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Nelson - The Digestive System > Viral hepatitis > Flashcards

Viral hepatitis Flashcards

1
Q

Acute response of liver to hepatotropic viruses: Direct cytopathic vs immune-mediated

A

Both

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2
Q

Necrosis in viral hepatitis is most marked in what area

A

Centrilobular areas

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3
Q

Inflammatory infiltrates are settles in what area in cases of chronic hep

A

Inflammatory infiltrates

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4
Q

Neonates often respond to hepatic injury by forming

A

Giant cells

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5
Q

Viral hepatitis T/F Rapidly falling aminotransferase levels reflect poor outcome

A

T

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6
Q

Most important marker of liver injury

A

Altered synthetic function

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7
Q

Most prevalent of the hepatotropic viruses

A

Hepatitis A

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8
Q

Hepa viruses: Responsible for most forms of acute and benign hepatitis

A

A

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9
Q

Hepa viruses: RNA

A

A, C, E

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10
Q

Hepa viruses: Picornavirus

A

A

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11
Q

Hepa A transmission

A

Person-to-person through fecal-oral route

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12
Q

T/F Hepa A is responsible for ACUTE hepatitis only

A

T

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13
Q

Hepa A infection is diagnosed by

A

Anti-HAV IgM

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14
Q

2 distinct complications of Hepa A infection

A

1) Acute liver failure, usually in adolescents and adults 2) Prolonged cholestatic syndrome

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15
Q

Hepa A treatment

A

None specific

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16
Q

Patients infected with HAV are contagious when

A

2 weeks before and 7 days after onset of jaundice (should be excluded from school, child care, or work)

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17
Q

Indications for IM administration of Ig and vaccine (pre- and post-exposure)

A

1) Ig for susceptible travelers to countries where HAV is endemic 2) Vaccine for healthy persons prior to travel 3) Ig for <1 y/o, patients allergic to vaccine component, or those who elect not to receive vaccine 4) Ig postexposure EXCLUSIVELY for <12 months, immunocompromised, chronic liver disease, or if vaccine is contraindicated

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18
Q

Hepa viruses: DNA

A

B

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19
Q

Hepa viruses: Hepadnaviridae

A

B

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20
Q

Hepa B: Serves as a marker of active viral replication

A

HBeAg

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21
Q

Correlates with HBV DNA levels

A

HBeAg

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22
Q

Hepa B transmission

A

Blood transfusion and sexual contact

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23
Q

Most important risk factor for acquisition of HBV in children

A

Perinatal exposure to an HBsAg positive mother

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24
Q

T/F Breastfeeding of nonimmunized infants by infected motgers confers a greater risk of hepatitis than formula feeding

A

F

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25
Q

Chronic HBV infection is defined as

A

Positive HBsAg for >6 months

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26
Q

T/F Risk of developing chronic HBV infection is inversely related to age of acquisition

A

T

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27
Q

Most prevalent cancer-related death in young adults in Asia where HBV is endemic

A

Hep B hepatocellular carcinoma

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28
Q

Hepa B: Direct cytopathic vs immune-mediated

A

Immune-mediated

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29
Q

First biochemical evidence of HBV infection

A

Elevation of ALT (begins to rise just before development of fatigue, anorexia, and malaise)

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30
Q

First serologic marker of infection to appear in HBV infection

A

HBsAg

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31
Q

HBV infection: During recovery from acute infection, ___ might be the only marker of acute infection

A

HBc IgM (since HBsAg levels fall before symptoms wane)

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32
Q

HBV infection: Valuable serologic marker of acute HBV infection as it rises early after the infection and remains positive for many months

33
Q

HBV infection: Marks serologic recovery and protection

34
Q

HBV infection: Only this serologic marker is present in persons immunized with Hep B vaccine

35
Q

HBV infection: Marker of infectivity

36
Q

T/F: HBeAg is present in active acute and chronic infection

37
Q

HBV infection: Development of ___ marks improvement and is goal of therapy in chronically infected patients

38
Q

Hepa viruses: Acute liver failure occurs more commonly with ___ than with other hepatotropic viruses

39
Q

T/F Treatment of acute HBV infection is largely supportive

40
Q

Goal of treatment in chronic HBV infection

A

Reduce viral replication

41
Q

Reduction of viral replication in HBV infection is defined by

A

1) Undetectable HBV DNA in the serum 2) Development of anti-HBe

42
Q

Hepa B: Treatment is only indicated for

A

Patients in immune-active form with evidence of ongoing inflammation and fibrosis, putting the child at higher risk for cirrhosis during childhood

43
Q

Hepa B treatment: Immunomodulator with antiviral effects

44
Q

Hepa B treatment: Oral synthetic nucleoside analog that inhibits viral enzyme reverse transcriptase

A

Lamivudine

45
Q

Hepa C: Most prevalent mode of transmission

46
Q

Hepa C: Direct cytopathic vs immune-mediated

A

Cytopathic

47
Q

Most likely hepatotropic virus to cause chronic infection

48
Q

Hepa viruses: Infection is associated with small vessel vasculitis

49
Q

Hepa viruses: Infection is associated with essential mixed cryoglobulinemia

50
Q

Hepa C: Most widely used serologic test

A

3rd generation EIA to detect anti-HCV

51
Q

Hepa C: Most widely used virologic assay

A

PCR assay that detects HCV RNA

52
Q

Hepa C: Most effective treatment in adults

A

Peg interferon combined with oral Ribavirin

53
Q

Hepa C: Goal of treatment

A

Sustained viral response

54
Q

Hepa C: Sustained viral response is defined as

A

Absence of viremia 6 months after stopping medications

55
Q

T/F There is no vaccine available to prevent Hepa C

56
Q

Annual tests done for patients in whom HCV infection is identified

A

1) Liver ultrasound 2) Serum AFP for HCC

57
Q

Smallest known animal virus which is considered to be defective

58
Q

Why is Hepa D considered to be defective

A

Cannot produce infection without concurrent HBV infection

59
Q

T/F Concurrent infection of Hepa D with Hepa B takes 2 forms - co-infection (at the same time) or superinfection (infect a person already infected with Hepa B

60
Q

Hepa D: Direct cytopathic vs immune-mediated

A

Cytopathic

61
Q

HDV-HBV co-infection vs superinfection: Acute hepatitis > chronic hepatitis

A

Co-infection

62
Q

HDV-HBV co-infection vs superinfection: Chronic hepatitis > acute hepatitis

A

Superinfection

63
Q

HDV-HBV co-infection vs superinfection: Risk for ALF is highest

A

Superinfection

64
Q

T/F HDV must be considered in all cases of acute liver failure

65
Q

Diagnosis of HDV infection is made by detecting

66
Q

T/F There are no specific HDV-targeted treatments

67
Q

Hepa viruses: Similar in structure to caliciviruses

68
Q

Hepa viruses: Epidemic form was formerly called non-A, non-B hepatitis

69
Q

HEV: Transmission

A

Fecal-oral

70
Q

HEV: Direct cytopathic vs immune-mediated

A

Cytopathic

71
Q

T/F Chronic illness does not occur in HEV infection

72
Q

Hepa viruses: Major pathogen in pregnant women in whom it causes ALF with a high fatality incidence

73
Q

Hepa viruses: Flavivirus

A

HCV, HEV, HGV

74
Q

HAV incubation period

A

15-30 days

75
Q

HBV incubation period

A

60-180 days

76
Q

HCV incubation period

A

30-69 days

77
Q

HEV incubation period

A

35-60 days

78
Q

Hepa viruses: Causes chronic infection in 90% of patients when acquired perinatally

79
Q

Hepa viruses: Increased risk of hepatocellular carcinoma

A

HBV and HCV

Nelson - The Digestive System (24 decks)

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