VI- Viral Hepatitis

Question 1

acute hepatitis presentation

Answer 1

1. jaundice
2. dark urine
3. acholic stool (light or clay colored)
4. prodrome- headache, myalgia, arthralgia, fatigue, nausea, vomit, pharyngitis, fever

Question 2

acute hepatitis lab values

Answer 2

1. bilirubin > 3, typically b/t 5-20
2. ALT and AST

Question 3

chronic hepatitis definition

Answer 3

hepatitis that doesn’t resolve in 6 mo
-predisposes to liver cirrhosis and hepatocellular carcinoma

Question 4

fulminant hepatitis presentation

Answer 4

1. rapid, severe hepatitis
2. massive hepatic necrosis
3. encephalopathy
4. edema

Question 5

complications of fulminant hepatitis

Answer 5

1. cerebral edema
2. brainstem compression
3. GI bleeding
4. sepsis
5. organ failure

Question 6

Hep A features

Answer 6

1. picornavirus +ssRNA
2. incubation 2-4 weeks
3. fecal oral transmission
4. no chronic infection

Question 7

Hep B features

Answer 7

1. hepadnavirus dsDNA
2. 6 week - 6 m incubation
3. body fluid transmission
4. yes develop to chronic

Question 8

Hep C features

Answer 8

1. flavivirus- enveloped +ssRNA
2. 2 mo incubation
3. body fluid transmissin- esp injection drugs
4. yes chronic infection

Question 9

Hep D features

Answer 9

1. deltavirus
2. 2-12 week incubatin
3. body fluid transmissin
4. yes chronic

Question 10

Hep E features

Answer 10

1. hepevirus +ssRNA
2. 6-8 week incubation
3. fecal oral transmission
4. no chronic

Question 11

Hep A diagnosis

Answer 11

1. acute infection has IgM Ab
2. anti HAV IgG for protective immunity

Question 12

Hep A outcomes

Answer 12

1. resolution within 2 mo
2. rarely causes fulminant

og symps usually asymptomatic all age groups

Question 13

HAV vaccine

Answer 13

-2 doses of inactivated whole virus IM injection
-all kids at 1 should get
-high risk groups include homosex men, travelers, illegal drug users, clotting factor disorders, close contact with international adoptee, occupation

Question 14

Hep B histology

Answer 14

1. dane particles aka complete virions infectious with HBeAg, HBcAg, HBsAg
2. tubes and spheres of incomplete noninfectious particles coated by HBsAg

Question 15

acute HBV antibodies if cleared

Answer 15

1. initial rise in IgM anti-HBc
2. isotype switch to IgG anti-HBc

will have anti-HBs (surface)

Question 16

acute HBV antibodies if chronic

Answer 16

1. rise and decline of IgM anti-HBc
2. anti-HBc (core) instead of surface like clearance

Question 17

Hep B outcomes

Answer 17

1. half are asymptomatic
2. if symps then milder than HAV acute hepatitis

Question 18

Hep B chronic treatments

Answer 18

1. oral polymerase inhibitors - lamivudine (nucleoside reverse transcriptase inhib) and tenofovir disoproxil fumarate (acyclic nucleotide analogue polymerase inhib)
2. cell intrinsic immune modulator - pegylated interferon (long acting interferon bound to polyethelene glycol) injected

Question 19

HBV vaccine

Answer 19

-protein vaccine with HBsAg
-IM injection 3 doses for routine vaccination kids or pre exposure high risk adults

Question 20

groups for post exposure prophylaxis HBV

Answer 20

1. premature infants with mothers HBsAg pos or unknown status
2. full term infant with HBsAg pos mother
3. percutaneous expsoure of health care workers

combo of vaccine + Hep B immunoglobulin

Question 21

HCV processing

Answer 21

1. HCV virion
2. +ssRNA genome translated
3. immature viral polyprotein proteolysed by HCV NS3/4A
4. mature viral proteins replicated by HCV NS5B RdRp and HCV NS5A
5. -ssRNA
6. virion assembly by HCV NS5A

Question 22

Hep C testing guidelines

Answer 22

one time for: all indivs 18+, under 18 if inc risk, prenatal care
periodic for: inc risk exposure groups
annual for: injection drug users, HIV infected men, men taking pre-exposure prophylaxis

Question 23

HCV diagnosis

Answer 23

1. screening test for anti-HCV antibodies
2. confirmatory test for detection of viral genome

Question 24

Hep C outcomes

Answer 24

majority develop to chronic, some acute but symps milder than HAV or HBV,
-some rapid progress to cirrhosis

Question 25

HCV treatments

Answer 25

-combo therapy with direct acting antivirals for 12-24 weeks, no vaccine
-can simplify if chronic without cirrhosis and not previously received treatment
-recommended for all patients acute or chronic

Question 26

HCV antivirals

Answer 26

1. protease inhibitors - glecaprevir, prevents cleavage to mature protein
2. RNA polymerase inhibitors - sofosbuvir, prevents genome rep
3. HCV HS5A inhibitors - pribentasvir, velpatasvir, stops replication and virion assembly

Question 27

Hep D structure

Answer 27

small circular ssRNA
-two proteins cover virions (delta short and delta long)
-helper dependent bc needs Hep B surface antigen to form external surface AND replication requires HBV proteins

Question 28

HDV outcomes

Answer 28

fulminant hepatitis more likely outcome if double infected with B and D
-directly injures hepatocytes instead of immune resp

Question 29

HDV diagnosis

Answer 29

1. elisa to detect anti-HDV antibodies or delta antigens
2. no specific treatments
3. prevent by HBV vaccine

Question 30

Hep E treatment

Answer 30

1. alleviate symptoms
2. prevent by clean water and proper food handling