Viral Hepatitis

Question 1

There are 5 main liver lab

Answer 1

Aspartate aminotransferase (AST)
○ Alanine aminotransferase (ALT)
○ Gamma-glutamyl transpeptidase
(GGT)
○ Alkaline phosphatase (Alk phos)
○ Bilirubin

Question 2

AST and ALT are found in

Answer 2

hepatocytes

Question 3

GGT and Alk Phos are found in

Answer 3

cells that line the bile ducts.`

Question 4

As hepatitis viruses invade and replicate within the hepatocytes, these cells eventually _____

Answer 4

rupture.

Question 5

Hepatocyte rupture associated with

Answer 5

Elevated AST and ALT, seen in Hepatitis

Question 6

If the hepatocellular injury is extensive and the liver swells, this can cause injury of the ____

Answer 6

biliary ducts

Question 7

If there is a gallstone (or other obstruction) blocking flow of bile down through the bile ducts, GGT and Alk Phos may be elevated
without _____

Answer 7

AST and ALT elevation.

Question 8

Hepatitis

Answer 8

Inflammation of the liver.

Question 9

Various causes of hepatitis

Answer 9

○ Infectious: Viral, parasitic, etc.
○ Non-infectious: ETOH, autoimmune, Rx
and OTC drugs, etc.

Question 10

____ is the end result of continued hepatocellular injury.

Answer 10

Cirrhosis

Question 11

Fibrosis, atrophy, and regenerative nodules throughout, describes what

Answer 11

Cirrhosis

Question 12

Most common cause of liver cirrhosis

Answer 12

Hepatitis C infection

Question 13

Viral hepatitis accounts for more than ____%
of acute hepatitis cases in the United States

Answer 13

50

Question 14

Classic acute presentation of viral hepatitis has four phases

Answer 14

○ Phase 1- Viral replication. Patient is asymptomatic, but LFTs and serologic studies may be abnormal.
○ Phase 2- Prodromal phase. Anorexia, nausea/vomiting, malaise, fatigue, urticaria, pruritus, very high AST and ALT.
○ Phase 3- Icteric phase. May note dark urine, pale-colored stools, jaundice, and right upper quadrant pain with hepatomegaly.
○ Phase 4- Convalescent phase. Symptoms and jaundice slowly resolve, liver enzymes return to normal

Question 15

Adults with acute Hepatitis A or B infection
are usually ____

Answer 15

symptomatic

Question 16

FHF

Answer 16

Fulminant Hepatic Failure

Question 17

Fulminant Hepatic Failure (FHF) is

Answer 17

Acute liver failure with Hepatic Encephalopathy
- associated with increased permeability of the blood brain barrier, leading to brain cell swelling (can be fatal)

Question 18

Percentage of evolution from acute to chronic infection

Answer 18

○ Up to 90-95% of neonatal acute Hepatitis B.
○ Up to 5% of adult acute Hepatitis B.
○ 75-85% of acute Hepatitis C

Question 19

___% of patient with Chronic Hepatitis B or Hepatitis C infection will
eventually develop Hepatic Cirrhosis.

Answer 19

20

Question 20

Hepatitis A Virus epidemiology

Answer 20

Young children are commonly affected, as well as adults 30-39 YOA.

Question 21

S/S Hepatitis A Virus

Answer 21

■ Malaise
■ Fever
■ Anorexia
■ Nausea/vomiting
■ Elevated LFTs
■ Hepatomegaly
Jaundice in severe cases

Question 22

US travelers to developing countries are at increased risk of developing Hepatitis ___ infection

Answer 22

A

Question 23

T/F Hepatitis A infection is usually a self-limited condition and treatment
of acute disease is supportive

Answer 23

T

Question 24

Hepatitis E Virus

Answer 24

● Sometimes called “Non-A Viral Hepatitis”
○ Shares a lot of similarities to Hepatitis A
infection
○ Hepatitis “E” stands for “Enteric”

Question 25

Hepatitis E Virus Transmission

Answer 25

Fecal oral route

Question 26

Hepatitis E Virus epidemiology

Answer 26

Considered endemic to Central and Southeast Asia mostly, but also in portions of Africa and Central America

Question 27

Diagnostics for Hepatitis A

Answer 27

Anti-HAV IgM = Acute, active infection Anti-HAV IgG = History of infection,

Question 28

Diagnostics for Hepatitis E

Answer 28

Diagnosed by testing for IgM anti-HEV antibodies in serum.

Question 29

Hepatitis B Virus

Answer 29

● Large DNA virus with an enveloped capsid. ● Extremely contagious

Question 30

Hepatitis B transmission

Answer 30

Extremely contagious and passed via parenteral transmission (Blood-to-blood contact): ○ Needle sharing ○ Accidental medical exposures ○ Sexual contact ○ Blood transfusions ○ Perinatal transmission

Question 31

Hepatitis B Virus presentations

Answer 31

○ Acute Hepatitis- Essentially identical to HAV infection S/Sxs. ○ Fulminant Hepatic Failure- As previously discussed. ○ Chronic Hepatitis-

Question 32

Chronic Hepatitis

Answer 32

■ Asymptomatic Carrier: Never developed immunity but avoids significant liver injury. ■ Chronic-Persistent Hepatitis: Low-grade, “smoldering” hepatitis. ■ Chronic Active Hepatitis: Acute hepatitis state continues without meaningful recovery. ■ Co-Infection with Hepatitis D Virus: See Hepatitis D slides (coming up).

Question 33

Filamentous structures that are attached to the outer part of the large Hep B virus, called

Answer 33

Hepatitis B Surface Antigen (HBsAg).

Question 34

Having Anti-HBsAg) antibodies = _____

Answer 34

Immunity.

Question 35

____ is used as a marker for Active Hep B Disease and a Highly Infectious disease state.

Answer 35

HBeAg

Question 36

Fusion of the virus with a host cell removes HBsAg, leaving the viral core open, which we call ____

Answer 36

Hepatitis B Core Antigen (HBcAg)

Question 37

Hepatitis B Virus and cell mediated immunity

Answer 37

○ Viral antigens on the surface of the hepatocytes are the target of the Cytotoxic T-Cells. ○ For this reason, immunocompromised patients are more likely to become Asymptomatic Carriers because their immune system is not able to mount an attack.

Question 38

Chronic Hepatitis B infection can lead to two main conditions

Answer 38

Hepatocellular Carcinoma Cirrhosis

Question 39

Hepatocellular Carcinoma

Answer 39

■ HBV DNA becomes incorporated into hepatocyte DNA (Lysogenic cycle) which can trigger malignant growth. ■ Patient with Chronic Hepatitis B (or C) is 200 times more likely to develop Hepatocellular Carcinoma than non-HBV.

Question 40

We can prevent HBV infection with____

Answer 40

the Vaccination

Question 41

Hepatitis B Vaccine

Answer 41

The vaccine is mass quantities of the HBsAg ONLY. ○ No capsid, no DNA, etc. ○ Allows the body to form Anti-HBsAg, creating immunity

Question 42

Hepatitis D Virus Transmission

Answer 42

This RNA virus is also transmitted Parenterally. ● Interestingly, it can only infect and replicate in the presence of Hepatitis B Virus.

Question 43

Hepatitis D co-infection

Answer 43

Hepatitis B and D can be transmitted together at the same time parenterally. Acute hepatitis will ensue. ○ Anti-HBsAg antibodies will provide protection against both.

Question 44

Hepatitis D Superinfection

Answer 44

○ If a person already has Chronic Hepatitis B (estimated 200+ million people worldwide), contracting Hepatitis D can result in an acute hepatitis. ○ Higher incidence of FHF, cirrhosis, or death

Question 45

T/F There is no Hepatitis D specific treatment.

Answer 45

T

Question 46

_____ is currently the mainstay of Hepatitis D treatment.

Answer 46

Control of Hepatitis B infection

Question 47

Hepatitis C transmission

Answer 47

An enveloped RNA virus that is transmitted Parenterally. ○ Most commonly by IV drug use or shared piercing/tattoo needles. ○ Far less common- Sexual relations or Perinatal.

Question 48

____ is the leading indication for liver transplant in the US.

Answer 48

Chronic Hepatitis C

Question 49

After a 6-12 week incubation period, acute infection with Hepatitis C virus is often ____.

Answer 49

asymptomatic

Question 50

Up to ____% of people with acute Hepatitis C will develop chronic Hepatitis C infection.

Answer 50

85

Question 51

Around ____% of those with chronic hepatitis C infection will go on to eventually develop Cirrhosis

Answer 51

20

Question 52

Hepatitis C screening test

Answer 52

Anti-HCV Enzyme Immunoassay ■ 97% accurate, but cannot distinguish acute from chronic

Question 53

If Hepatitis C screening test is positive, _____

Answer 53

order HCV RNA by PCR.

Question 54

Treatment of Hepatitis C Virus involves

Answer 54

Antiviral medications

Question 55

Treatment of Hepatitis C

Answer 55

○ Alpha Interferons, + or - Ribavirin. ○ New Hepatitis C medications are considered “curative.” (harvoni, Olysio, Sovaldi, etc)

Question 56

Can be performed to evaluate the extent of liver damage caused by the chronic Hepatitis B or C infection

Answer 56

Liver Biopsy