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GI_EB > Viral hepatitis > Flashcards

Viral hepatitis Flashcards

1
Q

Hepatitis ____ and ____ virus are transmitted by the fecal oral route and cause acute, self limited illness but not chronic infection

A

HAV

HEV

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2
Q

In HAV infection, injury to the liver occurs mainly due to _________

A

host immune response to virus

CD8 T cells, NK cells, gamma interferon

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3
Q

Where does HAV still occur in the US?

A

Coastal and southern states
chronic care institutions
day care centers

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4
Q

How is HAV transmitted?

A

fecal-oral route

most cases are sporadic- person to person transmission within households, daycare centers

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5
Q

Describe the causes of point source outbreaks of HAV

A

shellfish, raw fruits and vegetables

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6
Q

Describe the clinical manifestations of HAV

A

Self limited, clinically silent in children and mild symptoms and jaundice in adults
possible dark urine, clay colored stools, ALT and AST elevation
rarely: rashes, arthritis, optic neuritis

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7
Q

Fecal shedding in HAV begins _______ and can last _______

A

begins 1-2 weeks before symptoms of jaundice

can last until 2 weeks after symptom onset

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8
Q

HAV can occasionally cause _________, particularly in patients with co-morbid chronic HCV infection

A

acute liver failure

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9
Q

How is HAV diagnosed?

A

anti-HAV IGM is detectable as soon as symptoms occur and can be detected for up to 6 months
IgG is detectable 2-8 weeks after symptom onset and remains positive for life

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10
Q

What is the treatment for HAV?

A

supportive therapy, work restrictions if food service industry
refer for liver transplant if acute liver failure

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11
Q

Who should be vaccinated against HAV?

A

All children born in US

Patients with chronic liver disease, immunocompromised, MSM, IVDU, travelers to endemic areas

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12
Q

In individuals who have been exposed to HAV, what is appropriate post exposure prophylaxis?

A

HAV vaccine, Ig available for people over 40 with chronic liver disease

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13
Q

What is the most common route of HEV exposure?

A

contaminated water and food

person to person is less common

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14
Q

Who is at risk of acute liver failure with HEV?

A

Pregnant women especially in final trimester

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15
Q

What form of HEV is common in the US? In the developing world?

A

US: endemic form, zoonotic transmission especially from pigs

Developing world: sporadic form, spread by contaminated water, fecal-oral

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16
Q

How is a diagnosis of HEV made?

A

anti-HEV antibody in serum or HEV PCR from serum or stool

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17
Q

________ has been reported to be effective in treating immune suppressed patients with HEV infection

A

Ribavirin

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18
Q

What is the treatment for acute infection with HEV?

A

supportive care

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19
Q

________ is useful clinically as a serum marker of viral replication. In contrast,______ accumulates in the cytoplasm of the infected hepatocyte and is utilized for
incorporation in complete virions.

A

HBeAg

HBcAg

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20
Q

What is the major mode of injury in HBV infection?

A

immune mediated

HLA class I restricted cytotoxic T-cell (CTL) response directed at HBcAg/HBeAg on HBV-infected hepatocytes leads to hepatic inflammation

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21
Q

What is the predominant method of transmission of HBV in areas where the virus is endemic?

A

Vertical

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22
Q

HBV requires ________ in the mucosal membrane in order to infect

A

a break in lining of mucosal membrane

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23
Q

Infectivity of chronically infected persons is highest amongst those who are _______+

A

HBeAg+

associated with higher serum HBV DNA

24
Q

Chronic infection is more likely in people who are infected with HBV when they are (young/old)

A

young
90% of infants
25-50% of children
5% of adults

25
Q

The_____ is a marker of the infectious viral material and it is the most accurate index of viral replication

A

HBcAg

26
Q

_________ appears during weeks 3 to 6 indicates an acute active infection at its most
infectious period, and means that the patient is infectious.
Persistence of this virological marker beyond 10 weeks shows progression to chronic infection and infectiousness.

A

Hepatitis B e antigen HBeAg

27
Q

______ antibodies do not neutralize the HBV virus

A

Anti-HBc

IgG and IgM types

28
Q

______ antibodies do neutralize HBV and provide protection against HBV infection

A

Anti-HBs

29
Q

Liver biopsy in HBV infection can show:

A

chronic hepatitis
ground glass hepatocytes
core Ag in nucleus with immunohistochemistry

30
Q

_________ was the first vaccine against human cancer

A

HBV vaccine

31
Q

How can transmission to an infant of an HBV infected mother be prevented?

A

Vaccine and HBIG

32
Q

How is acute HBV infection treated?

A

Supportive

if severe, oral antivirals

33
Q

What oral antiviral drugs are used in severe acute HBV infection?

A

entecavir, tenofovir- nucleoside analogs

lamivudine- blocks reverse transcriptase step

34
Q

What treatments are used for chronic HBV infection?

A

antivirals

immune modulators including interferons

35
Q

_________ is a defective RNA virus that is only infectious in the setting of active HBV infection

A

HDV

36
Q

________ of HBV and HDV usually resolves. ______, however, frequently causes chronic HDV infection and chronic active hepatitis

A

coinfection

superinfection

37
Q

How is HDV diagnosed?

A

measurement of anti-HDAb IgM and IgG.

38
Q

How is HDV treated?

A

high dose interferon

Lamivudine is helpful for HBV but not beneficial for chronic HDV

39
Q

How is HDV prevented?

A

Prevention of HBV

40
Q

List factors associated with increased risk of HCC in the setting of HBV

A
  • higher levels of HBV DNA
  • HBV infection in early childhood
  • male
  • cirrhosis
  • smokers
  • aflatoxin exposure
41
Q

_________ of HBV DNA can cause disruptions in the expression of tumor supressor genes and proto-oncogenes

A

integration into host genome

42
Q

______ should be monitored regularly in HBsAg carriers to screen for early development of HCC

A

serum alpha fetoprotein

liver ultrasound

43
Q

List sources of HCV infection

A

IVDU> sexual> transfusion> hemodialysis, vertical, non-sexual contact

44
Q

The risk of transmitting HCV via sexual contact is ______

A

low

45
Q

Unlike HBV, which is a DNA virus, HCV is an RNA virus and it does not _______

A

integrate into the human (host) genome.

46
Q

HCV genotype influences:

A

responsiveness to interferon alpha therapy

47
Q

What is responsible for the liver damage in HCV

A

HCV is not directly hepatotoxic

Cytotoxic T cells

48
Q

______ becomes chronic in more than 70% of infected adults

A

HCV

49
Q

What factors cause an accelerated rate of progression of cirrhosis?

A

heavy alcohol use
male sex
older age at infection
HIV co infection

50
Q

Unlike HBV infection, the HCC risk is not increased prior to development of ________.

A

cirrhosis

51
Q

How is diagnosis of HCV made?

A

ELISA confirmed with HCV RNA PCR

52
Q

What does liver biopsy show in chronic HCV?

A

chronic interface hepatitis
lymphoid aggregates
occasionally steatosis

53
Q

How is acute HCV treated?

A

treatment with PEGylated interferon alpha during the acute phase reduces the risk of conversion to chronicity

54
Q

What therapies used to be used for chronic HCV?

A

interferon + ribavirin

55
Q

Patients infected with genotype ____ of HCV tend to have a poor response to interferon + ribavirin

A

1

56
Q

______ and ______ are protease inhibitors used to treat chronic HCV

A

telaprevir and boceprevir

57
Q

What is currently considered standard of care in HCV treatment?

A

combination therapy with oral direct acting agents only

GI_EB (39 decks)

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