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ID Exam 4 > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

There are 5 main liver lab

A

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

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2
Q

AST and ALT are found in

A

hepatocytes

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3
Q

GGT and Alk Phos are found in

A

cells that line the bile ducts.`

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4
Q

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

A

rupture.

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5
Q

Hepatocyte rupture associated with

A

Elevated AST and ALT, seen in Hepatitis

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6
Q

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

A

biliary ducts

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7
Q

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 _____

A

AST and ALT elevation.

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8
Q

Hepatitis

A

Inflammation of the liver.

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9
Q

Various causes of hepatitis

A

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

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10
Q

____ is the end result of continued hepatocellular injury.

A

Cirrhosis

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11
Q

Fibrosis, atrophy, and regenerative nodules throughout, describes what

A

Cirrhosis

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12
Q

Most common cause of liver cirrhosis

A

Hepatitis C infection

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13
Q

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

A

50

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14
Q

Classic acute presentation of viral hepatitis has four phases

A

○ 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

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15
Q

Adults with acute Hepatitis A or B infection
are usually ____

A

symptomatic

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16
Q

FHF

A

Fulminant Hepatic Failure

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17
Q

Fulminant Hepatic Failure (FHF) is

A

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

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18
Q

Percentage of evolution from acute to chronic infection

A

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

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19
Q

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

A

20

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20
Q

Hepatitis A Virus epidemiology

A

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

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21
Q

S/S Hepatitis A Virus

A

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

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22
Q

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

A

A

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23
Q

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

A

T

24
Q

Hepatitis E Virus

A

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

25
Q

Hepatitis E Virus Transmission

A

Fecal oral route

26
Q

Hepatitis E Virus epidemiology

A

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

27
Q

Diagnostics for Hepatitis A

A

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

28
Q

Diagnostics for Hepatitis E

A

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

29
Q

Hepatitis B Virus

A

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

30
Q

Hepatitis B transmission

A

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

31
Q

Hepatitis B Virus presentations

A

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

32
Q

Chronic Hepatitis

A

■ 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).

33
Q

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

A

Hepatitis B Surface Antigen (HBsAg).

34
Q

Having Anti-HBsAg) antibodies = _____

A

Immunity.

35
Q

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

A

HBeAg

36
Q

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

A

Hepatitis B Core Antigen (HBcAg)

37
Q

Hepatitis B Virus and cell mediated immunity

A

○ 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.

38
Q

Chronic Hepatitis B infection can lead to two main conditions

A

Hepatocellular Carcinoma
Cirrhosis

39
Q

Hepatocellular Carcinoma

A

■ 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.

40
Q

We can prevent HBV infection with____

A

the Vaccination

41
Q

Hepatitis B Vaccine

A

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

42
Q

Hepatitis D Virus Transmission

A

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

43
Q

Hepatitis D co-infection

A

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.

44
Q

Hepatitis D Superinfection

A

○ 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

45
Q

T/F There is no Hepatitis D specific treatment.

A

T

46
Q

_____ is currently the mainstay of Hepatitis D treatment.

A

Control of Hepatitis B infection

47
Q

Hepatitis C transmission

A

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.

48
Q

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

A

Chronic Hepatitis C

49
Q

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

A

asymptomatic

50
Q

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

A

85

51
Q

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

A

20

52
Q

Hepatitis C screening test

A

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

53
Q

If Hepatitis C screening test is positive, _____

A

order HCV RNA by PCR.

54
Q

Treatment of Hepatitis C Virus involves

A

Antiviral medications

55
Q

Treatment of Hepatitis C

A

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

56
Q

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

A

Liver Biopsy

ID Exam 4 (3 decks)

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