Quiz 7 - Spivak, A - Hepatitis Flashcards
What is acute hepatitis?
Incubation = several wks
Flu-like symptoms
- Fever
- Myalgias
- Pharyngitis
Jaundice
-Painful liver
Elevation in Liver Fx Test (LFT)
Resolves on its own
Which types of Hepatitis cause acute hepatitis?
A
B
E
Which types of hepatitis cause chronic hepatitis?
B
C
What is chronic hepatitis?
Often asymptomatic
Portal hypertension or liver inflammation
LFTs can be normal or elevated
Persists for years or decades
Tell me about Hep A.
Non-enveloped ssRNA virus
Fecal-oral route
Very common in developing countries
-Incidence is 100% among children
*Foodbourne outbreaks are common
Overcrowding
Poor sanitation
Polluted water sources
T/F - Hep A is the MOST COMMON cause of acute hepatitis.
TRUE
Tell me some clinical presentations of Hep A.
Most adults symptomatic, but 70% of children are asymptomatic
Risk factors
- None
- Day care
- Travel
- MSM
- IV drug use
Mostly a self-limited illness, but some rare complications:
- Coagulopathy
- Encephalopathy
- Renal failure
Tell me about the Hep A vaccine.
First dose and then second dose 6-12 months later
Hep A Ig is available for immediate passive immunity
When does a Hep A vaccine happen?
Children at 1 yo
Everyone needs to be vaccinated
Hep E is what type of virus?
Non-enveloped ssRNA virus
Tell me about Hep E.
Causes acute hepatitis that is not different from Hep A
Fecal-oral
Person-person spread is RARE
Tell me about the Hep B virus.
Enveloped DNA virus
-Partially dsDNA/ssDNA
SMALLEST KNOWN HUMAN DNA VIRUS
Compact, overlapping reading frames
All infants at birth should be vaccinated
What is the most common transmission of Hep B in low-prevalence areas?
Sexual
What mode of Hep B transmission dominates in high prevalence areas?
Perinatal
-From mom
—90% of children get Hep B from their Hep B infected mother
However, if they are then given the Hep B vaccine, they are cured in 95% of these children
What is the most commonly transmitted blood-borne virus in the health care setting?
Hep B
-B>C>HIV
—Common among IV drug-use
Parenteral (Needle stick)
HIV vs Hep C vs Hep B needle stick.
HIV - 0.3% of clinicians get HIV
Hep C - 3% of clinicians get Hep C
Hep B - 30% of clinicians get Hep B
What factors influence chronic Hep B disease?
Viral replication
Host immune response
Sex
-Men more likely to develop cirrhosis
Alcohol consumption
Viral co-infection (other viruses)
*Broad spectrum from asymptomatic to chronic hepatitis to cirrhosis
What is the most feared outcome of chronic Hep B?
Hepatocellular carcinoma (HCC) -associated with cirrhosis
What is cirrhosis?
Scarred liver
Hep B dx?
- Hep B surface antigen (HBsAg) and antibody
- Meaning your body as not cleared surface antigen via antibodies*
-Hep B core antigen and antibody
—Tells us that infection was present
- Hep B virus e antigen and antibody
- Hep B virus serum DNA PCR
Tx of Hep B?
2 types of antivirals
-IFN and nucleoside analogs
Treat when blood says infection AND disease symptoms are present
*1st line defense meds: TENOFOVIR (6 months) and ENTECAVIR (this one is taken when pt also has HIV and is on for life)
Tell me about Hep D.
Defective ssRNA virus
Passenger virus accompanying Hep B virus
- ONLY LIVES WITH Hep B
- It needs its machinery to replicate
Who is at great risk for a major Hep D infection?
Pt that has chronic Hep B infection
How to treat against Hep D?
VACCINATE AGAINST HEP B
- IFNalpha is only approved tx
- Low success rate
Tell me about Hep C.
Enveloped RNA virus
Blood borne
- Blood
- IV
- Needle sticks
- Sex
Leads to chronic hepatitis (60-80%)
Long term risk of cirrhosis and HCC
Hep C dx?
2 tests:
- Antibody immunoassay
- Molecular testing for presence of Hep C virus RNA
Who should be tested for Hep C?
Everyone born b/t 1945 and 1965
IV drug use
Transfusion recipients (prior to 1992)
Pts on hemodialysis
HIV infected
Pts w/ liver disease
Children of Hep C+ mothers
T/F - When testing for Hep C, always test for HIV and Hep B
TRUE
Hep C management.
Pegylated IFN
Ribvirin
Always test for HIV and Hep B
Determine genotype for drug selection
Evaluate for liver damage and cirrhosis
If absence of viral RNA 12 weeks after tx, then 97-100% chance of cure
**Goal of tx is to reduce Hep C amount in blood to undetectable levels
—This leads to cure
Treat for CURE
