Viral Hepatitis Flashcards
Hep A transmission and risk factors
transmission via water (fecal-oral) risk = international travel incubation period 2-7 weeks
Hep A sx
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
Hep A dx
HAV IgM
who should be vaccinated for hep A?
clotting factor disorders
chronic liver disease
travel, exposure to people from areas w/ endemic HAV
what to do post-Hep A exposure
HAV vaccine
immunoglobulin for pts at risk of severe illness
how long is the incubation period for Hep A?
2-7 weeks
E antigen functon in HBV
E antigen is soluble, secreted into blood – toleraizes the fetus to the infection, fetus can’t fight the virus and gets it –> VERTICAL transmission
ground glass hepatocytes of HBV
HBV incubation time
6 weeks –> 6 months
what do these blood tests tell you:
- HBsAg
- total anti-HBc
- IgM anti-HBc
- Anti-HBs
are older pts more or less likely to develop chronic HBV after an acute infection?
LESS
blood tests in chronic HBV
HBsAg +, HBcAb-, IgG +
fill in this table
HBV transmission
contact w/ infected blood or body fluids - 100x more infectious than HIV
vertical transmission
horizontal - unsafe injections, sexual contact
who do you tx w/ HBV? how?
acute HBV and HBeAg+ immune active phase
use tenofovir and entecavir
screen every 6-12 months w/ US and AFP blood test for HCC
HDV - two methods of acquisition
coinfection: simultaneous intro of HDV and HBV
superinfection: intro of HDV into HBsAg-positive host
dx for HDV
detectable HDV RNA
immuno-histochemical staining for HDV Ag
IgM HDV
tx for HDV
IFN (conventional or PEG) only
measure HDV RNA to see if it is working
Hepatitis E - incubation time
2-9 weeks
Hep E clinical picture
may cause acute liver failure
chronic form possible in immunosuppressed
mortality 1%, but up to 20% in pregnancy
Hep E transmission
water: fecal-oral
epidemic by contaminated water
developed countries: exposure to pigs, blood donors (very rarely transmittted now)
HCV incubation time
2-26 weeks
what is the leading cause of HCC, cirrhosis, liver disease death and liver transplant in US?
hep C!
but it takes 20-30 yrs to become destructive
extrahepatic manifestations of HCV
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
screening for Hep C
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
Hep C- dx
HCV nucleic acid detection
(can also test for HCV antibody - but this only tells you if you were exposed, not about chronicity)
staging of HCV
to determine if and how to tx, check for advanced fibrosis
liver biopsy or fibroscan
cure rate for HCV
60 - 90%
Hep C - tx
used to use interferon - really unpleasant
now there are a bunch of really good curative options
