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F3 E3 Shea > Liver 2 COPY > Flashcards

Liver 2 COPY 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
How do you prevent HBV
Hepatitis B vaccine | (universal infant immunization)
26
What should be given for postexposure prophylaxis for casual sexual partners of patients with HBV
Passive immunization- **Hepatitis B immune globin** followed by **HBV vaccine series**
27
What should be given to newborns of HBsAg-positive mothers
Hepatitis B immune globulin (HBIG) + HBV vaccine--\> given immediately after birth
28
All people with chronic HBV that are not immune to Hep A should be given what
Hep A vaccine
29
Patients with chronic HBV should be advised to avoid what due to it being an additional risk factor for the rapid progression to cirrhosis
avoid heavy alcohol use
30
T/F: someone with HBV can go straight to Hepatocellular carcinoma without going through end stage liver disease first
true
31
Most people with HBV are asymptomatic, however, some will present with what 4 complications
1. Cirrhosis 2. Hepatocellular carcinoma 3. Liver failure
32
HDV requires presence of what
HBV
33
What 3 instances would make you suspect HDV?
1. **Fulminant** HBV infection 2. Acute HBV that improves and then **relapses** 3. **Progressive** chronic HBV without active HBV replication
34
T/F: Acute HBV-HDV coinfection is usu. self limited
True
35
If you have a patient with chronic HBV who contracts actue HDV have what? This patient is at increased risk for what
superinfection Higher risk for cirrhosis
36
HDV infection: **_IgM_** Anti-HBc= coinfection or HDV superinfection
coinfection
37
**_IgG_** Anti-HBc= coinfection or HDV superinfection
HDV superinfection
38
How do you treat HDV?
High dose **interferon alpha** and **PEG IFN**
39
Which Hep C genotype is MC in US?
1
40
Chronic HCV: Local inflammation triggers what?
fibrogenesis
41
HCV--\> cirrhosis can be accelerated by what 2 external factors
1. Chronic alcohol consuption 2. Coincidental viral infections
42
How is Hep C transmitted?
by any **_percutaneous blood exposure_** | (MCly among **IV drug users**)
43
What are 3 strong risk factors for Hep C
1. **_IVDU_** 2. Blood transfusion before **1992** or clotting factor transfusion before **1987** **3. _HIV_**
44
USPSTF recommends screening for Hep C in which 2 groups
1. Groups at high risk for infection 2. Ppl born b/w 1945-1965
45
Clinical presentation of what? * Most asymptomatic * Prodromal and jaundice sxs * Majority will develop chronic infection
Hep C
46
Diagnosis of what? * + anti-HCV * HCV RNA
Acute HCV
47
The following lab findings are seen in what IL28B genotype CC IL28B Genotypes CT and TT
**_Self limited Hep C_** (genotype CC has more freq spontaneous resolution)
48
The definition of chronic infection with Hep C is defined as detection of ______ in the blood for at least _____ months
**_HCV RNA_** for at least **_6_** months
49
Although patients with chronic HCV are usually asymptomatic, they often present with features of what 3 conditions
1. chronic liver disease 2. decompensated cirrhosis 3. Hepatocellular carcinoma
50
What 5 factors influence the development of chronic/progressive liver disease in chronic Hep C
* **Older age** at time of infection * **Male** * Concurrent chronic Hep B * HIV infection * **High alcohol intake**
51
Why is obtaining the HCV quantitative test important to obtain? (3)
1. Establish baseline before initiating tx 2. Quantitative best way to confirm response to tx 3. Success of tx measured by logarithmic drop
52
What 2 vaccines should be given to a patient wth HCV
HAV and HBV
53
Why is it important to test for HCV genotype
determines the tx regimen that will be given
54
What is the purpose of ordering HCV qualitative vs quantitative?
_Qualitative_- detects low limits _Quantitative_- Good to establish baseline b4 tx and success of tx measured
55
What are the 4 main goals of antiviral tx for Hep C
1. Clear virus 2. Stabilization 3. Sx control 4. Prevent complications (cirrhosis, decomp liver dz, HCC)
56
Hep C treatment: If you have a patient who is already cirrhotic what is the goal of antiviral tx?
Clear virus prior to liver transplant
57
What is first line antiviral therapy for tx of Hep C
**_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
What is the MC route of transmission of Hep C
IVDU
59
What is the goal of Hep C treatment
eradicate viremia
60
What are 2 long term complications of Hep C
cirrhosis Hepatocellular carcinoma

F3 E3 Shea (24 decks)

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