Viral hepatitis

Question 1

What are 3 disease-defining symptoms of viral hepatitis?

Answer 1

1) Tea coloured urine, yellow sclera
2) Abdo/ankle swelling
3) Hematemesis, melena

Question 2

What are 3 points in a px Hx that may suggest viral hepatitis?

Answer 2

1) HPI:
- prodromal symptoms
- disease-defining symptoms (jaundice, portal HTN, edema)

2) Social Hx
- contact Hx
- risk factors

3) Family Hx
- of chronic viral hepatitis

Question 3

What are 4 PE findings that are suggestive viral hepatitis?

Answer 3

1) Jaundice
2) Stigmata of chronic liver disease (eg. spider angiomas, palmar erythema)
3) Hepatomegaly
4) Splenomegaly
5) Mental state
6) Ascites/ankles edema

Question 4

What are 4 complications of chronic hepatitis?

Answer 4

Cirrhosis:
1) Jaundice
2) Ascites
3) Ankle edema
4) Variceal hemorrhage

Liver failure:
5) Coma

6) Liver Cancer

Question 5

What are 3 supportive tests for viral hepatitis?

Answer 5

1) Liver function test (ALT, AST)

2) Severity
- serum bilirubin
- PT

3) Chronicity
- serum bilirubin, plateley count
- US abdo

4) Others
- Plasma NH4+
- drug levels, liver auto Abs (exclude other etiologies)

Question 6

What are 5 tests for etiologic confirmation of viral hepatitis?

Answer 6

1) Anti-HAV IgM
2) HBsAg
3) Anti-delta (total)
4) Anti-HEV IgM, IgG, HEV< RNA
5) Anti-HCV, IgG, HCV RNA

Question 7

What are 4 tests to determine hepatic viral activity?

Answer 7

1) Anti-HBc IgM
2) HBeAg, Anti-HBe
3) HBV DNA
4) Stool HEV RNA

Question 8

Which px would have a poor prognosis of acute hepatitis?

Answer 8

1) Progressive ↑bilirubin and PT

2) Change of mental state/asterixis

3) Elderly

4) Underlying Cirrhosis

Signs of acute fulminant liver failure/irreversible hepatic decompensation from cirrhosis → Liver transplant

Question 9

What are 4 supportive treatments for acute viral hepatitis?

Answer 9

1) Maintain normal electrolytes and glucose levels

2) Maintain good enteral nutrition

3) Lactulose → promote bowel movement → prevent hepatic encephalopathy

4) IV Vit. K supplement

5) Ursodeoxycholic acid (2° bile acids)

Question 10

How would you monitor a px progress after Rx?

Answer 10

1) Regular PE
2) Serial blood tests (PT, LFT, Renal function)

Question 11

What are the specific treatments for HAV, HBV, HEV?

Answer 11

None

Question 12

What are the specific treatments for HCV?

Answer 12

DAA (direct acting antiviral)

Question 13

What are the specific treatments for chronic HBV/HDV?

Answer 13

1) Nucleot(s)ide analogs (oral)
- eg. entecavir, tenofovir

2) Pegylated interferon

Question 14

What are the specific treatments for chronic HCV?

Answer 14

Direct antivirals (eg. sofosbuvir)

Question 15

What are the specific treatments for chronic HEV?

Answer 15

Ribavirin

Question 16

True or false.
Patients with chronic hepatitis should be given prophylaxis vaccination against other hepatitis viruses.

Answer 16

True

Question 17

What are the supportive treatments for chronic viral hepatitis?

Answer 17

1) Low salt diet
2) Diuretics (spironolactone)
3) ß-blockage, endoscopic treatment of esophageal varices
4) Control hepatic encephalopathy (eg. lactulose, rifaximin, maintain normal serum electrolytes and glucose)
5) Maintain good enteral nutrition