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House AMP > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

Aetiology (causes) of viral hepatitis

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

A

Viruses

Bacterial

Metabolic

Toxic

Immunologic

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2
Q

Metabolic diseases

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

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

A

Chronic

Alpha 1 antitrypsin

carbohydrate metabolism

Hemochromatosis

Wilson’s

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3
Q

Alcohol induced liver disease

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

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

A

steatosis; fatty change

hepatitis

Cirrhosis

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4
Q

viruses

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

•_____-newborn or immunosupressed.

•__________ virus.

• ______ – mild hepatitis.

• ________ virus

• ________viruses.

A

hepatitis A-G

CMV

Yellow fever

EBV

Rubella

Adeno

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5
Q

From hepatitis A- G,

Which is DNA, which is RNA

A

DNA- B

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

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6
Q

From hepatitis A- G,

Which ones are chronic and which ones aren’t

A

Chronic - B,C,D

Acute- A,E,F,G

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7
Q

From hepatitis A- G,

List the mechanism of spread

A

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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8
Q

Hepatic manifestation

Herpes simplex
Herpes zoster
Adenoviruses group

A

Necrotizing hepatitis

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9
Q

Hepatic manifestation

Cytomegalovirus

Rubella

A

Hepatitis, neonatal giant cell hepatitis

Neonatal hepatitis

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10
Q

Hepatic manifestation

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

A

Hepatitis, granulomas, lymphoproliferative disorders

Hepatitis, haemorrhagic necrosis

hepatitis

Hepatocyte ballooning

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11
Q

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

A

hepatotropic

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12
Q

hepatotropic viruses, so called because ____________________

A

they have high affinity for the liver.

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13
Q

hepatotropic viruses

• These are hepatitis ________________ viruses

More are still being discovered

A

A,B,C,D,E & G

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14
Q

Hepatitis A virus

• Discovered 1973

•____nm

•___RNA

•______virus

A

27

ss

picorna

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15
Q

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.

A

low- and middle

Poor

Low

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16
Q

Hepatitis A virus

• Incubation period is ________

• It lives in _______ in the ______

A

14-28days

faeces

intestinal tract

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17
Q

Hepatitis A virus

• Transmitted by _____ route-

A

faeco-oral

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18
Q

HAV

• Contaminated _____ to wash _______

• Contaminated _______/_______

• Eating __________________ harvested from infected water

A

water; fruits and vegetables or

ice block/pure water

raw/partially cooked shellfish

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19
Q

HAV

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

• May also cause ________.
•

A

2wks; 1wk

diarrhoea

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20
Q

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

A

Adult

Children

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21
Q

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

T/F

A

F

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

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22
Q

HAV infection

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

• Additional test –______ to detect _____

A

immunoglobulin G (IgM)

RT-PCR

HAV RNA

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23
Q

HAV infection

• Less than 1% of cases will develop ____________

A

fulminant hepatic failure.

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24
Q

Treatment of HAV infection??

A

No treatment, most will recover

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25
Q

HAV infection

Chronicity (yes or no?)

cirrhosis (yes or no?)

cancer-(yes or no?)

A

No

No

No

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26
Q

Hepatitis B virus

• ____nm

•___DNA

•_______virus

• Incubation Period: _________

A

45

ds

hepadna

30-180days;

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27
Q

Hepatitis B virus

• Found in ____________________

•_______% of neonatal HBV progresses to chronic hepatitis

A

blood and other body fluids

90-95

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28
Q

Hepatitis B virus

• Chronicity (yes or no?)

cirrhosis (yes or no?)

cancer (yes or no?)

A

Yes

Yes

Yes

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29
Q

_______% of neonatal HBV progresses to chronic hepatitis

____% of adult HBV becomes chronic hepatitis.

A

90-95

5

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30
Q

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

A

1

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31
Q

HBV Carrier state

–very (common or rare?)

______% of acute Hepatitis

A

Common

5-10

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32
Q

HBV Remains in the body even after transplantation

T/F

A

T

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33
Q

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 _______

A

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

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34
Q

Risk factors for HBV

•_______ in patients with kidney failure
• ______________ among health workers

•_________ activity

•__________,_________

A

Dialysis

Needle stick accidents

Homosexual

Circumcision, tattooing.

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35
Q

• H____V; most versatile.

A

B

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36
Q

Course of HBV infection

• Can cause _______,______,_______, and ___________

• Present in _____ body fluids except _____ and produces several antigens:

A

acute, chronic, acute severe fulminant hepatitis and liver cirrhosis,

all; stool

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37
Q

Course of HBV infection

– HBsAg appears before _____, peaks during _______ and declines in ________

– HBeAg, HBVDNA & DNA polymerase – are markers of ______, which leads to _____
– HBcAg

A

onset; overt disease ; 3-6month

active replication/ active infection

chronic

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38
Q

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

A

s

e

c

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39
Q

HBV

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

A

c, e,s

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40
Q

HBV

Anti-HBe detectable after ____________

• Anti -HBc IgM appears before ___________ and later replaced by _____

• Anti-HBs appears after __________ and remains ______

A

disappearance of HBeAg

onset of disease ; IgG

acute disease is over

for life

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41
Q

Anti-HBs is detectable at the window periods

T/F

A

F

Anti-HBs is not detectable at the window periods

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42
Q

Prevention of HBV

WHO recommendation:
•take _________ as soon as possible after birth

A

HBV vaccine

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43
Q

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

A

2-3

4 weeks

Antiviral prophylaxis

sex

44
Q

Hepatitis C virus
• 1989

•_______nm

•enveloped or naked?

•___RNA

•_____/______ virus

A

30-60

Enveloped

ss

flavi/pesti

45
Q

Hepatitis C virus

• IP- _________

• It is a (slowly or rapidly?) progressing infection

A

20-90days

Slowly

46
Q

Hepatitis C virus

• Clinical features/LFT correlate with liver damage

T/F

A

F

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

47
Q

Hepatitis C virus

• biopsy is important for diagnosis

T/F

A

T

48
Q

HCV

About ____% of infected people spontaneously clear the virus within _______ of infection without any treatment.

• The remaining ____% will develop ________

A

30

6 months

70; chronic HCV infection.

49
Q

HCV

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

A

cirrhosis

20

50
Q

HCV

• cancer (yes or no?)

A

Yes

51
Q

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

A

Blood and blood products

Organ transplant

IV drug

Unprotected sex

HCV-infected mother

52
Q

Hepatitis D virus
•1977

•____nm

•enveloped or naked

•______strandedRNAvirus

•________ is defective

•(known or unknown?) class

A

35

Envelopes
Single stranded

replication

Unknown

53
Q

Hepatitis D virus

• Incubation period - ____________

•____________ occurs in 3-4%

A

30-50days

fulminant Hepatitis

54
Q

Hepatitis D virus

• Transmission- similar to ____

• It is a _______ virus that requires _________________ and ___________

A

HBV

defective

HBV to reproduce itself and establish its infection

55
Q

Hepatitis D virus

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

A

Superinfection/ coinfection.

56
Q

Hepatitis D virus

• Carrier- ____%

•chronicity_____%(co-infection)

•_____% in superinfection

HCC-yes or no?

A

1-10

<5

80

Yes

57
Q

Hepatitis E virus

• 1980

•______nm

•enveloped or un-enveloped?

•_____virus

A

32-34

un-enveloped

Calci

58
Q

Hepatitis E virus

• IP- __________

A

15-60days

59
Q

Hepatitis E virus

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

A

self-limited; acute

epidemic outbreaks

sporadic hepatitis

60
Q

Hepatitis E virus

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

A

faeces

contaminated food or water

poor sanitation

61
Q

Hepatitis E virus

__________Hepatitis occur in 0.3-3%, ___% in pregnant women

A

Fulminant

20

62
Q

• 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 _____%.

A

E

20

63
Q

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

T/F

A

F

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

64
Q

HEV

Carrier -______

chronicity- ______

• occurrence of HCC is _______ but _____

A

unknown

none

unknown; likely

65
Q

Clinico-pathologic syndromes- various forms that hepatitis can present

•_____ hepatitis
•__________ hepatitis
•______ state
• ______ hepatitis

A

Acute

Acute fulminant

Carrier

Chronic

66
Q

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 ______.

A

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

67
Q

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

A

Slowly

liver cirrhosis

68
Q

Pathological features of hepatitis
The major pathological components of hepatitis are: –

_______________

_____________ damage

A

Inflammatory cell infiltration

Hepatocellular

69
Q

Pathological features of hepatitis

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

A

cholestasis

Kupfer

Siderosis

Endotheli

Bileductular

Bileduct

Hepatocellular

70
Q

Morphological appearances in acute hepatitis

• Diffuse _________ (_______ degeneration)

•________ – bile plugs & _________ of hepatocytes

•___________ is unusual except in HCV

A

hepatocyte swelling; balloon

Cholestasis; brown pigmentation

Fatty change

71
Q

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

T/F

A

T

72
Q

Two pattern of hepatocyte cell death -

Drop out ______
 ________

A

necrosis; Apoptosis

73
Q

pattern of hepatocyte cell death -

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

A

bridging necrosis

hypertrophy and hyperplasia

portal tracts

Bile duct; HCV

74
Q

Fate and morphological sequelae of acute viral hepatitis

• ________
•_________
•__________ Or ______________
•_______ hepatitis
•___________
• Hepatocellular _______

A

Resolution

Scarring

Fatal outcome or need for liver transplantation

Chronic

Cirrhosis; carcinoma

75
Q

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

A

HAV, HBV, HEV

severe hepatitis

HCV; HBV

chronic hepatitis

76
Q

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.

A

Mild to severe

Portal tracts; mixed inflammatory cells

Lymphoid aggregates

Interface; bridging; loss & fibrosis

77
Q

Symptoms and signs of hepatitis

• These vary depending on the __________ and _______________

A

cause and overall health status of the individual

78
Q

Symptoms and signs of hepatitis

•____________ in some cases

• Body ______, loss of appetite, nausea, fever

•_______ pain and tenderness

•_______ (HAV, HEV)
• _______

A

Asymptomatic

weakness

Abdominal

Diarrhoea

Jaundice

79
Q

complications of acute hepatitis

•____________

• Liver _______

• Liver _________

A

Chronic hepatitis

cirrhosis

cancer

80
Q

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 _____,____,_____

A

incurable; slow but progressive liver damage

replacement of dead liver cell by non functional scar tissue ; portal hypertension

B, C,D

81
Q

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

A

tender liver with jaundice

high risk activity

Ultrasound

Serology

82
Q

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.

A

biopsy

Blood for Liver function test-

83
Q

Is viral hepatitis surmountable?

A

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

84
Q

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 _________.

A

HCV

Mother to child

sexually

85
Q

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

A

chemists/ quacks

Faeco-oral

86
Q

Challenges of hepatitis

• B) challenges of asymptomatic disease-______

• C)vaccination-availability/affordability - No vaccine for _____________

• D)____ of treatment- role of _______

A

HCV

HCV,HEV,HGV

cost; poverty

87
Q

Challenges of hepatitis

• E) poor ________ about the ________ as compared to _______

• F)role of the experts/NGO/Governments meeting these challenges

A

public awareness; gravity of the disease

AIDS

88
Q

prevention of hepatitis

• Vaccination for hepatitis _________

______ vaccine is recommended for all travelers to countries with poor sanitation.

A

A & B.

HAV

89
Q

• HBV though a potentially devastating disease is easily preventable

T/F

A

T

those at potential risk should be protected using hepatitis B vaccine

90
Q

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

A

T

91
Q

hepatitis B vaccine does not also prevent against HDV

T/F

A

F

It does

92
Q

• HBV vaccine

This vaccine is now part of the _______ and _______

A

EPI and free.

93
Q

prevention of hepatitis

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

A

Screening

94
Q

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

A

Washing hand

immunoglobulins; HA & B ; two weeks

Early

95
Q

treatment available for hepatitis B & C and is cheap

T/F

A

F

treatment available for hepatitis B & C though expensive

96
Q

Drug treatment

• Are now available for the treatment of Hepatitis _________

• These are _______,______,________ etc

A

B and C.

lamivudine, ribavirine, alpha interferon

97
Q

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

T/F

A

F

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

98
Q

Drug treatment

• The limitations however are

– Drug ________
– The drugs are quite ________
– Not all patients _________________

A

resistance

expensive

respond effectively to therapy

99
Q

Drug treatment

• The limitations however are
– Drug resistance -this can be overcome by ________________

– Therefore the gold standard is to ________________

A

combination of more than drugs

intensify efforts on awareness and preventive measures

100
Q

Fulminant hepatitis

•Liver is (Smaller or Larger?) in size due to _____________

• (Soft or Hard?)

• Capsule is ________

A

Smaller ; extensive loss of liver cells

Soft

wrinkled

101
Q

Fatty change in the liver
• Fat ______ in the liver cells

• Sometimes this accompany _____ infection

A

vacuoles

HCV

102
Q

Fatty change in the liver can Sometimes accompany HCV infection

T/F

A

T

103
Q

Fatty change in the liver

• Commonly fatty change is associated with _____________ disease

A

alcohol induced liver

104
Q

Liver cancer

This can also be a late complication of viral hepatitis

T/F

A

T

105
Q

Liver cirrhosis
• Late complication of ____________

• Liver cell form ______

• Some of the areas are replaced by ________________ which form _____ in between the _______

A

chronic hepatitis

nodules

dead scar tissue(fibrosis)

bands; nodules

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