Liver Flashcards
Inflammation of the liver parenchyma
Acute Viral Hepatitis
Caused by many viruses
Cytomegalovirus, Epstein-Barr
Acute Viral Hepatitis
Hepatitis A Hepatitis B Hepatitis C Hepatitis D (Delta) Hepatitis E are \_\_\_\_\_\_\_ hep
viral
RNA virus spread by fecal-oral route
Also called enteric hepatitis
Hepatitis A (HAV)
2- to 7-week incubation period
Hepatitis A (HAV)
Prodromal period of _______ includes
Jaundice, RUQ pain. malaise, anorexia, nausea, low-grade fever, children may not experience jaundice
Hepatitis A (HAV)
Followed by jaundice lasting approx 2 weeks
Self-limited course
Hepatitis A (HAV)
Prevention Careful hand washing Segregation Cleaning of laundry and personal items Immunization and γ-globulin
Hepatitis A (HAV)
Treatment includes:
Supportive (rest, nutritious diet)
Avoid ETOH, acetaminophen, hepatotoxins
Hepatitis A (HAV)
Serologic testing for _____ includes
Anti-HAV IgG (____ infection)
IgM (____infection)
Hepatitis A (HAV); previous; acute
Partially double-stranded DNA virus
Spread by parenteral contact with infected blood or blood products
Includes contaminated needles and sexual contact
Hepatitis B (HBV)
Also called serum hepatitis
300 million (5%) of world population have chronic infection
1 to 1.25 million in United States
Hepatitis B (HBV)
Risk factors
Perinatal, health care settings (3%); transfusions and dialysis (1%); acupuncture, tattooing, extended overseas travel, residence in an institution
Hepatitis B (HBV)
Incubation period of 2 to 6 months
Hepatitis B (HBV)
Prodromal period
Asymptomatic or rashes, arthralgia, arthritis, angioedema, serum sickness, glomerulonephritis, jaundice (lasting 2 weeks on average)
Hepatitis B (HBV)
Treatment
Persons with detectable virus and HBeAg positive readily transmit virus to their contacts, and should be counseled
Hepatitis B (HBV)
Most nonfulminant infections resolve spontaneously
About 5% progress to chronic infection
Hepatitis B (HBV)
Liver transplant treatment for
Hepatitis B (HBV)
Surface antigen (HBsAg)
early/active and chronic infection in Hepatitis B (HBV)
Surface antibody (HbsAb)
resolution and immunity in Hepatitis B (HBV)
Core antigen (HBcAg)
appears first in active infection in Hepatitis B (HBV)
Core antibody (HBcAb)
seroconversion in Hepatitis B (HBV)
Hepatitis B e antigen (HBeAg):
viral replication and infectivity n Hepatitis B (HBV)
Interferon-alpha
24 to 48 weeks of therapy
Response rate of 33%
treatment for ______
Hepatitis B (HBV)
Lamivudine, Telbivudine
Adefovir, Tenofovir
treatment for _____
Hepatitis B (HBV)
Entecavir (treatment of choice)
Response rate of 67%
Extremely expensive
treatment for ______
Hepatitis B (HBV)
Immunizations for _____
Doses given at 0, 1, and 6 months
95% response rate
Recommended as part of the childhood vaccination regimen and for high-risk individuals, and after exposure
Hep B (HBV)
Prevention of _______
Administration of HBIG postinoculation
Hep B (HBV)
Contains high levels of hepatitis B surface antibody
Given within 7 days of exposure
HBIG postinoculation
Neonates born to HBsAg-positive mothers
Prophylaxis after needlestick or sexual exposure in nonimmune persons
After liver transplantation in patients who are HBsAg+ prior to transplantation
indications of exposure to ________
Hep B (HBV)
Single-stranded RNA virus (Flavivirus)
Spread through IV drug use or blood transfusions prior to 1990
Hepatitis C (HCV)
Also called non-A, non-B hepatitis
3% worldwide infected
Hepatitis C (HCV)
Have 6 types
Hepatitis C (HCV)
most common in the United States but has a lower response rate to treatment
Type 1 HCV
common in N. America
Type 2-3 HCV
common overseas
Types 4-6 HCV
Usually asymptomatic
Course is erratic with wide fluctuations on liver enzymes
Acute HCV infection
Usually asymptomatic until advanced liver disease intervenes
Most common cause of end-stage liver disease with cirrhosis
Chronic HCV infection
Treatment for _______ infection of _____
Supportive and expectant
Early treatment not recommended
acute; HCV
20% to 40% of acute seropositive patients will convert to seronegativity and an undetectable viral load during 1st 6 months after infection
Immune globulin is not helpful in preventing infection
in _______ infection of _____
acute; HCV
Treatment for _______ infection of _____
Assessed by a viral load and viral genotype
Liver biopsy to stage disease activity
chronic; HCV
Treatment for ________ infection of ______
Pegylated interferon-alpha with ribavirin and protease inhibitor
5% to 10% drop out of treatment because of side effects and cost (expensive)
Type 1: 48 weeks
Other types: 24 weeks
chronic; HCV
Treatment for ______ active _____
Counsel regarding blood-borne precautions
Centers for Disease Control and Prevention does not currently recommend barrier methods for patients with long-term sexual partners because of the apparent low risk of infection
chronic; Hep C
Treatment for chronic active hepatitis C infection
includes vaccinating against hep _____ and _____
A and B
Defective RNA virus that requires the helper function of HBV to replicate
Infection appears to accelerate and worsen HBV infection symptoms
Prevention of HBV infection also prevents infection
Hepatitis D (Delta)
Transmitted parenterally and intimate contact
Prevention of HBV infection also prevents infection
Hepatitis D (Delta)
Prevention
Safe sexual practices
Avoidance of IV drug use
Vaccination of susceptible persons with HBV vaccine
Hepatitis D (Delta)
No specific treatment
Hepatitis D (Delta)
Diagnosis
Anti-HDV IgM and IgG enzyme linked immunosorbent assay (ELISA)
Hepatitis D (Delta)
RNA virus spread via fecal-oral route
Contaminated H2O
Parenteral transmission
Hepatitis E (HEV)
Most common in developing countries or recent travel to these areas
Relatively high mortality rate in pregnant women
Hepatitis E (HEV)
Incubation period is 2 to 9 weeks
Hepatitis E (HEV)
Prevention
Careful hand washing
Avoidance of undercooked foods
Drinking safe H2O and beverages
Hepatitis E (HEV)
Supportive treatment
Hepatitis E (HEV)
Prodromal and icteric illness
Usually last only 2 weeks
Similar to HAV infection
Hepatitis E (HEV)
