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GI > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

Where is hepA commonly transmitted?

A

daycare, prison, travelers etc

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2
Q

Where is HepA most commonly found?

A

S America, Africa, SE Asia

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3
Q

How is HepA transmitted?

A

fecal oral, very high content in feces

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4
Q

What is the incubation period for HepA?

A

4 wks (2-6)

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5
Q

What type of genetic material does HepA have?

A

RNA

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6
Q

What are the symptoms of acute HepA?

A

fever, malaise, anorexia, nausea, vomiting, jaundice, abdominal/RLQ pain, hepatomegaly

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7
Q

Are adults or children at higher risk for infection? do adults or children get more symptoms?

A

adults get more symptoms but are at lower risk of infection

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8
Q

Is a hepA infection usually acute or chronic?

A

acute

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9
Q

What is seen in serology with a hepA infection?

A

ALT spike from 1-2mo, overlaps wtih symptoms
Anti-HAV IgM-indicates active infection (acute <6mo)
Anit-HAV IgG-indicates previous exposure and reocvery//immunity/vaccination

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10
Q

How can HepA be prevented?

A

hygeine/sanitation
immune globulin pre and post exposure
HepA vaccine

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11
Q

Who is the Hep A vaccine recommended for?

A

infants
ppl who work or are traveling to areas with high incidence of HAV
ppl w/chronic liver disease

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12
Q

When in HAV immune globulin given?

A 
pre exposure to travelers going to high HAV region
post exposure (w/i 14 days) of exposure to household/intimate contact, daycare centers w/outbreak
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13
Q

Who is at greatest risk of death from a HepE infection?

A

pregnant women (15-45% mortality)

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14
Q

Is a HepE infection usually acute or chronic?

A

acute

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15
Q

Where is HEV most commonly found?

A

N Africa, SE Asia, likely underreported due to lack of monitoring in many countires

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16
Q

Is there and HEV vaccine?

A

no

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17
Q

What are the signs/symptoms of an acute HEV infection?

A

fever, malaise, anorexia, nausea, vomiting, jaundice, abdominal/RLQ pain, hepatomegaly

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18
Q

What serology findings are found in a patient w/HEV?

A

ALT spike 1-2 mo, overlaps w/symptoms, overlaps w/onset of HgM and IgG response
Anti-HEV IgM-indicates active infection (acute <6mo)
Anti-HEV IgG-indicates recovery/immunity (protective)

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19
Q

Is HepB usually an acute or chronic infection?

A

chronic

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20
Q

Is HepC usually an acute or chronic infection?

A

chronic

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21
Q

What is HepD?

A

incomplete RNA virus that requires HBsAg to replicate

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22
Q

How is HepD transmitted?

A

sexual, blood

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23
Q

What serology is seen in HBV/HDV COinfection?

A 
ALT spikes w/symptoms, then disappears
HBsAg/HDV RNA;present briefly
Anti-HDV IgM-acute infection
Anti-HDV IgG
Anti-HBs
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24
Q

What is unique about anti-HDV IgG?

A

disappears and is not protective!

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25
Q

What does Anti-HBs indicate?

A

ability to clear the infection (HBsAg required for replication)

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26
Q

Does coinfection or superinfection have a greater chance of causing chronicity?

A

superinfection

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27
Q

Does coinfection or superinfection cause more severe symptoms?

A

coinfection

28
Q

What serology is seen with HBV/HDV SUPERinfection?

A 
ALT-fluctuates
HBsAg/HDV RNA-persists
Anti-HDV IgM-acute infection
Anti-HDV IgG-persists
No Anti-HBs
29
Q

What does coinfection mean?

A

simultaneous acquisition

30
Q

What does superinfection mean?

A

HBV then HDV

31
Q

What is HepB?

A

chronic DNA virus

32
Q

How is HepB transmitted?

A

sexually or via IVDU

33
Q

Is HBV more likely to become chronic in kids or adults?

A

more chrnoic in newborns

34
Q

Does HBV cause more symptoms in adults or kids?

A

adults

35
Q

Where is HBV most commonly found?

A

Africa, SE Asia, Alaska, Canada

36
Q

What is the incubation period for HBV?

A

60-90 days

37
Q

Where is HBV concentration highest in infected persons?

A

highest: blood, serum, wounds
mod: semen, vaginal, saliva
low: breastmilk, feces

38
Q

What is the natural progression of HBV infection?

A
  1. acute infection
  2. chronic infection
  3. cirrhosis
  4. liver faulture/liver CA (go directly to liver CA w/o cirrhosis)
  5. liver transplant or death
39
Q

What are the goals of HBV therapy?

A
  1. eleiminate/suppress HBV replication
  2. prevent progression to cirrhosis and HCC
  3. ALT normalizaiton
  4. histological improvement
  5. Loss of HBeAg, development of HBeAb
  6. Loss of HBsAG
40
Q

What is seroconversion?

A

loss of HBeAg and development of HBeAb

spontaneous immune response against envelope protein

41
Q

What is the best time to give HBV IVIG?

A

w/in 24hrs of exposure preferrably, but up to a week)

42
Q

Who gets the HBV vaccine?

A

all infants and previously unvaccinated children by age 11

those exposed to HepB in last 24hrs-wk

43
Q

What is the treament for a newborn of a HBsAg positive mother?

A

HBIG and vaccine

44
Q

What are the chronic therapy drugs?

A

interferon
PEG-IFN (works in low viral load, High ALT/AST pts) provides best chance of eradication
Nucleotide/nucleoside inhibitors Ientecavir/tenofovir)

45
Q

What are the side effects of IFNs?

A

flu-like sx
bone marrow depression
neuropsych sx

46
Q

What are the serologic findings in acute HBV infection?

A

HBsAg: appears 2-8wks post exposure, last up to 4mo
HBeAg/HBV DNA-after HBsAg but before HBsAb
Anti-HBe
Anti-HBc Igm
Anti-HBc IgG
Anti-HBs

47
Q

What does anti-HBcIgM indicate?

A

acute HBV infection

48
Q

What does anti-HBc IgG inidcate?

A

previous exposrue to HBV (lifelong)

49
Q

What does Anti-HBs indicate?

A

PROTECTION!

marker of immunization or recovered from natural infection

50
Q

What serology findings in chronic HBV infection?

A

HBsAg-lasts longer than 6mo (def of chronic)
HBeAg/HBV DNA: persists longer than in acute
Anti-HBe-develops in a small amt of pts (seroconversion)
Anti-HBc IgM
Anti-HBc IgG
***Anti-HBs never develops in chronic infection

51
Q

What is an important differences in HBeAg/HBV DNA duration in acute vs chronic HBV?

A

lasts longer in chronic, differentiates healthy chronic carrier from infective chronic carrier

52
Q

What type of infxn does a person with HBsAg have?

A

current HepB (acute or chronic)

53
Q

What does anti-HBc indicate?

A

natural exposure (IgM-recent IgG-old exposure)

54
Q

What is HCV?

A

chronic RNA virus

*HUGE virion production (10^12 daily)

55
Q

How is HCV transmitted?

A

IVDU, sexual, potentially blood transfusions before 1992

56
Q

Where is HCV most commonly found?

A

high in US, E Europe, W Pacific, SE Asia

57
Q

What is the normal progression of HCV?

A
  1. exposure and acute phase
  2. chronic
  3. cirrhosis
  4. ESLD or HCC
  5. Transplant or death
58
Q

What is the incubation period of HCV?

A

6-7 wks

59
Q

What are the most common HCV genotypes in the US

A

1A, 1B, 2, 3

60
Q

What is an important clincial presentation of HCV?

A

fibrosis

-variable rates of progression (slow w/low LT complications, fast w/high LT complications)

61
Q

What increases the likelyhood of a fast fibrotic progression in pts w/HCV?

A

EtOH
obesity
other liver disease

62
Q

What serology is seen in chronic HCV?

A

ALT-spike 2-4mo, stays elevated but fluctuates
HCV RNA- confirms chronic infection/viral load (2-4 wk)
Anti HCV IgM
Anti HCV IgG-indicates active infection or recovery, non protective

63
Q

What changes in serology occur during acute HCV reaction?

A

no change anti-HCV, HCV RNA goes away (<6mo)

ALT normalizes

64
Q

How is HCV diagnosed?

A

HepC Ab in all exposures, even thought that spontaneously clear virus/have successful tx
HepC viral RNA-those who are viremic only

65
Q

How is HCV treated?

A

Interferon therapy

Polymerase Inh, Protease Inh

66
Q

What evidence suggests that HCV has been eradicated?

A

undetectable virus 6mo after completion of therapy

GI (20 decks)

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