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Clinical Final Exam > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

How is hep A transmitted? (3 ways)

A

Hep A:
Fecal - oral route (from travel, underdeveloped countries)
Person - Person (sexual, residential, daycare)
Ingestion of contaminated food or water

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2
Q

What are risk factors for hep A?

A 
International travelers
Household or sexual contact with infected person
MSM
Illegal drug users
Chronic liver disease
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3
Q

What is the incubation time for hep A?

When do patients begin to shed the virus?

A

Incubation: about 28d (range 15-50d)
Shedding 1-2 weeks after exposure
(shedding precedes GI symptoms)

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4
Q

What are the 3 stages of hep A?

A

Prodromal (preicteric) period
Acute illness
Icteric hepatitis

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5
Q

Describe the prodromal period of hep A

A

Non-specific flu-like symptoms, such as anorexia, nausea, fatigue, malaise

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6
Q

Describe the acute illness stage of hep A

A

Abrupt onset of anorexia, nausea, vomiting, malaise, fever, headace, RUQ pain

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7
Q

Describe the icteric hepatitis phase for hep A

A

Dark urine, light stools, worsened systemic symptoms, pruritis

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8
Q

When do liver enzymes peak in hep A?

When do they normalize?

A

Enzymes increase in the first few weeks, peak at the 4th week, normalize by 8th week

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9
Q

What does hep A look like in a patient <6 years old

A 
Usually asymptomatic (no jaundice occurs if there are symptoms)
(virus still shedding)
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10
Q

How does hep A present in older children and adults?

A

Most present with symptoms for <2 months, 70% of adults have jaundice

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11
Q

Does hep A result in chronic infection?

How frequent to fatalities occur?

A

Doesn’t result in chronic infection

Fatalities are rare

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12
Q

What are potential complications of hep A? (3)

A

Relapsing hepatitis
Cholestatic hepatitis
Fulminant hepatitis

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13
Q

When do the majority of patients have resolution of hep A?

A

Majority by 2 months

Almost all by 6 months

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14
Q

What is the treatment for hep A?

What is important surrounding it?

A

Treatment is nonspecific, patients should be given general supportive care.
Prevention and prophylaxis is important.

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15
Q

What is the dosing schedule for the hep A vaccine?

A

2 doses:
1 dose of HAV (primary) followed by booster dose 6-36 months later
(timeframe depends on product)

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16
Q

Who is the hep A vaccine recommended for?

A

Hep A vaccine recommended for individuals >6 months old for those at risk of infection or severe hep A; or those wanting to decrease the risk.

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17
Q

What are the adverse events of the hep A vaccine?

A

Generally well tolerated - maybe a mild and transient soreness/redness at injection site.
Less common: headache, irritability, malaise, fatigue, GI symptoms.
(anaphylaxis is rare)

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18
Q

What are the contraindications of the hep A vaccine?

A

History of anaphylaxis from previous dose or any ingredient in the product.
Vaccine administration should be postponed in patients with moderate to severe acute illness (minor illness can receive)

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19
Q

Is there an increased risk to pregnant mother or infant receiving hep A vaccine?

A

No evidence that there is

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20
Q

What is human immune globulin (Ig) used for in hep A?

A

Used as a post-exposure immunoprophylactic option - boosts immune response.

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21
Q

When is it recommended to use human Ig for hep A?

A

Infants <6m
Contraindication to hep A vaccine
Hep A vaccine not available

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22
Q

When should you give Ig in addition to hep A vaccine?

Who else may you give it to?

A

In addition to hep A vaccine in immunocompromised patients or those with chronic liver disease.
Also to susceptible adults, those >60y, and are household/close contacts of an individual with hep A.

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23
Q

What is the timeframe for post-exposure prophylaxis Ig use?

A

Should be given as soon as possible after exposure - unknown efficacy >14 days after exposure

24
Q

What are the non-pharms for hep A prevention for a traveler?

A

Safe food and water
Frequent handwashing
(soap and water, at least 20 seconds)
Alcohol based sanitizer if soap and water not available

25
Q

What are ways to ensure safe food and water?

A

Boil it, cook it, peel it, or leave it
Hot and well cooked foods
Avoid raw/undercooked meats and fish - including shellfish
Drink water only if it has been boiled or disinfected, or commercially sealed
Avoid swallowing while bathing, showering, swimming

26
Q

How is hepatitis B transmitted?

A

Sexually
Parenterally
Perinatally
(any percutaneous or mucosal contact with biological fluids that contain the virus)

27
Q

What are risk factors for hepatitis B?

A 
Infants exposed during birth
Sexual contact
Injection drug use
Household contact of HBV-positive patient
Procedures with percutaneous exposure
28
Q

What is the incubation period of hep B?

A

Average between 60-90 days (range 24-180)

29
Q

What percentage of patients are asymptomatic?

A

50% of adults, 90% of children are asymptomatic

30
Q

What are symptoms of hep B (when they do occur)?

A

Anorexia
Abdominal pain
Nausea/vomiting
Jaundice

31
Q

How long can the acute illness last for?

A

Up to 3 months

32
Q

What is the risk of hep B in pregnant women?

A

Risk of fulminant hepatitis and death is increased

Fetal risk of premature delivery, asphyxia, and death

33
Q

What is the risk of becoming a chronic carrier in different age groups?

A

Infants: 90-95%
1-5 years: 25-50%
Adolescents/adults: 3-10%
– risk also increased in immunocompromised, adults with diabetes

34
Q

What do chronic carriers of hep B have an increased chance of developing?

A

Cirrhosis

Hepatocellular carcinoma

35
Q

What is the dosing schedule for monovalent Hep B vaccine?

A

3 doses:
1st (month 0)
2nd at month 1
3rd at month 6

36
Q

Who is the hep B vaccine recommended for? (there’s a lot)

A

Those who are in close contact with HB carriers (workplace, household)
Communities in which hep B is highly endemic
Residents and staff of institutions for developmentally challenged, or correctional facilities
Lifestyle risks for infection (unprotected sex, more than one partner in the previous 6 months, history of sexually transmitted infections, high risk sexual practices, injection drugs, MSM)
— just look at the link
https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-7-hepatitis-b-vaccine.html#tab2

37
Q

What are the adverse events of a hep B vaccine?

A 
Well tolerated, mild and transient reactions:
Irritability
Headache
Fatigue
Pain/redness at injection site
(anaphylaxis is rare)
38
Q

Contraindications to hep B vaccine?

A

History of anaphylaxis to previous dose or ingredient of vaccine (there is yeast in it)
Postpone in patients with moderate to severe acute illness (but weigh risk vs. benefit if giving post-exposure)

39
Q

Is there an increased risk to pregnant mother or infant?

A

no evidence

40
Q

Who should post-exposure prophylaxis (hep B Ig) be offered to?

A

Infant of mother with acute or chronic hepatitis infection
Percutaneous or mucosal exposure to blood or bodily fluids that may contain the virus
Sexual/household contacts of an individual with acute hep B or is a chronic carrier

41
Q

What are non-pharms for hep B prevention

A

All chronic hep B patients should be educated to prevent transmission
Sexual and household contacts require vaccination
Chronic hep B patients need to further prevent liver damage – avoid alcoho, get immunized against hep A
Consult with HCP before using any new medications

42
Q

What is the dosing schedule for twinrix?

A

It is the hep B dosing schedule:

month 0, 1, and 6

43
Q

Should both hep A and B be recommended to travelers?

A

Hep A for sure
Hep B - even if the patient does not have risky lifestyle, they may still be in an accident and require a blood transfusion etc.

44
Q

How is hep C transmitted?

A

Blood (contaminated needles, procedures)
Sexual contact
Perinatal transmission

45
Q

Hep C risk factors?

A 
Injection drug use
Prisoners
Homeless
Blood transfusion
Healthcare associated transmission is rare
46
Q

How many patients with hep C are asymptomatic?

A

80%

47
Q

What are the symptoms of hep C, if they occur?

A

Anorexia, abdominal pain, fatigue, nausea, dark urine, jaundice

48
Q

How many people with acute hep C will develop chronic hep C infection?

A

up to 85%

49
Q

How many chronically infected hep C patients will develop serious liver disease?

A

10-20%

50
Q

What is the treatment for hep C?

A

Oral regimens with durations of 6-12 weeks to 24-48 weeks
Few side effects
Cure rate >90%

51
Q

How do you determine which treatment will be most effective for hep C infection?

A

Hep c virus genotype

52
Q

Non-pharm treatment for hep C?

A 
Vaccinate against hep A or B
Avoid alcohol
Eat well balanced diet
Routine exercise
Avoid smoking
53
Q

Is there a hep C vaccine?

A

NO

54
Q

Is there an Ig option for hep C

A

No

55
Q

What should you counsel patients on for hep C prevention?

A

Avoid being blood, organ, or semen donors
Minimize blood mucus exposure (avoid sharing razor, toothbrush, cover open wounds)
Avoid sharing drug paraphernalia (if using illegal drugs)

Clinical Final Exam (5 decks)

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