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Liver > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

HAV

A

Duration: Acute, self limited
Route of infection: Fecal-oral. (usually)
Outcome: asymptomatic in young, acute hepatitis in later ages
NO Chronic liver failure.
Rare acute liver failure
Immunization is available.
Immunity is lifelong.
No therapy.
No cancer

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2
Q

HAV

A

ssRNA Picornavirus.
40% of all acute viral hepatitis is HAV
Mortality <0.5%
Incubation: 15-50 days.
Virus secreted into bile and stool
11 days prior to formation of anti-HAV IgM (patients are infectious before they know they are ill).

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3
Q

HAV Diagnosis

A

HAV IgM: Acute or recent infection
HAV IgG: past infection or immunization.
Can be detected in stool: not performed.
PCR HAV: not performed.

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4
Q

HAV typical serologic course

A
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5
Q

HAV Prevention

A

Sanitation and hygiene, handwashing.
Inactivated HAV vaccine
Live, attenuated HAV vaccine
95% protective, >25 years duration
Vaccination in US at 1-2 years of age
First dose: protection by 2-4 weeks after vaccination
US incidence has dropped 90% since 1990
Verify titers in all liver disease patients: revaccinate.

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6
Q

HBV DNA Hepadnavirus

A

Duration: Acute, Chronic, Lifelong
Route of Infection: Blood, Sexual, Vertical
Usual outcome: Asymptomatic, Chronic, Fulminant
Chronic infection: Occasional (adults), common (infants).
Cirrhosis and Liver failure: common.
Acute liver failure: Occasional.
Immunization: Mandated, Available.
Therapy: Indirect, Direct, Variable success.
Malignancy: HBV is major cause of HCC.

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7
Q

HBV Epidemiology

A

240-350 million chronic infections worldwide.
750,000 die from HBV annually.
300,000 cases of liver cancer annually.
Sub-Saharan Africa, East Asian infection rates in adults: 5-10%.

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8
Q

Hep B The Details

A

Exposure to blood/body fluid, or at birth.
Endemic areas: infection at birth or in infancy.
Epidemic areas: IV drug use, sex, blood, other.
Incubation: 30-180 days.
Detection in blood: 30 days post infection.
Infection at birth: >90% develop chronic HBV.
Infection >5 years old <10% chronic HBV.
Most chronic carriers are asymptomatic.
In chronic disease: cirrhosis and liver CA can occur. Early mortality: 15-25%

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9
Q

Hep B Clinical

A
  • Acute hepatitis: typically self resolve, some are asymptomatic/unrecognized.
  • Chronic infection may be symptomatic or asymptomatic
  • Cirrhosis
  • HBV and HCV together account for 50% of HCC
  • Extra intestinal features: Membranous GN, Serum sickness, Cryoglobulinemia, Aplastic anemia
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10
Q

Hep B markers

A
  • HBsAg: surface antigen: first viral detectable antigen.
  • HBcAg: core antigen
  • Anti-HBc IgM: early serological evidence of infection.
  • “Window” HBsAg cleared, but anti-HBS still negative.
  • HBeAg: presence is associated with decline in replication.
  • Anti-HBs IgM: early clearance
  • Anti-HBs IgG: clearance of infection.
  • HBV PCR: quantitative assay of viral load.
  • ALT: evidence of chronic “hepatitis”
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11
Q

How to tell if a patient is immune to HBV due to vaccination:

A

anti HBS is positive
anti E antibody is absent
anti core antibody is absent

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12
Q

HBV Transmission

A

Highly infectious.
Vertical transmission: HBsAg+ mother: 20% transmission to infant.
HBeAg+: 90% infective.
Natural history: ultimately 1/4 die of HBV complications.
Can be transmitted within households.
Parenteral transmission
Sexual transmission.

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13
Q

Hep B prevention

A

Education
Screening of blood donors.
Screening of mothers
Vaccination.

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14
Q

HEP B therapy

A

Acute HBV is self resolving by definition: supportive care.
Chronic infections: candidates for therapy:
- persistently elevated ALT, appropriate levels of HB DNA
therapies vary by medication/dosage and genotype.

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15
Q

HEP B therapy meds

A

Antiviral drugs
Immune system modulators.

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16
Q

HCV

A

Duration: Chronic, lifelong
ROI: blood (rarely sexual, some vertical).
Common route: Parenteral blood exposure
Usual outcome: Asymptomatic, chronic
Chronic infection: typical
Cirrhosis and liver failure: common
Acute liver failure: rare
Immunization: not available.
Therapy: indirect, direct, excellent recent success.
Malignancy: Yes. Major cause of HCC

17
Q

HCV

A

ss RNA. 7 major genotypes. Genotype correlated with treatment success, particularly with IFN.
200 million people infected: 3% of the world.
11 million new cases per year.

18
Q

HCV

A

75-85% of infections become chronic.
Risk factors: IV drug use, medical equipment, needlestick, tattooing, incarceration.
vertical transmission occurs (rate is <10%, higher if mother is HIV+)
Sexual transmission rate low or very low for monogamous heterosexual couples.

19
Q

HCV Clinical

A

Acute HCV: symptomatic in 15%, fatigue, nausea, anorexia, weight loss, mostly anicteric. HCV infection resolves in 10-50%.
Chronic HCV >6 months.
Can be asymptomatic for decades.
ALT/AST can be normal in up to 50%.
10-30% develop cirrhosis by 3 decades.
Alcohol increases risk 100 fold.
other risk factors: male, HBV, HH (iron)
Many extraintestinal manifestations

20
Q

HCV Prevention

A

No vaccine
Education
Blood screening
Needle sharing/needle exchanges

21
Q

HCV Detection

A

HCV Ab EIA or ELISA
Qualitative and Quantitative HCV PCR.
Antibodies can take weeks to be detectable.
PCR detection at 1-2 weeks.
antibody is not protective.

22
Q

HCV Therapy

A

Direct Acting Antivirals (DAAs). Cure rates as high as 93-99%.
Immune Enhancing Regimens.
Liver transplantation

23
Q

HCV in children

A

incidence in pregnant mothers: 1-8%
Vertical transmission: 3-5 % (higher if mother is HIV+)
spontaneous clearance in 25-50%

24
Q

Hep D

A

ssRNA virus.
Can only replicate in presence of HBV.
Simulatneous infection of HDV
Superinfection of HDV in patients with HBV: results in more severe complications, increased liver failure.

25
Q

HEV

A

ssRNA
Fecal-oral transmission.
Incubation: 3-8 weeks
Short prodromal phase, virus is cleared early from blood, may persist in stool for weeks.
in pregnancy is associated with fulminant liver failure, 20% mortality if infected in 3rd trimester.

26
Q

Hep E prevention

A

Sanitation, personal hygiene
Vaccine, not yet licensed.

27
Q

TORCHES

A

Toxoplasma
“Others”
Rubella
Cytomegalovirus
Herpes
Enterovirus
Syphilis

28
Q
A
29
Q

Hepatitis B: Acute Infection with recovery

A
30
Q

Hepatitis B: Acute Infection: “Window:

A
31
Q

Hepatitis B Chronic Infection

A
32
Q

Hepatitis B Vaccination Results

A
33
Q

Hepatitis C Acute HCV Infection

A
34
Q

Hepatitis C Chronic Infection

A
35
Q

Hepatitis C Testing Sequence

A
36
Q

Hep D on Hep B Super-Infection

A
37
Q

Hep D and Hep B Confection

A
38
Q

Hepatitis E- HEV

A

Liver (2 decks)

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