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GI 2 > viral hepatitis > Flashcards

viral hepatitis Flashcards

1
Q

most hep is hep B>A>C acute infections

Chronic hep is hep C>B

A

in the US

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2
Q

Hepatitis A

A

RNA virus, fecal oral transmission
Single serotype worldwide, only infects humans
Incubation period: 4 weeks- (2-6)
Symptomatic illness: 10% kids, adults 70-80%
Fatality: .3%, >50 yrs 1.8%
No chronocity

Personal contact with shit, day cares, young people

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3
Q

Hepatitis A Virus infection Typical serology course

A

Incubation period ALT goes up

IgM (associated with acute disease) goes up for 3 moths and goes away at 6

IgG Total anti HAV continues to go up and stays up at 1-2 yrs (lifelong)

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4
Q

Hepatitis E

A

transmission fecal -oral, contaminated drinking water, minimal person-person contact, recent travel to endemic areas

Incubation for 40 days

Case fatality- overall 1-3%, pregnant women 15-45% (higher than hep A)

no chronicity

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5
Q

Hep E virus infection, typical serology

A

ALT goes up, IgM (acute infection) goes up and down, IgG is lifelong, pretty much the same as Hep A

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6
Q

Hep B

A

DNA virus, infects humans and primates, incubation period (60-90 days)

Acute case-fatality (.5%-1%), chronicity determined by age at exposure, premature mortality from chronic disease 15-25%
Leading cause of hepatocellular carcinoma worldwide

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7
Q

Outcome of Hep B virus by age

A

if a new born is exposed (to surface Ag)- very likely to get chronicity, but goes down in 6m kid

Symtoms are likely the older you are

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8
Q

Concentration of HBV in various body fluids

A

High: blood, serum, wound exudates

Moderate: semen, vaginal fluid, saliva

Low/Not detectable: urine feces, sweat, tears, breastmilk

Heterosexuals, MSMs, IV drugs big risk factors

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9
Q

Acute vs chronic hepatitis B serology

A

Acute Hep B infection with recovery (older pts, typically have symptoms): 1st HBs-Ag rises first, IgM anti-HBc (acute), IgG/ Total anti HBc goes up and stays up (previous exposure), after 8 weeks after there is anti HBs (immunity)

HBeAg- present early on- there high amounts of circulating Ag and active infection, followed by anti-HBe, (disappearnace)

Chronic Hep B: HbS-Ag remains high for 6 mo, core IgM has the same bump and the total anti HBc is also high. No sureface antibody. HBE- ag will be high for a long time, there is sometimes HBe anti seroconversion

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10
Q

Natural history HBV infection

A

Acute–> Chronic infection–> Cirhsis, Liver cancer, liver failure,–> liver transplant, and death

Chronic infection can immediately go to liver cancer

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11
Q

Hepatitis D

A

Coinfection with B or Superinfection (pt already has B and gets D)

ALT can become elevated
DIgG an IgM get high

Co infection will have worse symptoms but less likely to get chronic

Superinfection can get chronicity

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12
Q

Hepatitis C

A

RNA virus, half life is short, rapid virion

Chronicity is very high
US (123, africa 4)

IV drugs, Sexual transmission,

Most patients never clear the virus, virion is high, with Anti HCV is high

Get fibrosis

Resolution or chronic-> cirhosisi-> ESLD or HCC–> Transplant

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13
Q

Clinical manifestation of acute viral hepatitis

A

Fever, malaise, anorexia, nausea, vomiting, jaundice, abdominal RUQ pain, hepatomegaly

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14
Q

heptatits A virus infection

A

Fecal material viral Hep A virus, Symtptoms and ALT is high
Followed by IgM anti HAV and IgG/Total Anti AV

Total anti HAV (aka HA-Ab) is IgG +IGM

IgM peaks and drops off at 6 months (no such thing as chronic hep A)

Diagnosis- if IgM- acute infection (<6mo), if IgG- theyve had a previous exposure or immune vaccination (protective Ab)

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15
Q

Hepatits A vaccination (2 shots)

A

Recommended for infants, people working in/traveling to areas with high incidence of HAV, people with chronic liver disease, people working with HAV

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16
Q

Hepatitis A Prevention immune globulin (give the immune globulin)

A

Preexposure- travelers to intermediate and high Hep A endemic regions

Post exposure (within 14 days)- routine if someone in the household has it, selected situations (institiutions day care, food prep by infected food handler)

17
Q

Hepatitis E

A

fecal oral transmission, in stool , alt peaks with symptoms during the high IgM anti HEV (acute infection), and IgG anti HEV ( during resolution phase for life)

pregnant woman with Hep E (have a high mortality rate)

18
Q

Hepatitis B (acute vs chronic)

A

Acute- exposure (usually as an adult, if infant you can die)- Hep B surface Ag

If the patient has a POSITIVE HEP B SURFACE Ag, they have HEP B and are actively infected,
IgM has acute and goes away at week 32, total anti HBc persisits, Anti HBs will peak after the window period

The window period- 8 wk period lost surface Ag, but not developed surface Ab, diagnosis is via IgM

Chronic: HBSAg never goes away, Total is still persisitant, and IgM goes away

HB e- a lot of active virus (can also use PCR today)

19
Q

Hep B diagnosis, the Hep B panel

A

Hep B surface Ag (Antigen) is positive?= you have a current Hep B (either chronic or acute)
Hep B surface Ab (Antibody) is positive?= Immune, recovered from natural infection, Vaccine)

Core Antibody= natural exposure, IgM recent exposure, IgG old exposure

20
Q

Hep B exposure in unvaccinated patients

A
  • preformed Hep B Ig within 24 hrs but can be givent up to a week after, secong HBIG dose 1 month later or
  • Hep B vaccine w/in 24 hrs or upt to a wk later, 2nd dose 1 monthh later 3rd dose 6 months later

if a pregnant mom has HBSAg- give newborns both the HBIG and vaccine

21
Q

Chronic Hep B therapy

A

Interferon: proteins (cytokines), released by host cells when infected by viruses, activate immune system

Nucleotide/nucleoside analogues- block reverse transcriptase which is necessary for HBV replication

no cure

Entecavir
Tenofovir
oral meds, no resistance
Lower rates of decompensation (complications/cirhhosis) and lower rates of liver related mortality

22
Q

hepatitis d

A

d for defective
Delta virus, requires presence of hepatitis B,
Co-infection- acquire hepatitis B and D simultaneously Results in severe acute infection, both viruses typically cleared
Superinfection- hepatitis D acquired after chronic hepatitis B is established, results in a chronic infection, both viruses are typically persist

Diagnosis (IgM, acute, IgG prevrious exposure, though not protective)

23
Q

hepatitis C virus and diaganosis

A

hepatitis C antibody seen in all exposures and remains present in all patients even those who spontaneously clear the virus/undergo successful treatment,
hep C viral RNA is present only in those who are VIREMIC

most people dont clear hep C

24
Q

Serologic pattern of acute HCV infection with progression with recovery vs with progression to chronic infection

A

Theyll have some RNA from HEP C, with (or w/o) symptoms, ALT will be elevated

Anti HCV Ab will persisits

only 15-20% of the tome

Chronic will continue to have fluctuating levels of RNA and ALTs, even though they have anti Hep C Ab

GI 2 (14 decks)

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