Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI 2 > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

Clinical manifestations of Acute viral hepatitis

A
  • Fever
  • Malaise
  • Anorexia
  • Nausea
  • Vomiting
  • Jaundice
  • Abdominal/RUQ pain
  • Hepatomegaly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Understand Hep A virus serology

A

refer to image

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When do you have symptoms with Hep A virus?

Where do you see virus in body?

A

Symptoms peak at 1 month post exposure with high ALT

fecal HAV high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What lab is ordered if pt is suspected of HAV infeciton?

A

Order Hep A IgG test~ if comes back +, run for IgM to tell if it’s acute or old infection of over 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When does IgM anti HAV peak?

IgG anti-HAV?

A

peaks at 3 months, then goes down

IgG starts to rise as 1 month and stays elevated= IMMUNITY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do you prevent HAV

A
  • Hygiene (e.g., hand washing)
  • Sanitation (e.g., clean water sources)
  • Immune globulin (pre- and post-exposure)
  • Hepatitis A vaccine (pre-exposure)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Who do we recommend to recieve the Hep A vaccine?

A

Recommended for:
– Infants
– People working in or traveling to areas with high incidence of HAV
– People with chronic liver disease
– People working with HAV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hep A:

____virus

____transmission

infection and serotypes:

Incubation period:

A

Hep A

RNA virus

fecal-oral transmission

inucbates for about 4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

A patient of yours is going to an HAV infected area, what do you do for your pt?

A

Give patient the hepatitis A immunoglobulin; better then vaccine and you would need booster in 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

A pt of yours works at a daycare and just found out several of her kids have Hep A

What do you recommend?

A

Give pt the Hep A immunoglobulin if it’s w/in 14 days

recommend all her contants get it too

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Area of HAV prevealance

is it chronic?

is it symptomatic?

A

Prevelant in S. America, Africa, Asia

not chonic

more sypmtomatic in adults (70%) and only 10% in children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What body fluids is HepA concentrated in?

A

Feces

Serum

Saliva

NOT urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Understand Serology of Hep E virus

A

Understand serology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Transmission of Hep E:

Incubation period:

Case-Fatality:

A

Transmission: fecal-oral, contaminated water, minimal person-person contact, recent travel to endemic area

Incubates 40 days

Case fatality: ovearll 1-3% pregnant women 15-45%

no chronicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When do we see Symptoms in Hep E pts?

A

Symtpoms when ALT rises during 5 months post exposure

see virus in stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When do we see increase in IgG and IgM in Hep E infection

A

IgG increases at 2 months and stays elevated

IgM rises and goes back down after 6 months and is present during acute infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do you diagnose Hep E?

A

• Hep E ab (there is no tx for Hep E)
• Hep E IgM = acute (<6 months)
• Hep E IgG = previous exposure (>6months) and now immune
***protective antibody

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Acute Hep B:

describe HBeAg and anti-HBe

A

in acute; HBeAg elevated and then there is seroconversion to anti-HBe

this is spontaneous and generally occurs around week 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

In the pt that clears Hep B virus, when do we see the peak in HBsAg

A

peaks at week 12 then goes back down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

In acute Hep B what does the total anti-HBc stand for?

A

its teh core antigen for IgM and IgG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the sign that you are immune to hep B?

A

At 32 weeks there is increase in anti-HBs which means you are immune

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Hep B is a _____virus

who does it infect?

Incubation period?

Acute-fatality:

A

DNA virus

infects humans and some primates

incubation is 60-90 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Hep B

  • Acute case-fatality :
  • Chronicity determined by :
  • Premature mortality from chronic disease 15%-25%
  • Leading cause of ________worldwide
A

0.5%-1%

age at exposure

hepatocellular carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Understand chronic Hep B

A

know figure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Why do we have chronic hep B?

A

there is no seroconversion from HBeAg to anti-HBe

the E antibody never develops and viral load never gets cleared

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the window period in Hep B?

A

The HBsAg will increase at week 4 adn then goes back down at 24 weeks

the anti-HB IgG will start to rise at 32:

there is an 8 week window to detect Hep B core antigen

28
Q

• Hep B Surface ag+ =

A

current hep B
(acute or chronic)

29
Q

• Hep B surface ab+ =

A

immune
(recovered from natural infection, vaccine)

30
Q

Hep B

• Core antibody = _______
IgM= recent exposure (
IgG= old exposure (> 6 months)

A

natural exposure

31
Q

Candidates for HBV vaccine

A

• Routine immunization
• All infants and previously unvaccinated children by age 11
• Increased risk for HBV
 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
 Clients or staffs of institutions for developmentally disabled persons
 Patients with chronic renal failure
 Patients receiving clotting-factor concentrates

32
Q

Chronic Hep B virus is more common in adults or children

A

children, adults that get Hep B usually have acute infection

Hep B infection is done via vertical transmission

33
Q

You have pt with Hep B exposure in unvaccinated patients, what can you do for them?

A

• Give hepatitis B immune globulin (HBIG), within 24 hours or 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

34
Q

• In Hepatitis B surface antigen positive mothers,
give newborn

A

both HBIG and vaccine

35
Q

CHRONIC HEPATITIS B:
GOALS OF 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
36
Q

What are modes of intervention in the treatement of chornic hepatits B infection

A

Antiviral therapy; works by smoking out virus or blocking DNA/RNA synthesis

Immune response targeted such as immunomodulatorys or antiviral therapy to rev up immune system; these are interfeurons.

37
Q

How does chronic Hep B Interferon work?

A

• Interferon
 proteins (cytokines)
 released by host cells when infected by viruses
 activate immune system.

38
Q

Chronic Hep B therapy works with nucleotide/nucleoside analogues:

A

block reverse transcriptase thats necessary for HBV replication; this is enough to acocmpish seroconversion, if you don’t achieve seroconversion, need to stay on drugs

39
Q

Two recommended Hep B treatments that are nucleotide/nucleoside analogues

A

Entecavir; nucleoside no resistance

Tenofovir; nucleotide, no resistance develops

These are both 1st line therapies

Peg-IFN has potential in specific population (low viral load, high ALT/AST) gives chance for eradication

40
Q

Side effect of Peg-INF

A

 flu-like symptoms
 neuropsychiatric symptoms/depression
 bone marrow depression

41
Q

Goal of Hep B therapy:

  • Eliminate or significantly suppress HBV replication:
  • Prevent progression to :
A

approx. 30% after therapy discontinuation

cirrhosis and possibly HCC

42
Q

Therapy: for HBV

• ALT normalization: approx. ___
• Histological improvement
• Loss of HBeAg, development of HBeAb
(seroconversion): approx. ___%
• Loss of HBsAg: approx. ___%

A

• ALT normalization: approx. 30%
• Histological improvement
• Loss of HBeAg, development of HBeAb
(seroconversion): approx. 30%
• Loss of HBsAg: approx. 5-7%

43
Q

Understand serology of Hep B/D coeinfection

A

person exposed to both at the same time. Pt clears Hep B and will still have anti-HB but anti-HD goes down

44
Q

Concentration of HBV in various body fluids

A

High in blood, serum, wound exudates

some in semen, vaginal fluid but low in urine, feces, sweat, tears

Hetero/homosexual men at high rish

45
Q

What does a Hep B-D Superinfection look like on serology?

A

Pt will have chronic Hep B, later time will get Hep D and will have chroinc infection of both

Ig-M from Hep D will go back down but IgG for Hep D don’t decrease

Have chronic levels of HDV RNA and HBsAg

46
Q

Diagnosis Hep D with antigens

A

• Hep D IgM = acute infection (< 6 months)
• Hep D IgG= previous exposure (> 6 months)
 IgG is not protective antibody

47
Q

Natural history of HBV infection: starting with acute

A

acute–> chronic in 90% children, 10% adults

Chronic–> cirrhosis 30% time

Chronic–> Liver cancer without going to cirrhosis 5-10%

Cirrhosis–> liver fail

48
Q

Hep C is what kind of virus?

A

RNA, spherical

Half-life = 2.7 hours

Daily production= 10 to 12 virions

some in US, all over the world with wide genotype distribution

1a most common in US

49
Q

Hep C antibody seen in all exposures and
remains present in all patients including those
who spontaneously clear the virus or undergo
successful treatment; what is present in only people that are viremic?

A

• Hepatitis C viral RNA is present only in those
who are viremic

50
Q

Understand Hep C serology

A

know this diagram

51
Q

When do we see anti-HCV in pts?

A

starts to rise at 2 months, peaks at 6 months and stays elevated

*have HCV RNA present in blood w/in two weeks

52
Q

Pattern of Hep C from acute to chronic infection

A

HCV RNA levels persist

53
Q

What antivirals are there for Hep C?

A

Sofosbuvir/Ledipasvir

54
Q

Cuase of Hep C

A

IVdrug use

55
Q

How does fibrosis progress in Hepatits pts?

A

variable progression of fibrosis over time

56
Q

HBsAg: negative
anti-HBc : negative
anti-HBs: negative

A

Susceptible to Hep B

57
Q

HBsAg : negative:

anti-HBc positive
anti-HBs positive

A

Immune due to natural infection

58
Q

HBsAg negative
anti-HBc negative
anti-HBs positive

A

Immune due to hepatitis B vaccination

59
Q

HBsAg positive
anti-HBc positive
IgM anti-HBc positive
anti-HBs negative

A

Acutely infected

60
Q

HBsAg positive
anti-HBc positive
IgM anti-HBc negative
anti-HBs negative

A

Chronically infected

61
Q

Hepatitis B surface
antibody (anti-HBs):

A

The presence of anti-HBs is generally interpreted as
indicating recovery and immunity from hepatitis B
virus infection. Anti-HBs also develops in a person
who has been successfully vaccinated against hepatitis B

62
Q 
IgM antibody to hepatitis B
core antigen (IgM anti-HBc):
A

Positivity indicates recent
infection with hepatitis B
virus (<6 mos). Its presence
indicates acute infection.

63
Q

Total hepatitis B core
antibody (anti-HBc):

A

Appears at the onset of symptoms in acute
hepatitis B and persists for life. The presence of anti-HBc indicates previous or ongoing infection with
hepatitis B virus in an undefi ned time frame

64
Q

Hepatitis B surface
antigen (HBsAg):

A

A protein on the surface of hepatitis B virus; it can
be detected in high levels in serum during acute or
chronic hepatitis B virus infection. The presence of
HBsAg indicates that the person is infectious. The
body normally produces antibodies to HBsAg as
part of the normal immune response to infection.HBsAg is the antigen used to make hepatitis B vaccine.

65
Q

Hep B window period

A

both serological markers HBsAg (Hepatitis B surface antigen) and Anti-HBs (antibodyagainst HBsAg) are negative (which is due to the fact that, although there are Anti-HBs antibodies present, they are actively bound to the HBsAg). Other serological markers, IgM (antibody) against HBc can be positive at this point but person wont be infective

GI 2 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions