Viral Hepatitis

Question 1

Hep A transmission and risk factors

Answer 1

transmission via water (fecal-oral) risk = international travel incubation period 2-7 weeks

Question 2

Hep A sx

Answer 2

prodromal period: fatigue, malaise, anorexia, fever, RUQ, lasts days - week

hepatitis:

• high ALT, AST
• mild “flu” to FHF no chronic phase
  
  • worse sx are from the immune response

Question 3

Hep A dx

Answer 3

HAV IgM

Question 4

who should be vaccinated for hep A?

Answer 4

clotting factor disorders

chronic liver disease

travel, exposure to people from areas w/ endemic HAV

Question 5

what to do post-Hep A exposure

Answer 5

HAV vaccine

immunoglobulin for pts at risk of severe illness

Question 6

how long is the incubation period for Hep A?

Answer 6

2-7 weeks

Question 7

E antigen functon in HBV

Answer 7

E antigen is soluble, secreted into blood – toleraizes the fetus to the infection, fetus can’t fight the virus and gets it –> VERTICAL transmission

Question 8

Answer 8

ground glass hepatocytes of HBV

Question 9

HBV incubation time

Answer 9

6 weeks –> 6 months

Question 10

what do these blood tests tell you:

• HBsAg
• total anti-HBc
• IgM anti-HBc
• Anti-HBs

Answer 10

Question 11

are older pts more or less likely to develop chronic HBV after an acute infection?

Answer 11

LESS

Question 12

blood tests in chronic HBV

Answer 12

HBsAg +, HBcAb-, IgG +

Question 13

fill in this table

Answer 13

Question 14

HBV transmission

Answer 14

contact w/ infected blood or body fluids - 100x more infectious than HIV

vertical transmission

horizontal - unsafe injections, sexual contact

Question 15

who do you tx w/ HBV? how?

Answer 15

acute HBV and HBeAg+ immune active phase

use tenofovir and entecavir

screen every 6-12 months w/ US and AFP blood test for HCC

Question 16

HDV - two methods of acquisition

Answer 16

coinfection: simultaneous intro of HDV and HBV
superinfection: intro of HDV into HBsAg-positive host

Question 17

dx for HDV

Answer 17

detectable HDV RNA

immuno-histochemical staining for HDV Ag

IgM HDV

Question 18

tx for HDV

Answer 18

IFN (conventional or PEG) only

measure HDV RNA to see if it is working

Question 19

Hepatitis E - incubation time

Answer 19

2-9 weeks

Question 20

Hep E clinical picture

Answer 20

may cause acute liver failure

chronic form possible in immunosuppressed

mortality 1%, but up to 20% in pregnancy

Question 21

Hep E transmission

Answer 21

water: fecal-oral

epidemic by contaminated water

developed countries: exposure to pigs, blood donors (very rarely transmittted now)

Question 22

HCV incubation time

Answer 22

2-26 weeks

Question 23

what is the leading cause of HCC, cirrhosis, liver disease death and liver transplant in US?

Answer 23

hep C!

but it takes 20-30 yrs to become destructive

Question 24

extrahepatic manifestations of HCV

Answer 24

hematologic: cryoglobulinemia, aplastic anemia, thrombocytopenia, B-cell lymphoma
renal: MP glomerulonephritis, nephrotic syndrome
dermatologic: porphyria cutanea tarda, lichen planus, leukocytoclastic vasculitis
vascular: polyarteritis nodosa
endocrine: glucose intolerance

Question 25

screening for Hep C

Answer 25

2012: recommended screening for all pts born 1945-1965 also: anyone with risk factors (drug use, tattoos, needle stick exposure, organ transplant \<1992, hx of dialysis, intimate contact - less common) or unexplained abnormal liver tests

Question 26

Hep C- dx

Answer 26

HCV nucleic acid detection (can also test for HCV antibody - but this only tells you if you were exposed, not about chronicity)

Question 27

staging of HCV

Answer 27

to determine if and how to tx, check for advanced fibrosis liver biopsy or fibroscan

Question 28

cure rate for HCV

Answer 28

60 - 90%

Question 29

Hep C - tx

Answer 29

used to use interferon - really unpleasant now there are a bunch of really good curative options