uw revision Autoimmune hepatitis, viral (A, B) Flashcards
Autoimmune hepatitis. CP?
Asymptomatic
Symptomatic (anorexia, nausea, abdominal pain, jaundice)
Autoimmune hepatitis. Lab. liver?
Hepatocellular pattern (incr. AST and ALT, +/- mildly elevated ALP and total bilirubin)
Autoimmune hepatitis. Labs immunoglobulins?
formula?
Hypergammaglobulinemia with elevated gamma gap
gap: total protein - albumin –> >4g/dl.
Autoimmune hepatitis. Antibodies?
Elevated anti-smooth muscle autoantibodies - more specific
also in case was antinuclear antibody - most common antibody
Autoimmune hepatitis. histology?
Portal and periportal lymphoplasmacytic infiltration
Autoimmune hepatitis. Age?
Chronic liver disease that occur in middle-aged women with comorbid autoimmune disease (eg autoimmune thyroiditis)
Autoimmune hepatitis. Tx?
Immunosupression with GK (PREDNISONE) +/- azathioprine
KEPENU TX in autoimmune?
in acute liver failure or decompensated cirrhosis.
Can be considered in autoimmune, but first step - immunosupression.
Hepatitis A table. Transmission/risk? 3
Fecal-oral transmission
Poor sanitation/hygiene, travel to endemic areas
Contaminated food and water
Hepatitis A table. CP?
Fever, nausea, RUQ pain, jaundice, hepatomegaly
Hepatitis A table. Diagnostic testing?
Elevated tranaminases (>1000)
Anti-hepatitis A serology
Hepatitis A table. Mx?
Supportive/expectant
Spontaneous recovery in most patients
Hepatitis A. Spread food?
Unsanitary foods, eg shellfish and water supplies.
Hepatitis A. venues?
Poor sanitation - homeless shelters and day care centers (children often do not have jaundice and may go undiagnosed)
Hepatitis A. Who is at risk?
unvaccinated persons, international travels, MENS HAVING SEX WITH MEN
Hepatitis A. Dx serology?
Anti-HAV IgM serology
Hepatitis A. how long takes to resolve?
2-3 months.
HBV table. HBsAg? 3
Acute HBV (early)
Chronic active HBV
Inactive HBV carrier state
HBV table. HBeAg - proteins that circulates in blood when virus replicates
Early phase
Might be +/- in chronic active HBV infection
negative HBeAg - shows low infectivity and viral load.
HBeAg and anti-HBeAg are positive only in a subset of patients and correlate with active viral replication [early infection, chronic infection with viral replication)
anti-HBeAg - typically evident in recovery phase of acute infection.
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HBV table. IgM anti-HBc. 2
Acute HBV early phase and WINDOW PERIOD
HBV table. IgG anti-HBc. 3
Acute HBV recovery
chronic active HBV infection
immune due to natural HBV infection
HBV table. Anti-HBs 3
Acute HBV recovery
Vaccinated for HBV
Immune due to natural HBV infection
HBV table. Anti-HBe 3
Acute HBV recovery
+/- chronic active HBV infection
Inactive HBV carrier state
HBV table. HBV DNA?5
Acute HBV:
Early phase: +++
Window: +
Recovery: likely +
Chronic active HBV infection: ++
Inactive HBV carrier state: normal/mildly +
HBV table.
Acute HBV - early phase. 4
HBsAg, HBeAg, IgM anti-HBc
HBV DNA +++
HBV table.
Acute HBV - window phase. 2
IgM anti-HBc
HBV DNA +
HBV table.
Acute HBV - recovery phase. 4
IgG anti-HBc, Anti-HBs, Anti-HBe
HBV DNA likely +
HBV table.
Chronic active HBV infection. 5
HBsAg
+/- HBeAg
IgG anti-HBc
+/- Anti-HBe
HBV DNA ++
HBV table. Inactive HBV carrier state?3
HBsAg
Anti-HBe
HBV DNA normal/mildly +
HBV table. vaccinated? 1
Anti-HBs
HBV table. Immune due to natural HBV infection. 2
IgG anti-HBc
Anti-HBs
Anti-HBc - only in response to viral infection, not present in vaccination.
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only diagnostic for early infection during window?
IgM anti-HBc
what correlate with active replication? 2
HBeAg and anti-HBeAg
negative HBsAg?
cleared infection
from answer: chronic infection (active or inactive), positive and negative?
positive HBsAg and negative anti-HBs
HBeAg - SHOWS INFECTIVITY, but poor test for acute HBV infection.
.
despite HBV DNA can be present prior others, but this test is generally not performed to diagnose acute infection.
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yra dvi schemos - acute and chronic - ju nepatariau niekur
