Viral Hepatitis Flashcards by Iseoluwa Ojo

Aetiology (causes) of viral hepatitis

•________
•__________ infections
•_________ disorders
•________ - alcohol, drugs, aerosol sprays, paint thinner.
•___________

Viruses

Bacterial

Metabolic

Toxic

Immunologic

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Metabolic diseases

• They cause (acute or chronic?) hepatitis commonly and these are:

• In-born error of metabolism such as -____________ deficiency
-Abnormality of______________
-____________
-__________ disease

Chronic

Alpha 1 antitrypsin

carbohydrate metabolism

Hemochromatosis

Wilson’s

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Alcohol induced liver disease

• This cause a variety of lesion in the liver as a result of its direct toxic effect.

• Alcoholic _______ (_________)
• Alcoholic ___________
• Liver ________

steatosis; fatty change

hepatitis

Cirrhosis

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viruses

• Hepatotropic virus such as ______________- classically cause “viral hepatitis’

•_____-newborn or immunosupressed.

•__________ virus.

• ______ – mild hepatitis.

• ________ virus

• ________viruses.

hepatitis A-G

CMV

Yellow fever

EBV

Rubella

Adeno

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From hepatitis A- G,

Which is DNA, which is RNA

DNA- B

RNA- A,C,D,E,F,G

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From hepatitis A- G,

Which ones are chronic and which ones aren’t

Chronic - B,C,D

Acute- A,E,F,G

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From hepatitis A- G,

List the mechanism of spread

A-faeco-oral

B-parenteral, perinatal, sexual

C-parenteral, sexual, sporadic

D-superinfection, coinfection with HBV

E-faeco-oral, epidemic, sporadic

F-parenteral, sporadic

G-parenteral, sporadic, vertical

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Hepatic manifestation

Herpes simplex
Herpes zoster
Adenoviruses group

Necrotizing hepatitis

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Hepatic manifestation

Cytomegalovirus

Rubella

Hepatitis, neonatal giant cell hepatitis

Neonatal hepatitis

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Hepatic manifestation

Epstein-Barr
Enterovirus (B coxsachie)
Measles (rubeola)
Parvovirus

Hepatitis, granulomas, lymphoproliferative disorders

Hepatitis, haemorrhagic necrosis

hepatitis

Hepatocyte ballooning

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Viral hepatitis
• This is the inflammation of the liver caused by _______ viruses

hepatotropic

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hepatotropic viruses, so called because ____________________

they have high affinity for the liver.

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hepatotropic viruses

• These are hepatitis ________________ viruses

More are still being discovered

A,B,C,D,E & G

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Hepatitis A virus

• Discovered 1973

•____nm

•___RNA

•______virus

picorna

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Hepatitis A virus

• Infection is common in ______________- income countries with (good or poor?) sanitary conditions and hygienic practices.

It is (low or high?) in high-income countries.

low- and middle

Poor

Low

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Hepatitis A virus

• Incubation period is ________

• It lives in _______ in the ______

14-28days

faeces

intestinal tract

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Hepatitis A virus

• Transmitted by _____ route-

faeco-oral

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HAV

• Contaminated _____ to wash _______

• Contaminated _______/_______

• Eating __________________ harvested from infected water

water; fruits and vegetables or

ice block/pure water

raw/partially cooked shellfish

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HAV

• Infectivity starts ______ before symptoms (jaundice) appears and continue _____ after

• May also cause ________.
•

2wks; 1wk

diarrhoea

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Acute HAV is more severe in (adult or children?) than in (Adult or children?)

Adult

Children

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HAV infection is clinically distinguishable from other types of acute viral hepatitis.

T/F

HAV infection is not clinically distinguishable from other types of acute viral hepatitis.

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HAV infection

• Specific diagnosis – detection of HAV-specific ___________(_____) antibodies in blood.

• Additional test –______ to detect _____

immunoglobulin G (IgM)

RT-PCR

HAV RNA

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HAV infection

• Less than 1% of cases will develop ____________

fulminant hepatic failure.

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Treatment of HAV infection??

No treatment, most will recover

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HAV infection Chronicity (yes or no?) cirrhosis (yes or no?) cancer-(yes or no?)

No No No

Hepatitis B virus • ____nm •___DNA •_______virus • Incubation Period: _________

45 ds hepadna 30-180days;

Hepatitis B virus • Found in ____________________ •_______% of neonatal HBV progresses to chronic hepatitis

blood and other body fluids 90-95

Hepatitis B virus • Chronicity (yes or no?) cirrhosis (yes or no?) cancer (yes or no?)

Yes Yes Yes

_______% of neonatal HBV progresses to chronic hepatitis ____% of adult HBV becomes chronic hepatitis.

90-95 5

About _____% person living with HBV infection (2.7million) are also infected with HIV infection.

HBV Carrier state –very (common or rare?) ______% of acute Hepatitis

Common 5-10

HBV Remains in the body even after transplantation T/F

Transmission of Hepatitis B virus • Transfusion of _________ • Unprotected ____________,_______ • Sharing _________ among ______ • Use of _______ by __________ to ______ • contact with semen, sweat, tears, saliva,breast milk, effusion •__________ to ________ during _______

blood and blood products. sexual intercourse, • Anal sex infected needles among drug abusers infected needles by quacks, chemists to give injection Mother to child (90-95%) during childbirth

Risk factors for HBV •_______ in patients with kidney failure • ______________ among health workers •_________ activity •__________,_________

Dialysis Needle stick accidents Homosexual Circumcision, tattooing.

• H____V; most versatile.

Course of HBV infection • Can cause _______,______,_______, and ___________ • Present in _____ body fluids except _____ and produces several antigens:

acute, chronic, acute severe fulminant hepatitis and liver cirrhosis, all; stool

Course of HBV infection – HBsAg appears before _____, peaks during _______ and declines in ________ – HBeAg, HBVDNA & DNA polymerase – are markers of ______, which leads to _____ – HBcAg

onset; overt disease ; 3-6month active replication/ active infection chronic

Course of HBV infection – HB___Ag appears before onset, peaks during overt disease and declines in 3-6month – HB___Ag, HBVDNA & DNA polymerase – are markers of active replication/ active infectionchronic – HB__Ag

s e c

HBV • The body produces antibodies to these antigens - anti HB___, Anti HB__ & anti HB__.

c, e,s

HBV Anti-HBe detectable after ____________ • Anti -HBc IgM appears before ___________ and later replaced by _____ • Anti-HBs appears after __________ and remains ______

disappearance of HBeAg onset of disease ; IgG acute disease is over for life

Anti-HBs is detectable at the window periods T/F

F Anti-HBs is not detectable at the window periods

Prevention of HBV WHO recommendation: •take _________ as soon as possible after birth

HBV vaccine

Prevention of HBV WHO recommendation: •_____doses of HBV vaccine at least _______ apart to complete vaccination •___________ for the prevention of HBV transmission from mother-to-child, • Safer ______ practices

2-3 4 weeks Antiviral prophylaxis sex

Hepatitis C virus • 1989 •_______nm •enveloped or naked? •___RNA •_____/______ virus

30-60 Enveloped ss flavi/pesti

Hepatitis C virus • IP- _________ • It is a (slowly or rapidly?) progressing infection

20-90days Slowly

Hepatitis C virus • Clinical features/LFT correlate with liver damage T/F

F Clinical features/LFT do not correlate with liver damage hence biopsy is important.

Hepatitis C virus • biopsy is important for diagnosis T/F

HCV About ____% of infected people spontaneously clear the virus within _______ of infection without any treatment. • The remaining ____% will develop ________

30 6 months 70; chronic HCV infection.

HCV Of those with chronic HCV infection ,15-30% will develop _____ over _____ years.

cirrhosis 20

HCV • cancer (yes or no?)

Yes

HCV Transmission - _______________ __________ patients ______ abusers have high incidence  Sharing needles, tooth brushes, razors ____________,  Children born to _________  Dialysis patients  Health workers with needle-stick injury or mucosal exposure to HCV-positive patient

Blood and blood products Organ transplant IV drug Unprotected sex HCV-infected mother

Hepatitis D virus •1977 •____nm •enveloped or naked •______strandedRNAvirus •________ is defective •(known or unknown?) class

35 Envelopes Single stranded replication Unknown

Hepatitis D virus • Incubation period - ____________ •____________ occurs in 3-4%

30-50days fulminant Hepatitis

Hepatitis D virus • Transmission- similar to ____ • It is a _______ virus that requires _________________ and ___________

HBV defective HBV to reproduce itself and establish its infection

Hepatitis D virus • Only those infected with HBV can have it as: – _________/________

Superinfection/ coinfection.

Hepatitis D virus • Carrier- ____% •chronicity_____%(co-infection) •_____% in superinfection HCC-yes or no?

1-10 <5 80 Yes

Hepatitis E virus • 1980 •______nm •enveloped or un-enveloped? •_____virus

32-34 un-enveloped Calci

Hepatitis E virus • IP- __________

15-60days

Hepatitis E virus • Hepatitis E is a ________ (acute or chronic?) viral hepatitis that occurs from _____________ in developing countries and __________ in non-endemic areas.

self-limited; acute epidemic outbreaks sporadic hepatitis

Hepatitis E virus • Lives in ____ and therefore transmitted through ________ • Common in area with ________

faeces contaminated food or water poor sanitation

Hepatitis E virus __________Hepatitis occur in 0.3-3%, ___% in pregnant women

Fulminant 20

• In endemic areas, hepatitis ____ virus is one of the most common causes of acute hepatitis and hepatic failure in PREGNANCY . Its mortality rate has been reported up to _____%.

E 20

In non-endemic areas, HEV infection without any travel history is very common T/F

F In non-endemic areas, HEV infection without any travel history is very rare.

HEV Carrier -______ chronicity- ______ • occurrence of HCC is _______ but _____

unknown none unknown; likely

Clinico-pathologic syndromes- various forms that hepatitis can present •_____ hepatitis •__________ hepatitis •______ state • ______ hepatitis

Acute Acute fulminant Carrier Chronic

Clinico-pathologic syndromes- various forms that hepatitis can present • Acute hepatitis – symptoms ___________ within __________ or ______ • Acute fulminant hepatitis, ________ with _______ and _______ • Carrier state–individual ______________ but _____________ • Chronic hepatitis- ___________ form occur in 5% of cases which may last for ______.

subside without treatment; a few weeks or months encephalopathy with liver failure and death. carrying hepatitis virus antigen; not showing any sign/symptom. incurable progressive ; years

Chronic Hepatits causes (slowly or rapidly?) progressive liver damage that may lead to __________

Slowly liver cirrhosis

Pathological features of hepatitis The major pathological components of hepatitis are: – _______________ _____________ damage

Inflammatory cell infiltration Hepatocellular

Pathological features of hepatitis Others are – Varying degrees of ________ – _______ cell activation –_________ – ___________itis – __________proliferation – __________ damage – ___________ regeneration

cholestasis Kupfer Siderosis Endotheli Bileductular Bileduct Hepatocellular

Morphological appearances in acute hepatitis • Diffuse _________ (_______ degeneration) •________ – bile plugs & _________ of hepatocytes •___________ is unusual except in HCV

hepatocyte swelling; balloon Cholestasis; brown pigmentation Fatty change

Morphological appearances in acute hepatitis can be produced equally by drug reactions. T/F

Two pattern of hepatocyte cell death - Drop out ______  ________

necrosis; Apoptosis

pattern of hepatocyte cell death - • When necrosis is severe, it becomes ________ • Kupffer cell ___________ and _______ • Mixed inflamatory infiltrates of the _______ •_______ reaction & proliferation particularly in ______

bridging necrosis hypertrophy and hyperplasia portal tracts Bile duct; HCV

Fate and morphological sequelae of acute viral hepatitis • ________ •_________ •__________ Or ______________ •_______ hepatitis •___________ • Hepatocellular _______

Resolution Scarring Fatal outcome or need for liver transplantation Chronic Cirrhosis; carcinoma

Fate and morphological sequelae of acute viral hepatitis • Resolution – most cases of ____________ • Scarring – follows ________ • Fatal outcome or need for liver transplantation • Chronic hepatitis – most cases of ____, many patients with ______ • Cirrhosis – almost always follow _________ • Hepatocellular carcinoma

HAV, HBV, HEV severe hepatitis HCV; HBV chronic hepatitis

Morphological appearances in chronic hepatitis •________ to _______ changes •_______ infiltrated by ___________ •___________ typically seen in HCV •______ hepatitis and ______ necrosis (P-P; P- C) • Continued hepatocyte _______ and ______ results to cirrhosis.

Mild to severe Portal tracts; mixed inflammatory cells Lymphoid aggregates Interface; bridging; loss & fibrosis

Symptoms and signs of hepatitis • These vary depending on the __________ and _______________

cause and overall health status of the individual

Symptoms and signs of hepatitis •____________ in some cases • Body ______, loss of appetite, nausea, fever •_______ pain and tenderness •_______ (HAV, HEV) • _______

Asymptomatic weakness Abdominal Diarrhoea Jaundice

complications of acute hepatitis •____________ • Liver _______ • Liver _________

Chronic hepatitis cirrhosis cancer

complications of acute hepatitis • Chronic hepatitis-this is almost _______ as it causes __________ but __________ • Liver cirrhosis – ____________ of __________ by _________ (with its attendant complications such as _________) • Liver cancer-with Hepatitis _____,____,_____

incurable; slow but progressive liver damage replacement of dead liver cell by non functional scar tissue ; portal hypertension B, C,D

diagnosis of hepatitis • Clinical features such as enlarged ________ with _______ • Past medical history to ask about recent __________ •_______ to exclude gall stones/cancer • _________ to identify the virus and assess its activity

tender liver with jaundice high risk activity Ultrasound Serology

diagnosis of hepatitis • Liver ______ to assess extent of damage particularly if it is chronic and exclude other non viral causes. • _________ for __________, to evaluate liver function such as bile pigment, enzymes, albumin etc.

biopsy Blood for Liver function test-

Is viral hepatitis surmountable?

• Yes or no depending on whether or not we can surmount the challenges posed by this disease

What are the challenges of hepatitis • (A) the fact about the transmission –_____ is not being screened before transfusionin most blood banks in Nigeria –______ to _____ transmission – HBV,HCV and HDV are transmitted _________.

HCV Mother to child sexually

What are the challenges of hepatitis • (A) the fact about the transmission challenges • Role of _______/______ • Transmission within the family-sharing of tooth brushes, razor blade, clipper etc •__________ transmission

chemists/ quacks Faeco-oral

Challenges of hepatitis • B) challenges of asymptomatic disease-______ • C)vaccination-availability/affordability - No vaccine for _____________ • D)____ of treatment- role of _______

HCV HCV,HEV,HGV cost; poverty

Challenges of hepatitis • E) poor ________ about the ________ as compared to _______ • F)role of the experts/NGO/Governments meeting these challenges

public awareness; gravity of the disease AIDS

prevention of hepatitis • Vaccination for hepatitis _________ ______ vaccine is recommended for all travelers to countries with poor sanitation.

A & B. HAV

• HBV though a potentially devastating disease is easily preventable T/F

T those at potential risk should be protected using hepatitis B vaccine

prevention of hepatitis It has been argued that even in very low-incidence countries such as the UK a policy based upon routine vaccination for hepatitis B may be an efficient and ethical way to reduce the burden of this disease. T/F

hepatitis B vaccine does not also prevent against HDV T/F

F It does

• HBV vaccine This vaccine is now part of the _______ and _______

EPI and free.

prevention of hepatitis ___________ of the blood and blood products before transfusion, avoid other high risk activities

Screening

prevention of hepatitis • __________ after using the toilet or changing baby diapers • Injection of ________ can prevent ______ if given within ______ of exposure • (Early or Late?) treatment of infected patients

Washing hand immunoglobulins; HA & B ; two weeks Early

treatment available for hepatitis B & C and is cheap T/F

F treatment available for hepatitis B & C though expensive

Drug treatment • Are now available for the treatment of Hepatitis _________ • These are _______,______,________ etc

B and C. lamivudine, ribavirine, alpha interferon

Drug treatment for hepatitis Are effective in people with active infection but not people that are just carriers T/F

F Drug treatment for hepatitis Are effective both in carriers and people with active infection

Drug treatment • The limitations however are – Drug ________ – The drugs are quite ________ – Not all patients _________________

resistance expensive respond effectively to therapy

Drug treatment • The limitations however are – Drug resistance -this can be overcome by ________________ – Therefore the gold standard is to ________________

combination of more than drugs intensify efforts on awareness and preventive measures

Fulminant hepatitis •Liver is (Smaller or Larger?) in size due to _____________ • (Soft or Hard?) • Capsule is ________

Smaller ; extensive loss of liver cells Soft wrinkled

Fatty change in the liver • Fat ______ in the liver cells • Sometimes this accompany _____ infection

vacuoles HCV

Fatty change in the liver can Sometimes accompany HCV infection T/F

Fatty change in the liver • Commonly fatty change is associated with _____________ disease

alcohol induced liver

Liver cancer This can also be a late complication of viral hepatitis T/F

Liver cirrhosis • Late complication of ____________ • Liver cell form ______ • Some of the areas are replaced by ________________ which form _____ in between the _______

chronic hepatitis nodules dead scar tissue(fibrosis) bands; nodules