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Gastrointestinal > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

microbiology of Hep A

A

a hepatovirus; a small, unenveloped symmetrical RNA virus which shares many of the characteristics of the picornavirus family

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2
Q

prevalence of hep A is highest in? (3 continents, 1 country)

A

south america, africa, southeast asia, and greenland

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3
Q

how is hep A transmitted?

A

fecal-oral via contaminated food/water

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4
Q

how does hep A manifest?

A

acute illness with flu-like sx, maybe N/V/D, icterus/jaundice

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5
Q

HAV IgM indicates?

A

acute exposure to hep A

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6
Q

HAV IgG indicates?

A

prior exposure OR vaccination

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7
Q

treatment of hep A

A

supportive, usually mild

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8
Q

close contacts to a pt with acute exposure to hep A should?

A

receive hep A immune globulin and vaccination

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9
Q

microbiology of Hep B

A

a member of the hepadnavirus group, double-stranded DNA viruses which replicate, unusually, by reverse transcription

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10
Q

prevalence of hep B is highest in?

A

southeast asia, africa, japan, northern canada and alaska

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11
Q

how is hep B transmitted?

A

parenteral, sexual, or perinatal contact

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12
Q

of those exposed to hep B, what % develop chronic HBV? Fulminant?

A

1%, 4%

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13
Q

what does it mean if a pt is positive for the HB surface antigen, and what test must be done next?

A

they are infected with HBV; the next test is for IgM anti-HBc to determine if it is acute (IgM+) or chronic (IgM-)

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14
Q

a person who has received the Hep B vaccine will be negative for all tests except?

A

antibody to HB surface antigen (HBsAb)

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15
Q

positivity to HBcAb and HBsAb implies?

A

immunity due to natural infection that has been fought off

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16
Q

a patient with all negative tests except for HBcAb (anti-HBc+) has?

A

one of several options: 1) resolved infection, 2) false+, so needs vaccine, 3) “low-level” chronic infxn, or 4) resolving acute infxn (in the window)

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17
Q

what is the most common form of HBV transmission in the West? In high prevalence areas (Asia/Africa)?

A

sexual/parenteral in the West; vertical in Asia, Africa

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18
Q

HBV immune tolerance occurs in ______-acquired HBV, manifests with (high/low) viral replication, (+/-) for HBeAg, and (+/-) for liver dz sx

A

perinatally; high viral replication; HbeAg+; no sx of liver dz (nl ALT)

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19
Q

during their 20s or 30s, patient with perinatally acquired HBV progress to the _________ stage, in which they are positive on which HBV tests? What is their ALT level?

A

immune clearance stage; positive for HBeAg, anti-HBe and sometimes anti-HBc (IgM); ALT spikes

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20
Q

inactive carriers of HBV show what lab results? Biopsy results?

A

low levels of DNA and ALT; HBeAg NEGATIVE, but anti-HBe positive; liver biopsy may show active dz

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21
Q

the “pre-core mutant” is?

A

an HBeAg negative form of chronic hepatitis where the patient has developed an alternate form of the virus that does not produce HBeAg (the patient has anti-HBe but no HBeAg)

22
Q

resolution of chronic HBV infection is (common/rare) and patients who resolve HBV still have ______ even after clearance (risk of reactivation in immunosuppressed)

A

rare; cccDNA

23
Q

hep D is tranmitted by?

A

parenteral or sexual

24
Q

hep D is a ____ virus that is only seen in the setting of __________

A

delta (defective RNA virus); chronic hep B

25
Q

how is hep D dependent on hep B?

A

requirs HB surface antigen to replicate

26
Q

where is hep D endemic?

A

Mediterranean area

27
Q

HDV is most likely in a patient with progressive liver dz and _____ hep B DNA

A

inactive/suppressed

28
Q

microbiology of hep C

A

enveloped single-stranded RNA virus with 6 major genotypes

29
Q

HCV is transmitted?

A

parenterally (sexual transmission very rare)

30
Q

HCV is of particularly high prevalence in?

A

the middle east, Egypt

31
Q

HCV is of intermediate prevalence in?

A

eastern europe, mediterranean, south america, asia

32
Q

HCV is (more/less) likely to result in chronic hepatitis than HBV

A

more

33
Q

which HBC serotype is most common in the US? Which is most difficult to treat?

A

GT 1; GT 1

34
Q

which genotype is found in Egypt and the Middle East?

A

GT 4

35
Q

the majority of patients infected with HIV (resolve infx/get chronic HCV)

A

chronic HCV (85%)

36
Q

the majority of patients with chronic HIV (become stable/develop cirrhosis)

A

become stable (80%)

37
Q

the majority of patients with HCV cirrhosis (are stable/die)

A

stable (75%)

38
Q

HCV is the leading indication for what procedure?

A

liver transplant

39
Q

the majority of patients with chronic HCV have what symptoms?

A

none or fatigue, nonspecific complaints

40
Q

if a screening exam shows a high ALT, what HCV test should be performed?

A

anti-HCV

41
Q

if a patient is positive for anti-HCV, what test should be performed next?

A

HCV RNA to determine whether the infection is present or cleared

42
Q

factors promoting progression or severity of HCV infection

A

alcohol intake, steatosis, age > 40, HIV or chronic HBV co-infection, male gender

43
Q

common extrahepatic manifestations of HCV

A

arthralgia, skin manifestations, HTN, sicca syndrome (mouth, eyes)

44
Q

hepatitis E is most similar to what other hepatitis?

A

hep A

45
Q

hep E is (acute/chronic), icteric, and self-limiting

A

acute

46
Q

how is hep E transmitted?

A

fecal-oral via contaminated water

47
Q

is there a strong case for animal to human transmission of HEV?

A

NO

48
Q

how long is the incubation period for HEV, and what causes damage to the liver?

A

2-10 weeks; immune-mediated rxn

49
Q

clinical manifestations of HEV are ____

A

highly varied; may cause icterus

50
Q

HCV illness in _____ is milder, but in _____ can be fatal

A

children; pregnant women

Gastrointestinal (40 decks)

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