG IFN

39
Q

Which Hep C genotype is MC in US?

A

1

40
Q

Chronic HCV:

Local inflammation triggers what?

A

fibrogenesis

41
Q

HCV–> cirrhosis can be accelerated by what 2 external factors

A
  1. Chronic alcohol consuption
  2. Coincidental viral infections
42
Q

How is Hep C transmitted?

A

by any percutaneous blood exposure

(MCly among IV drug users)

43
Q

What are 3 strong risk factors for Hep C

A
  1. IVDU
  2. Blood transfusion before 1992 or clotting factor transfusion before 1987

3. HIV

44
Q

USPSTF recommends screening for Hep C in which 2 groups

A
  1. Groups at high risk for infection
  2. Ppl born b/w 1945-1965
45
Q

Clinical presentation of what?

  • Most asymptomatic
  • Prodromal and jaundice sxs
  • Majority will develop chronic infection
A

Hep C

46
Q

Diagnosis of what?

    • anti-HCV
  • HCV RNA
A

Acute HCV

47
Q

The following lab findings are seen in what

IL28B genotype CC

IL28B Genotypes CT and TT

A

Self limited Hep C

(genotype CC has more freq spontaneous resolution)

48
Q

The definition of chronic infection with Hep C is defined as detection of ______ in the blood for at least _____ months

A

HCV RNA for at least 6 months

49
Q

Although patients with chronic HCV are usually asymptomatic, they often present with features of what 3 conditions

A
  1. chronic liver disease
  2. decompensated cirrhosis
  3. Hepatocellular carcinoma
50
Q

What 5 factors influence the development of chronic/progressive liver disease in chronic Hep C

A
  • Older age at time of infection
  • Male
  • Concurrent chronic Hep B
  • HIV infection
  • High alcohol intake
51
Q

Why is obtaining the HCV quantitative test important to obtain? (3)

A
  1. Establish baseline before initiating tx
  2. Quantitative best way to confirm response to tx
  3. Success of tx measured by logarithmic drop
52
Q

What 2 vaccines should be given to a patient wth HCV

A

HAV and HBV

53
Q

Why is it important to test for HCV genotype

A

determines the tx regimen that will be given

54
Q

What is the purpose of ordering HCV qualitative vs quantitative?

A

Qualitative- detects low limits

Quantitative- Good to establish baseline b4 tx and success of tx measured

55
Q

What are the 4 main goals of antiviral tx for Hep C

A
  1. Clear virus
  2. Stabilization
  3. Sx control
  4. Prevent complications (cirrhosis, decomp liver dz, HCC)
56
Q

Hep C treatment:

If you have a patient who is already cirrhotic what is the goal of antiviral tx?

A

Clear virus prior to liver transplant

57
Q

What is first line antiviral therapy for tx of Hep C

A

Direct-acting antivirals (prevent HCV from replicating):

  1. NS3-4 protease inhibitors (-previr)–> genotype 1&4
  2. NS5B polymerase inhibitors (-buvir)–> all genotypes
  3. NS5A replication complex inhibitors (-Tasvir)–> genotypes 1&4
58
Q

What is the MC route of transmission of Hep C

A

IVDU

59
Q

What is the goal of Hep C treatment

A

eradicate viremia

60
Q

What are 2 long term complications of Hep C

A

cirrhosis

Hepatocellular carcinoma

GK F3 E3 (24 decks)

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