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GI/Nutrition > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

What are some clinical manifestations of acute viral hepatitis?

A
  • Fever
  • Malaise
  • Anorexia
  • Nausea
  • Vomiting
  • Jaundice
  • Abdominal/RUQ pain
  • Hepatomegaly
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2
Q

Which type of antibody is associated with acute hepatitis A? Which antibody persists after recovery from the disease?

A

IgM for acute

IgG persists after the disease (immunization)

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3
Q

What is recquired for a hepatitis A diagnosis?

A

Hep A ag

Hep A antibody (IgM) = acute (6 months)

Hep A IgG = indicates exposure although now immune

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4
Q

How do you prevent Hep A?

A
  • Hand washing
  • Sanitation
  • Immune Globulin
  • Hepatitis A vaccine
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5
Q

Who is recommended to have the Hep A vaccine?

A
  • Infants
  • People working in or traveling to areas with high incidence of HAV
  • People with chronic liver disease
  • People working with HAV
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6
Q

When should preventative immune globulin for Hep A be given to patients who do not have exposure?

A

When people are travelling and high HAV endemic region

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7
Q

Post exposure immune globulin should be given within ___ days of the exposure

A

14 days

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8
Q

In what year was the Hepatitis A vaccine licensed?

A

1995

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9
Q

What is the significance of IgG and IgM in Hep E infection?

A

IgG signifies a disease more than 6 months prior

IgM signifies acute disease (<6 months)

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10
Q

What is required for a Hep E Diagnosis?

A
  • Hep E ab
  • Hep E IgM = acute (<6 months)
  • Hep E IgG = previous exposure (>6months) and now immune (protective antibody)
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11
Q

Is there a vaccine for Hepatitis E?

A

No

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12
Q

In hepatitis B, what is the significance of surface antigen?

What is the significance of E antigen?

A

Surface antigen indicates an ongoing disease

E antigen indicates virus in the blood stream

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13
Q

In Hepatitis B, which antibody signifies immunity to the virus?

A

Surface antigen antibody

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14
Q

What is Seroconversion in Hep B?

A

Losing E antigen and developing E antibody

It indicates that the virus has left the bloodstream

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15
Q

What antibody is not present in chronic Hepatitis B?

A

Surface antigen antibody

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16
Q

What is required for a diagnosis of Hepatitis B? What is the signficance of core antibody?

A
  • Hep B Surface ag+ = current hep B (acute or chronic)
  • Hep B surface ab+ = immune (recovered from natural infection, vaccine)
  • Core antibody = natural exposure
    • IgM= recent exposure (<6 months)
    • IgG= old exposure (> 6 months)
17
Q

Unvaccinated infants should be vaccinated by what age (Hep B)?

A

11

18
Q

Which populations are at greater risk for Hep B infection?

A
  • People with multiple sexual partners
  • Sexual partners or household contacts of HBsAg-positive people
  • Homosexually active men
  • Users of illicit drugs
  • Travelers to regions of endemic disease ( > 6 months)
  • People occupationally exposed to blood or body fluids
19
Q

Is the incidence of Hepatitis B increasing or decreasing?

A

Decreasing since the 1980s

20
Q

How is the Hepatitis B vaccine administered?

How is it administered to newborns of infected mothers?

A
  • Give hepatitis B immune globulin (HBIG), preferably within 24 hours (but can be given up to a week after)
    • Second HBIG dose 1 month after first-or…
  • Hepatitis B vaccine, preferably within 24 hours but can be given up to a week after
    • Second dose of vaccine 1 month after first
    • Third dose of vaccine 6 months after first
  • In Hepatitis B surface antigen positive mothers, give newborn both HBIG and vaccine
21
Q

What are the goals of chronic HBV therapy?

A
  • Eliminate or significantly suppress HBV replication
  • Prevent progression to cirrhosis and possibly hepatocellular carcinoma (HCC)
  • ALT normalization
  • Histological improvement
  • Loss of HBeAg, development of HBeAb (seroconversion)
  • Loss of HBsAg
22
Q

How is liver cancer progression different between Hep B and Alcoholic liver disease?

A

In Hep B, the liver does not have to go through cirrhosis before progression to liver cancer

23
Q

Medication for Hep B can be stopped after elimination of _____

A

E antigen (seroconversion)

24
Q

What are the two mechanisms of treating Hepatitis B?

A

Activating the immune system (Immunomodulators)

Antiviral therapy (nucleosides/nucleotiedes)

25
Q

What is used to activate the immune system in HBV therapy?

What enzyme is blocked by nucleosides/nucleotides?

A

Interferons

Reverse transcriptase

26
Q

What is the difference between Interferon-alfa-2B and Peg-interferon-alfa-2a?

A

Peg-interferon alfa-2a is a slow release preparation

27
Q

What two drugs are considered first line therapy for HBV?

A

Entecavir and Tenofovir (low resistance rates) - Viral therapy

28
Q

When should Peg-IFN be used and what are its side effects?

A

It should be used in HBV with low viral load and high ALT/AST

  • SE:
    • flu-like symptoms
    • neuropsychiatric symptoms/depression
    • bone marrow depression
29
Q

What percentage of HBV patients reach seroconversion/ALT normalization with therapy?

What percentage get the Surface antigen antibody?

A

30%

5-7% get surface antigen antibody

30
Q

What is the difference between a co-infection with HDV and a superinfection with HDV?

A

Co-infection occurs in patients with acute HBV who develop HDV at the same time (infection < 6months)

Super infection is a person with chronic hepatitis B who acquires hepatitis D

31
Q

In which type of infection does the IgG antibody for HDV go away?

A

Acute HBV/HDV co-infection (IgG does not go away with chronic infection/super infection)

Note: IgM goes away in both

32
Q

When did widespread blood screening begin in the US, significantly decreasing cases of HCV? What other disease did this decrease correlate with?

A

1992; HIV (many of the same risk factors)

33
Q

What are the two types of protein for HCV?

A

Structural and non-structural (viral replication)

34
Q

How is Hep C diagnosed?

A

Requires presence of Hep C viral RNA (indicates active infection)

Hep C antibody seen in all exposures (never clears even with clearance of disease so cannot be used for diagnosis)

35
Q

What percentage of patients with acute HCV progress to chronic HCV? What is the difference

A

80%

Chronic HCV is more likely to show symptoms and viral RNA does not clear

36
Q

What is the target of the newer HCV medications? (Ledipsavir and Sofosbuvir)

A

Non-structural proteins (direct acting antivirals)

GI/Nutrition (36 decks)

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