Patient with Jaundice: viral hepatitis Flashcards

1
Q

HAV

A
acute illness 
Very rarely fulminant 
Never chronic 
Vaccine 
No treatment  
Major risk factor = travel
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2
Q

HBV

A

Acute illness
Very rarely fulminant
chronic infection yes, but risk depends on age: <1 yrs = 90%, 1-5yrs = 10-25%, adults <5%
Vaccine
Treatment = suppression
Major risk factor = vertical transmission

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3
Q

HCV

A
Acute illness 
Fulminant disease rare outside japan 
Chronic infection likely: 50-85% 
No vaccine 
Can be cured 
Usually transmitted by needle sharing
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4
Q

The difference between hepatitis viruses and other viruses that cause hepatic inflammation

A

Hep viruses: the liver is the main site of inflammation
Others that also cause hepatic inflammation: EBV, cytomegalovirus, HIV, mumps, yellow fever etc in glandular fever other symptoms and signs dominate over the liver problems

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5
Q

What is IgG is showing up in bloods?

A

detect antibody response IgG type, then current disease not caused by HPV they must have been infected a while ago
Whereas if they have IgM positive antibodies their current illness will likely be hepA

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6
Q

The difference age of infected patients and whether they will develop chronic infection

A

High proportion of babies born to mothers with HBV have been infected (vertical transmission) very high proportion of those, >90% will develop in their cells which can lead to liver fibrosis and cirrhosis and liver failure –> liver cancer
If you catch HBV from playing outside with other kids at say age 3 your risk of developing chronic infection has dropped considerably, because the immune system is more mature and able to clear virus. With adults it is quite uncommon to develop chronic infection.

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7
Q

HBV reactivation in chemo patients

A

When someone gets cleared of hep B they might still have Hep B DNA in their chromosomes because we have enzymes inner cells which if they find free DNA floating around will incorporate into a chromosome = marginally increased risk of liver cancer
BUT if we give chemotherapy there is possibility to reactivate HBV
Note: HAV and HCV don’t get stored in the genome of liver cells

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8
Q

The types of antigens and antibodies we can detect in

A
HBSAg - vaccine is recombinant surface antigen? / person has been infected 
Early Ag - lots of virus in their bod 
Core Ag - never found in serum 
Anti- HBS = cured or vaccinated 
anti-HBE = not usually measured 
Anti- HBC = cured of acute infection IgM
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9
Q

Adult after 5 years of chronic hepatitis will develop?

A

12-20% cirrhosis = 85% alive at 5 years
20-25% with cirrhosis will decompensated - 15-35% alive at 5 years
6-15% with cirrhosis will develop hepatocellular carcinoma - seldom alive at 5 years unless curable (this from those infected overall is 2-3%)

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10
Q

What to do if you cant determine whether acute or chronic?

A

Take bloods now and again 6 months later

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11
Q

Treatment of acute viral hepatitis

A

not required
supportive care
fulminant case -transplant

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12
Q

Treatment of chronic hepatitis

A

to prevent cirrhosis and cancer
to reduce transmission
HBV - suppress
HCV - cure

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13
Q

HBV treatment

A
Those with complications 
those with high ALT (2x normal) 
Reverse transcriptase inhibitors 
entecavir 
tenofivir
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14
Q

How are we preventing HBV?

A

vaccinate at risk to prevent vertical transmission
- screen pregnant women
- if pos, give HBV Ig at birth, and start vaccination at birth (so 4 doses total)
- Check after last vaccine to check anti-HBS levels
(all infants on the vaccine program get 3 times in their first year anyway)

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15
Q

What actually causes damage to the liver in hepatitis

A

viral réplication inside the liver cell doesn’t actually damage the cell (unusual for viruses) It is the cytotoxic T cell response that comes along later that causes liver damage approx. 3 months post infection

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