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Clin Med semester 2 > Schoenwald: Infections of GI tract-Hepatitis: slide 30 on > Flashcards

Schoenwald: Infections of GI tract-Hepatitis: slide 30 on Flashcards

1
Q

Hepatitis B Vaccine: is a ___ dose series

A

3 dose series

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2
Q

Hepatitis B vaccine: 3 dose series schedule?

A

-typical schedule 0, 1-2, 4-6 months - no maximum time between doses (no need to repeat missed doses or restart) -FDA approved in **newborns and above -Engerix and Recombivax

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3
Q

Hepatitis B vaccine protection: -which demographic is the vaccine less protective for?

A

~30-50% dose 1; 75% - 2; 96% - 3; lower in older, immunosuppressive illnesses (e.g., HIV, chronic liver diseases, diabetes), obese, smokers

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4
Q

Hepatitis B vaccine: adults?

A

-2 dose series (adult dose) –licensed by FDA for 18 years and older –Heplisav-2 doses given Day 0 and at 1 month -TwinRix- see Hep A vaccine slides

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5
Q

Hepatitis B Vaccination ACIP Recommendations: which groups should be vaccinated?

A

-Routine infant -Ages 11-15 “catch up”, and through age 18(VFC eligible) -**Over 18 – high risk: –Occupational risk (HCWs) –Hemodyalisis patients –All STD clinic clients –Multiple sex partners or prior STD –Inmates in Correctional settings –MSM (males sex w males) -IDU -Institution for developmental disability -Pre-vaccination testing – if cost effective -Post-vaccination testing: 1-2 months after last shot, if establishing response critical (HCW)

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6
Q

Hepatitis C: infection is ___x as widespread when compared to HIV

A

5x

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7
Q

Hepatitis C: is the leading cause of ____ cancer and liver transplantation in the US

A

liver cancer

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8
Q

Hepatitis C: Vaccine?

A

no vaccine available (but it can be cured wihth newer meds)

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9
Q

Hepatitis C: risk for infection after a needle stick exposure is ___%

A

2%

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10
Q

Hep C virus infection: incubation period?

A

6-7 weeks (range of 2-26 weeks) -usually pts are asymptomatic

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11
Q

Hep C virus infection: acute illness (jaundice) (what % of Pts have jaundice)?

A

mild (<20%)

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12
Q

Hep C virus infection: case fatality rate?

A

low

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13
Q

Hep C virus infection: chronic infection?

A

60-80%

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14
Q

Hep C virus infection: Chronic hepatitis?

A

10-70% (most asymptomatic)

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15
Q

Hepatitis C virus infection: Cirrhosis ___%?

A

<5-20%

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16
Q

Hep C virus infection: mortality from CLD (chronic liver dz?

A

1-5%

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17
Q

Chronic Hepatitis C: list factors that promote progression or severity

A

-increased alcohol intake -Age >40 yo at time of infection -HIV co-infection -Other (male gender or chronic HBV co-infection)

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18
Q

Exposures known to be assoc. with HCV infection in the US

A

-injecting drug users -Transfusion, transplant from infected donor -Occupational exposure to blood (needle sticks) -Iatrogenic (unsafe injections) -Birth to HCV-infected mother -sex with infected partner -Multiple sex partners

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19
Q

Exposures known to be assoc. with HCV infection in the US

A

-injecting drug users (60%) -Transfusion, transplant from infected donor -Occupational exposure to blood (needle sticks) -Iatrogenic (unsafe injections) -Birth to HCV-infected mother -sex with infected partner -Multiple sex partners

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20
Q

Hepatitis C 2016 all age groups US: highest % in which age groups?

A

-25-34 yo -35-44 yo -15-24 yo

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21
Q

alcohol and hepatitis C are exponential risk factors for ______

A

cirrhosis

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22
Q

Hepatitis C Labs:

A

-Hepatitis C Antibody (if +, they may have hep C, but you will want to confirm with PCR test) -HCV (Hepatitis C Virus) PCR= **Confirmatory test -Genotype –1-6 –Genotype 1 is MC in US(80%) followed by type 2 and 3. 4-6 more common in Asian countries.

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23
Q

HCV testing is routinely recommended based on (2 things)?

A

-Based on increased risk for infection -Based on need for exposure management

24
Q

HCV testing: describe the need for testing based on increased risk for infection

A

-ever injected illegal drugs -Pt received clotting factors made before 1987 - Received vlood/organs before 1992 -Ever on chronic hemodialysis - Evidence of liver dz

25
Q

HCV testing: describe the need for testing based on the need for exposure management

A

-healthcare, emergency, public safety workers after needle-stick/mucosal exposures to HCV- positive blood -Children born to HCV-positive women

26
Q

CDC recommendation for HCV testing:

A

-Anyone born from 1945 to 1965 -People in this age group are 5 times more likely to be infected

27
Q

Treatment: Hepatitis A

A

supportive

28
Q

Treatment: hepatitis B

A

-difficult, -Adefovir, entecavir,tenofivir

29
Q

Treatment: Hepatitis C

A

-Pegylated interferon -Ribaviron -Protease inhibitors released May of 2011, obsolete -Polymerase inhibitors released Dec 2013, obsolete -Combination therapy- non interferon based released late 2014.

30
Q

List ex’s of Hepatitis C Polymerase Inhibitors

A

-Simeprevir (Olysio) -Sofosbovir (Sovaldi) -Released December of 2013 -Used with pegylated interferon and ribavirin

31
Q

Hepatitis C treatment:

A

-Harvoni: Sofosbovir/Ledipasvir (harvoni is a combo pill with both sofosbivir/Ledipasvir) (this one is commonly used!!) KNOW (also know harvoni is an 8 week treatment) -Viekira pak: ombitasvir,paritaprevir and ritonavir, dasabuvir tabs (these are used more for genotype 2 or 3)

32
Q

Hepatitis C: current treatment- (list 3)

A

-Zepatier-elbasvir/grazoprevir (2016): –NS5A inhibitor/NS3/4A inhibitor –**Need to test for NS5A resistance in Genotype 1a (dont use this med in pts with this resistant gene) -Epclusa: sofosbuvir/velpatasvir (2016) –NS5B inhibitor/NS5A inhibitor –**No resistance testing needed –FDA approved for all genotypes –**12 week treatment -Mavyret(glecaprevir/pibrentasvir) 2017: –NS34A protease inhibitor/NS5A inhibitor –Approved for all genotypes –8 week treatment (this is usually preferred on medicare)

33
Q

Recent black box warning for Hepatitis C treatment

A

-Risk of hepatitis B reactivation in patients co infected with hepatitis C and B -Routine testing for Hep B reactivation during and post treatment. What tests?

34
Q

HCV antibody nonreactive=

A

No HCV antibody detected, no further action required

35
Q

HCV antibody reactive & HCV RNA NOT detected=

A

-NO current HCV infection, so they either had a false + test or cleared the infection. No further action required

36
Q

HSV antibody reactive=

A

presumptive HCV infection, confirm with HCV RNA test

37
Q

HCV antibody reactive AND HCV RNA detected=

A

CURRENT HCV infection, link person to care with ID and GI

38
Q

Hep C about ____% go onto have chronic infection

39
Q

Infectious Esophagitis: -MC organism? -MC demographic

A

-Candida albicans MC -CMV or Herpes virus also common -MC in immunosuppression -HIV/Diabetes

40
Q

Infectious Esophagitis: clinical sx? -diagnosed by?

A

-Dyspahgia, odynophagia, retrosternal chest pain -Diagnosed by endoscopy

41
Q

Infectious Esophagitis: -management is dependent on ?

A

-Depends on pathogen -C albicans–>diflucan -CMV–>ganciclovir -HSV–>acycolvir

42
Q

Helicobacter pylori= gram ____ rod residing in ..

A

Gram negative rod residing in mucous gel coating of epithelial cells of stomach

43
Q

Helicobacter pylori: 1 in ___ Pts with peptic ulcer disease

44
Q

Helicobacter Pylori: ___x increase risk of gastric carcinoma

45
Q

Helicobacter pylori is associated with _____

A

MALT cell lymphoma

46
Q

Helicobacter Pylori Diagnosis: -sx? -tests?

A

Sx: Nausea, abdominal pain Tests: -Stool Ag for H pylori -Urea breath tests -Endoscopy

47
Q

Helicobacter pylori tx

A

-Combination of PPI and 2 antibiotic agents: clarithromycin and amoxicillin+PPI -Smoking cessation

48
Q

Diverticulitis: sx

A

-LLQ pain -Tenderness, bloody stools, fever

49
Q

Diverticulitis- tx?

A

combination of metronidazole and fluoroquinolone

50
Q

Botulism: -organism?

A

clostridium botulinum= Gram positive rod with spore production

51
Q

Botulism: describe the toxin and sx associated

A

*Toxin production–>toxin prevents release of acetylcholine at neuro-muscular junction -**Flaccid paralysis

52
Q

Botulism: clinical sx

A

-Rapid onset of symptoms following ingestion of contaminated food -**Symmetric impairment of cranial nerves followed by weakness/paralysis of muscles of extremities and trunk (descending paralysis) -Dysphagia, dry mouth, diplopia, dysarthria, fatigue, upper extremity weakness, constipation, lower extremity weakess, dyspnea, vomiting and dizziness

53
Q

Botulism: Physical exam findings

A

-Ophthalmoplegia and ptosis of eyelids -Decreased gag reflex -Facial weakness with normal mental status -Descending paralysis

54
Q

Miscellaneous: botulism -hx of eating ______?

-wound botulism stems from ______?

A
  • History of eating home canned food or honey (infants)
  • Wound botulism–> IV drug usage**
55
Q

Botulism: tx

A

-ICU management -Induce vomiting -**Antitoxin=mainstay of treatment -ABX controversial: +/- penicillin IV

Clin Med semester 2 (24 decks)

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