Viral hepatitis Flashcards by CM A

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

Both

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Necrosis in viral hepatitis is most marked in what area

Centrilobular areas

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

Inflammatory infiltrates

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Neonates often respond to hepatic injury by forming

Giant cells

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

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Most important marker of liver injury

Altered synthetic function

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Most prevalent of the hepatotropic viruses

Hepatitis A

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

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Hepa viruses: RNA

A, C, E

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Hepa viruses: Picornavirus

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Hepa A transmission

Person-to-person through fecal-oral route

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T/F Hepa A is responsible for ACUTE hepatitis only

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Hepa A infection is diagnosed by

Anti-HAV IgM

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2 distinct complications of Hepa A infection

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

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Hepa A treatment

None specific

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Patients infected with HAV are contagious when

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

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

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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Hepa viruses: DNA

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Hepa viruses: Hepadnaviridae

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Hepa B: Serves as a marker of active viral replication

HBeAg

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Correlates with HBV DNA levels

HBeAg

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Hepa B transmission

Blood transfusion and sexual contact

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Most important risk factor for acquisition of HBV in children

Perinatal exposure to an HBsAg positive mother

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

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Chronic HBV infection is defined as

Positive HBsAg for >6 months

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

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

Hep B hepatocellular carcinoma

Hepa B: Direct cytopathic vs immune-mediated

Immune-mediated

First biochemical evidence of HBV infection

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

First serologic marker of infection to appear in HBV infection

HBsAg

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

HBc IgM (since HBsAg levels fall before symptoms wane)

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

Anti-HBc

HBV infection: Marks serologic recovery and protection

Anti-HBs

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

Anti-HBs

HBV infection: Marker of infectivity

HBeAg

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

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

Anti-HBe

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

Hepa B

T/F Treatment of acute HBV infection is largely supportive

Goal of treatment in chronic HBV infection

Reduce viral replication

Reduction of viral replication in HBV infection is defined by

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

Hepa B: Treatment is only indicated for

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

Hepa B treatment: Immunomodulator with antiviral effects

IF-α-2b

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

Lamivudine

Hepa C: Most prevalent mode of transmission

Perinatal

Hepa C: Direct cytopathic vs immune-mediated

Cytopathic

Most likely hepatotropic virus to cause chronic infection

Hepa C

Hepa viruses: Infection is associated with small vessel vasculitis

Hepa C

Hepa viruses: Infection is associated with essential mixed cryoglobulinemia

Hepa C

Hepa C: Most widely used serologic test

3rd generation EIA to detect anti-HCV

Hepa C: Most widely used virologic assay

PCR assay that detects HCV RNA

Hepa C: Most effective treatment in adults

Peg interferon combined with oral Ribavirin

Hepa C: Goal of treatment

Sustained viral response

Hepa C: Sustained viral response is defined as

Absence of viremia 6 months after stopping medications

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

Annual tests done for patients in whom HCV infection is identified

1) Liver ultrasound 2) Serum AFP for HCC

Smallest known animal virus which is considered to be defective

Hepa D

Why is Hepa D considered to be defective

Cannot produce infection without concurrent HBV infection

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

Hepa D: Direct cytopathic vs immune-mediated

Cytopathic

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

Co-infection

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

Superinfection

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

Superinfection

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

Diagnosis of HDV infection is made by detecting

HDV IgM

T/F There are no specific HDV-targeted treatments

Hepa viruses: Similar in structure to caliciviruses

HEV

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

HEV

HEV: Transmission

Fecal-oral

HEV: Direct cytopathic vs immune-mediated

Cytopathic

T/F Chronic illness does not occur in HEV infection

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

HEV

Hepa viruses: Flavivirus

HCV, HEV, HGV

HAV incubation period

15-30 days

HBV incubation period

60-180 days

HCV incubation period

30-69 days

HEV incubation period

35-60 days

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

HBV

Hepa viruses: Increased risk of hepatocellular carcinoma

HBV and HCV