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GI Pathophys > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

What are the two variables in deciding who to treat for Hep B?

A
  • HBV DNA level

- HBe Ag positive (E positive means high viral replicative state)

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2
Q

What is the most common cause of acute viral hepatitis?

A

Hep A

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3
Q

Which viral hepatitises are transmitted via oral fecal route?

A

Hep A and E (vowels)

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4
Q

How to treat a Hep B infection

A
  • first line = nucleos(t)ide analog to inhibit viral DNA polymerase
  • not really used any more b/c of flu-like side effects = interferon
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5
Q

How to treat a Hep D infection

A

Treat the underlying Hep B infection (nucleo(t)ide analogs to interrupt viral DNA polymerase

-if you get rid of the Hep B, the Hep D cannot survive b/c it needs Hep B’s envelope protein to infect the hepatocyte

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6
Q

Which Hep infections have vaccines?

A

HAV and HBV

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7
Q

How is Hep B transmitted?

A

mucous membranes and blood exposure

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8
Q

How is Hep C transmitted?

A

mucous membranes and blood exposure

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9
Q

How is Hep D transmitted?

A

mucous membranes and blood exposure

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10
Q

Marker present during incubation period of HBV

A

HBsAg = hep B surface antigen

-marker of acute and chronic infection (chronic if persists for > 6 mo)

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11
Q

Prodrome, acute disease marker of HBV

A

HBsAg (hep B surface antigen) and anti-HBC

-anti-HBC = Hep B core antibody IgM = marker of acute infection

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12
Q

Marker of high rate of viral replication in HBV

A

HBeAg = HepB E-antigen

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13
Q

Marker of seroconversion to low viral replicative state of HBV

A

HBeAb = HepB E surface antibody

-when pt seroconverts to HBeAb (antibody instead of the antigen) then they are much less infective

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14
Q

Marker of recovery from HBV

A

Anti-HBs and anti-HBc

Anti-HBs = HepB surface antibody
-marker of history of HBV infection or vaccination

Anti-HBc = IgG anti-HBc is a marker of cleared infection or chronic infection w/ HBV

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15
Q

Describe the window period in Hep B

A

The time btwn being surface antigen negative and surface antibody positive

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16
Q

Describe titer findings in a pt w/ chronic HBV

A

HBsAg (surface antigen) remains positive

  • dont have anti-HBs (surface antibody)
  • can be HbeAg positive or negative
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17
Q

Immune tolerant phase of HBV

A
  • only in pts infected at birth or during early childhood
  • doesnt happen in pts infected as adults
  • have detectable HBV DNA in serum, but minimal inflammation or fibrosis of the liver
  • immune system is not attacking the infected hepatocytes
18
Q

Immune clearance phase of HBV

A
  • immune tolerant can progress to this active immune clearance phase
  • immune system starts attacking infected hepatocytes
  • elevated aminotransferases, signs of chronic hepatitis
  • usually HBeAg positive
19
Q

Inactive carrier state of HBV

A

-state after immune clearance active phase where virus calms down: normal ALT and low HBV DNA levels

20
Q

Reactivation phase of HBV

A
  • uncommon, occurs after pt moves from active immune clearance –> inactive carrier state and then reactivations
  • elevated ALT, high HBV DNA levels
  • occurs when pt is put on immunosuppression therapy that is then withdrawn (b/c then immune system ramps up and starts attacking hepatocytes
21
Q

Three indications for treating an HBV pt

A

(1) ALT > 2x UL (upper limit of normal)
(2) High HBV DNA levels
(3) Pts w/ decompensated cirrhosis

22
Q

What is the post-exposure prophylaxis regimen for HBV?

A
  • HBIG and HBV vaccine
  • HBIG = Hep immunoglobulin that confers immunity against HBV

-also give HBIG + HBV vaccine to children born w/ infected mother (HBsAg + mother)

23
Q

What is the mechanism of liver injury in HBV?

A

CD8+ T cells cause apoptosis of HBV infected hepatocytes

-so not due to the virus itself, but due to the immune system’s response to the virus

24
Q

Compare the rate of infection after exposure to HBV and HCV?

A

Much higher risk of developing chronic liver disease once exposed to HCV

  • only 2-5% of adults exposed to HBV => chronic liver disease (higher as you look at younger populations)
  • while 50-90% of ppl infected w/ HCV progress to chronic liver disease
25
Q

What are the two treatment options for HBV?

A
  • interferon: directly affects the virus and improves immune system against the virus. but flu-like side effects
  • nucleos(t)ide analogs to inhibit viral DNA synthesis
26
Q

Compare course of HCC in pts w/ HBV and HCV

A
  • pts w/ HBV can develop HCC w/ or w/o cirrhosis

- only pts w/ HCV who have cirrhosis have chance of developing HCC

27
Q

Differentiate Hep D Co-infection and superinfection

A

Co-infection = have both hep D and hep B active infections, get infected w/ both simultaneously (better prognosis)

Superinfection = get infected w/ hep D on top of chronic HBV (worse prognosis)

28
Q

What key serum measurement differentiates co-infection and super infection?

A

Look for IgM for Hep B core antigen (acute immune response marker to Hep B)

  • if (-) IgM anti-HBc = superinfection (meaning HBV infxn is chronic)
  • if (+) IgM anti-HBc = coinfection (was previously HBsAg-)
29
Q

How do you treat Hep D?

A

Treat Hep B and then Hep D will go away

-Hep D needs the Hep B envelope protein to replicate

30
Q

Which hepatitis virus is a DNA virus?

A

Hep B

31
Q

How to distinguish a chronic from an acute HDV infection?

A
  • acute infection will have HDV IgM (marker of acute inflammation)
  • Chronic infection will have HDV IgG
32
Q

Which Hep virus is known for being found in shellfish?

A

Hep A

-can say alive in an oyster for 5 days (ew)

33
Q

Which two hepatitis viruses are self-limited?

A

Hep A and E- meaning they’ll run their course and resolve (most of the time) w/o intervention

Exceptions

  • Hep A => fulminant hepatitis in some pts
  • Hep E very dangerous in pregnant women
34
Q

What is a clinical finding common to all hepatitis viruses?

A

Jaundice!

-in hep A starts around week 4

35
Q

What is the treatment for HEV?

A

Mostly supportive care (all that is needed b/c is usually self-limited)
^same for Hep A

-while rare cases (esp. pregnant women) may require liver transplant

36
Q

Which hepatitis has 6 specific genotypes?

A

HCV

-genotypes important for determining treatment

37
Q

Which genotype of HCV is the most common in the US?

A

Genotypes 1a/1b

38
Q

What is the marker of a chronic HCV infection?

A
  • presence of HCV RNA for > 6 months

- serum ALT levels usually fluctuate

39
Q

Ribavirin

A

-nucleoside inhibitor used (in conjunction w/ interferon) to treat Hep C

40
Q

What is the leading cause of liver transplant in the US?

A

HCV

41
Q

Common outcomes of chronic HCV

A
  • cirrhosis

- in pts w/ cirrhosis => HCC

42
Q

What are three markers present in an acute HBV infection?

A
  • HBsAg (surface antigen)
  • HBcAb IgM (acute antibody against core protein)
  • HBV DNA (detectable via PCR)

GI Pathophys (4 decks)

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