T4 - Liver Flashcards
Types of hepatitis (5)
Viral
Alcoholic
NAFLD
Drug-induced
Autoimmune
The Hepatitis virus that is spread by ingestion?
A and E
The hep virus that is spread parenterally?
C
The hep viruses that are spread parenteral, sexual contact?
B
All hep viruses are tested for using IgM except for?
Hep C
Which hepatitis is more high risk in pregnancy?
Hep E
IgM is ______ it leaves 6mo after an acute infx.
IgG ___ it will be present after infection.
Immediate.
Stays.
Someone who has a negative anti-HBs
Has never had HBV or vaccine - they are susceptible.
Someone who has a positive anti-HBs. AND a positive anti-HBc
Is immune to HBV from a natural infection.
Anti-HBs positive shows immunity through ______
Anti-HBc positive shows immunity through _____
Vax
Natural infx.
If the HBsAg is positive:
The patient has a current acute or chronic HBV infx.
POs IgM anti-HBcand negative anti-HBs means
Acute infection.
What should you consider before selecting medication to treat HEPC
There are different genotypes of HCV - need to test to see which one to select the best medication to target that specific genotype.
Screening for HCV
18 and older - once lifetime
<18 - if risky behavior.
Routine prenatal screening with every pregnancy.
Annual for IV drug users and HIV infected MSM and MSM who take PrEP.
_____ % of HCV infections clear, and ______% are chronic.
15-25%
75-85%
______% of chronic HCV patients develop cirrhosis over 20 year.
10-20%
2 step testing for HCV:
Antibody - negative - no infx
Positive -> HCV RNA -> positive: current HCV infx, Negative, past infx
T/F: the gold standard for dx of cirrhosis is liver biopsy and it is always performed.
False.Gold standard IS liver biopsy, but many risks, so alternatives are usually used.
Most common Hepatitis causes?
Hep C and alcohol
How does a fibroscan work?
It measures the stiffness of the liver to stage the degree of liver fibrosis.
Earliest s/s of liver cirrhosis:
Pruritis, wt loss, fatigue, weakness, malaise, dark urine and pale stools.
What MELD-Na score do you need to refer for liver transplant?
> 17
3 types of HIV testing - which one can give you the earliest recognition?
NAT test - w/in 10-13 days of exposure. The rest are over 18-90 days.
interdisciplinary care for patients with HIV
SW, MH, nutrition, substance abuse, dental, ophtho, colonoscopy, mammogram, pap (if age appropriate) and ID.
Your HIV + patient presents with oral thrush. What should you do?
Start prophy for pneumocystitis PNA
If you patient with HIV has a CD4 ct below 200, then
Start daily Bactrim for infx prophy.
In an acute HIV infection, the viral load will be ____ and the CD4 count will be ____. As the acute phase wanes, these levels with alternate. Don’t confusion this _____ CD4 count with the ____ CD4 count in AIDS.
Hight
Low
Low
Low
How often do you f/u with patients with HIV?
3-6mo
Administer PEP no later than ______
72hours post exposure
T/F: PEP is safe during pregnancy
True.
Why should you repeat HIV testing in 24weeks for a patient who is co-infected with HepC?
HepC has been shown to delay the HIV sero-conversion.
What must you do before starting PrEP?
Documented negative 4th gen HIV test.
Rapid HIV POC HIV test negative and no high risk sex 3 weeks prior to starting
No s/s of acute HIV infection
Normal renal fxn
Doc Hep B SAb POs.
After starting PrEP, follow up in _____. What should you assess at this f/u visit?
3mo
Med adherence, HIV test, behavioral risk support, med SEs, STI s/s, renal fxn, STI test Q6 o.
T/F: your patient has been prescribed PrEP. They are protected right after their first dose.
False. PrEP takes 7 days for adequate rectal tissue protection, and 20 days for blood and vaginal tissue protection.
