SM_154b: Clinical Features of Viral Hepatitis

Question 1

Hepatitis has ___, ___, and is transmitted ___

Answer 1

Hepatitis has ssRNA, 3 genotypes, and is transmitted fecal/oral

• Fecal/oral: poor sanitation, food / water, day-care

Question 2

Describe pathogenesis of Hepatitis A

Answer 2

Hepatitis A pathogenesis

• Hepatotrophic: enteric -> blood stream -> liver
• Hepatotoxicity: immune-related

Question 3

Describe symptoms and signs of Hepatitis A

Answer 3

Hepatitis A symptoms and signs

• Incubation: weeks
• Duration: weeks (to months: relapsing course)
• Jaundice, fatigue, fever, poor appetite: more likely in adults

Question 4

Diagnosis of Hepatitis A involves ___

Answer 4

Diagnosis of Hepatitis A involves HAV IgM (acute infection)

Question 5

Describe treatment and prophylaxis of Hepatitis A

Answer 5

Treatment and prophylaxis of Hepatitis A

• Acute: supportive / hygienic care
• Pre/post exposure prophylaxis and/or close contacts: vaccine or Ig

Question 6

Hepatitis A has ____ chronicity

Answer 6

Hepatitis A has NO chronicity

Question 7

Hepatitis B has chronicity in ____

Answer 7

Hepatitis B has chronicity in perinatal period

Question 8

Hepatitis B has ____ and is transmitted via ____ and ____

Answer 8

Hepatitis B has dsDNA and is transmitted via parenteral route of pregnancy (vertical transmission)

• Parenteral, sexual, IV drug use, hemodialysis
• Pregnancy (vertical transmission): maternal viral load is critical parameter

Question 9

Describe pathogenesis of Hepatitis B

Answer 9

Hepatitis B pathogenesis

• Hepatotropic: cccDNA in hepatocyte nucelus (+ extra-hepatic reservoirs)
• Hepatotoxicity: immune-related ± cytotoxic

Question 10

Describe symptoms and signs of Hepatitis B

Answer 10

Hepatitis B symptoms and signs

• Incubation: months
• Duration: depends on exposure age (chronicity)
• Jaundice, fatigue, abdominal discomfort: symptoms in acute setting correlate with immune activation / clearance

Question 11

Diagnosis of Hepatitis B is ____ and ____

Answer 11

Diagnosis of Hepatitis B is HBV sAg + cAB total (IgM and IgG) and DNA viral load

Question 12

Describe Hepatitis B serologies

Answer 12

Hepatitis B serologies

• Acute: + HBsAg, + total anti-HBc, + IgM anti-HBC
• Chronic: + HBsAg, + total anti-HBc, - IgM anti-HBC

Question 13

In chronic Hepatitis infection, ____ and ____ remain high

Answer 13

In chronic Hepatitis infection, HBsAg and totla anti-HBc remain high

Question 14

Treatment of Hepatitis B is determined by ___, ___, and ___

Answer 14

Treatment of Hepatitis B is determined by liver status, host immune status, and viral load

(not just infection)

• Vaccine available
• HBV can generate hepatocellular carcinoma without cirrhosis

Question 15

Hepatitis C chronicity is ___

Answer 15

Hepatitis C chronicity is 75%

Question 16

Hepatitis C is ____ and transmitted by ____

Answer 16

Hepatitis C is ssRNA and transmitted by IV drug use / tattoos / blood transfusions

Question 17

Describe pathogenesis of Hepatitis C

Answer 17

Hepatitis C pathogenesis

• Hepatotropic: hepatocytes (+ extrahepatic reservoirs)
• Hepatotoxicity: immune-related and cytotoxic

Question 18

Describe symptoms and signs of Hepatitis C

Answer 18

Hepatitis C symptoms and signs

• Incubation: months
• Duration: months (acute) to life-long (chronic)
• Asymptomatic (80%), jaundice / fatigue / abdominal discomfort

Question 19

Diagnosis of Hepatitis C involves ____

Answer 19

Diagnosis of Hepatitis C involves HCV Ab and RNA viral load

Question 20

Describt therapies for Hepatitis C

Answer 20

Hepatitis C therapies

• NS3/4A protease inhibitors (glecaprevir po)
• NS5A replication complex inhibitors (velpastasvir po)
• NS5B polymerase inhibitors (sofosbuvir po)

(screen for hepatocellular carcinoma in cirrhotic patients despite HCV cure)

Question 21

Hepatitis D chronicity is ____

Answer 21

Hepatitis D chronicity is dependent on HBV

Question 22

Hepatitis D is ____ and transmitted via ____

Answer 22

Hepatitis D is circular ssRNA and transmitted via parenteral / sexual / IV drug use

Question 23

Describe symptoms and signs of Hepatitis D

Answer 23

Hepatitis D symptoms and signs

• Incubation: weeks to months
• Duration: contingent on HBV status
• Jaundice, flu-like, abdominal discomfort

Question 24

Hepatitis D can occur in ____ and ____

Answer 24

Hepatitis D can occur in coinfection with acute HBV and superinfection with chronic HBV

• Coinfection (acute HBV): HDV IgM and viral load
• Superinfection (chronic HBV): HDV IgM/IgG and viral load
• HBV vaccination

Question 25

Hepatitis E is only chronic in ___

Answer 25

Hepatitis E is only chronic in patients with solid organ transplant

Question 26

Hepatitis E is ____ and transmitted via ____

Answer 26

Hepatitis E is ssRNA and transmitted via fecal/oral

• Poor sanitation, feed/water

Question 27

Describe symptoms and signs of Hepatitis E

Answer 27

Hepatitis E symptoms and signs

• Incubation: weeks
• Duration: weeks
• Jaundice, fatigue, fever, poor appetite (more likely in adults)

Question 28

Diagnosis of Hepatitis E involves ____ and ____

Answer 28

Diagnosis of Hepatitis E involves HEV IgM (not always positive) and RNA viral load

Question 29

Hepatitis E has high fatality rate in ____

Answer 29

Hepatitis E has high fatality rate in pregnancy

Question 30

Summarize the Hepatitis viruses

Answer 30

Hepatitis viruses