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Gen. Path > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

How many types of viral hepatitis?

A

5

A, B, C, D, E

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2
Q

Which types are enteric transmission?

A

A and E

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3
Q

What does enteric transmission mean?

A

GI system, transmitted through ingestion by something like dirty water with decal contamination

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4
Q

How are HBV, HCV and HDV transmitted?

A

Parenteral, blood tranmission

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5
Q

Which type depends on the presence of another type?

A

Hep D depends on Hep B to be present, thus when we vaccinate against Hep B we are also doing so against Hep D

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6
Q

Which type is classified as picornavirus?

A

HAV

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7
Q

Which type is classified as hepacivirus?

A

HCV

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8
Q

Which type is classified as hepadnavirus?

A

HBV

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9
Q

Which type is classified as hepevirus?

A

HEV

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10
Q

Which type is classified as deltavirus?

A

HDV

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11
Q

Which of the types have possible chronicity?

A

HBV and HDV uncommon

HCV common

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12
Q

What is the pathway for acute viral hepatitis sign and symptom wise?

A

Flulike illness
Pre-icteric phase
Icteric phase (yellow appearance) with pre-icteric phase symptoms persisting

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13
Q

What does icteric mean?

A

Yellow or jaundice, jaundice means greenish yellow

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14
Q

What causes the yellow colour?

A

Accumulation of bilirubin by hepatocellular damage

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15
Q

Possible outcomes of acute viral hepatitis?

A

Recovery- no more signs and symptoms
Chronic infection- carrier state
Chronic active hepatitis- asymptomatic
Chronic active hepatitis

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16
Q

Outcomes of chronic active hepatitis?

A

Liver cirrhosis
Portal hypertension
Portal thrombosis
Hepatic failure

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17
Q

What are the possible complications of chronic active hepatitis?

A

Hepatocellular carcinoma

Extra-hepatic lesions

18
Q

What age group has highest percentage of developing chronic infection if infected with HBV?

A

Neonates (90%), this is why vaccinate right away
25-50% as infants
5-10% as adults

19
Q

What percentage of HBV carriers develop chronic active hepatitis?

A

25% of carriers

20
Q

What percentage of HCV infected individuals develop chronic infection/carrier state? What percentage develop chronic active hepatitis?

A

80-90% carrier state

40-50% chronic active hepatitis

21
Q

Which hepatitis has the highest risk of developing hepatocellular carcinoma?

A

HCV

22
Q

What is the most common chronic blood borne infection in the US?

A

HCV

23
Q

About what percent of chronic active HCV hepatitis patients progress to various degrees of liver cirrhosis?

A

About 1/4

24
Q

What type if necrosis is viewed histologically with chronic active hepatitis?

A

“Piecemeal” necrosis, liver cells are replaced with chronic inflammation

25
Q

How can the extent of chronic hepatitis be graded?

A

By the degree of activity (necrosis and inflammation)

26
Q

How can the extent of chronic hepatitis be staged?

A

By the degree of fibrosis

27
Q

What must be sought for treatment and why?

A

The etiology of the hepatitis. The treatment may depend on knowing the cause and chronic liver diseases of different etiologies may appear microscopically and grossly similar.

28
Q

Infection with what types of HCV lead to more sever liver disease, faster progression to chronic hepatitis, and less responsiveness to therapy?

A

HCV type 1b and 4

29
Q

What types of HCV have a more favourable prognosis?

A

Types 1a, 2, 3, and 5

30
Q

What is the most common cause of macro nodular cirrhosis?

A

Viral hepatitis (B or C)

31
Q

What is the widely used and established test for evaluation of disease severity in patients with liver cirrhosis?

A

Child-Pugh score

32
Q

What other types of tests are there for evaluation of disease severity in patients with liver cirrhosis?

A

Liver biopsy- not used much due to invasive
Breath test for 13C-methacetin
MELD (Model for end-stage liver disease) score
Imaging techniques like MRI and ultrasound

33
Q

What type of hepatitis has extra-hepatic lesions?

A

HCV

34
Q

What causes extra-hepatic lesions?

A

Caused by host immune response rather than the direct killing of the virus

35
Q

What is a concern side-effect of extra-hepatic lesions?

A

Hyposalivation

36
Q

Are patients with chronic hepatitis, cirrhosis, or liver failure prone to have bleeding tendency?

A

NO

They are low in coagulation factors but also low in anti-coagulation factors (protein C and S) so it balances out.

37
Q

What was found to be higher in patients with liver failure? What is the concern about this?

A

The generation of thrombin. Concern with generation of thrombus.

38
Q

If a patient with liver disease does have bleeding problems what is it caused by?

A

Vascular abnormalities and portal hypertension, such as ruptured varicose or gastric ulcers.
Increased platelet sequestration in the spleen as a result of congestive splenomegaly, related to portal hypertension.

39
Q

What lab test can be used to predict patient bleeding tendency after dental surgery?

A

No reliable test, patient history and clinical signs are the best predictor (bleeding history, bruises)

40
Q

What abnormalities exist in patients with liver disease that makes them hypercoagulable and prone to thrombus formation?

A
  • High factor VIII
  • Low anticoagulants (antithrombin, protein C, protein S, tissue factor pathway inhibitor)
  • High VWF, low VWF-cleaving protease (ADAMTS-13)
  • low plasminogen, high plasminogen activator inhibitor
41
Q

What is higher in patients with liver disease contributing to pro-thrombosis?

A

High VWF
High factor VIII
High plasminogen activator inhibitor

42
Q

What is lower in patients with liver disease contributing to pro-thrombosis?

A

Low ADAMTS-13(VWF-cleaving protease)
Low anticoagulants (antithrombin, protein C, protein S, tissue factor pathway inhibitor)
Low plasminogen

Gen. Path (7 decks)

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