Viral Hepatitis Flashcards
1
Q
Hepatitis A is more symptomatic / severe in
A. Adults
B. Children
A
Adults
2
Q
Only hepatitis virus with a DNA genome
A
HBV
3
Q
Is the most frequent indication for liver transplant
A
CLD from HCV
Chronic liver disease from HCV
4
Q
Defective virus that requires helper function of HBV for replication and expression
A
HDV
5
Q
Usually from contaminated water supply after monsoon flooding in endemic areas
A
HEV
6
Q
Tx for HDV
A
Interferon
7
Q
Tx for HAV and HEV
A
None
8
Q
Tx for HBV
A
Entecavir Tenofovir Adefovir Interferon PEG-IFN Lamivudine Telbivudine
9
Q
HCV tx
A
PEG-IFN + Ribavirin
DAAs (direct acting antiviral agents):
Daclatasvir, Sofobuvir, Telaprevir, Boceprevir
10
Q
Prophylaxis for HAV
A
Immunoglobulin
Inactivated vaccine
11
Q
Prophylaxis HBV
A
HB-Ig
Recombinant vaccine
12
Q
Prophylaxis for HCV
A
None
13
Q
Prophylaxis for HDV
A
HBV recombinant vaccine
14
Q
HEV prophylaxis
A
Vaccine
15
Q
Prognosis
HAV
A
Excellent
16
Q
Prognosis
HBV
A
Variable
17
Q
Prognosis
HCV
A
Moderate
18
Q
Prognosis
HDV
A
Variable
19
Q
Prognosis
HEV
A
Good
20
Q
Will not progress to chronicity
A
HAV, HEV
21
Q
Commonly progresses to chronic hepatitis
A
HDV, HCV
22
Q
Progression to chronicity HBV
A
Occasional, common if perinatal
23
Q
Severity
HAV
A
Mild
24
Q
Severity
HBV
A
Occasionally severe
25
Severity
| HCV
Moderate
26
Severity
| HDV
Occasionally severe
27
Severity
| HEV
Mild
28
Predominant modes of transmission
| HAV
Fecal-oral
29
Predominant modes of transmission
| HBV
Percutaneous, perinatal, sexual
30
Predominant modes of transmission
| HCV
Percutaneous
31
Predominant modes of transmission
| HDV
Percutaneous, sexual
32
Predominant modes of transmission
| HEV
Fecal-oral
33
Onset
| HAV
Acute
34
Onset
| HBV
Insidious or acute
35
Onset
| HCV
Insidious
36
Onset
| HDV
Insidious or acute
37
Onset
| HEV
Acute
38
Prodromal symptoms
```
Anorexia
Nausea and vomiting
Fatigue
Malaise
Arthralgias
Myalgias
Headache
Photophobia
Pharyngitis
Cough
Coryza
```
39
Prodromal symptoms may precede onset of jaundice by
1-2 weeks
40
With the onset of jaundice the prodromal symptoms
A. Becomes severe
B. Diminish
Diminish
41
Complete clinical and biochemical recovery occurs after
1-2 months - hepatitis A and hepatitis E
| 3-4 months -after onset of jaundice hepatitis B and hepatitis C
42
Among health adults, acute hepatitis B is self-limited in
95-99%
43
Among health adults, acute hepatitis C is self-limited in
15%
44
AST and ALT increase during this phase of acute viral hepatitis preceding the rise in bilirubin level
Prodromal phase
45
Symptoms and signs of viral hepatitis
| Phases
Prodromal
Jaundice
Recovery phase
46
Peak levels of aminotransferases vary from
400-4000 IU or more
47
Is hypoalbuminemia common in viral hepatitis
No.
| it is uncommon in uncomplicated viral hepatitis
48
Lab results requested for viral hepatitis
```
Liver function test
AST, ALT
Bilirubin
PT prothrombin time
Alkaline phosphatase
Serum albumin
```
HBsAg
IgM Anti-HAV
IgM Anti-HBc
Anti-HCV
49
(+) HBsAg
(-) IgM Anti-HAV
(+) IgM Anti-HBc
(-) Anti-HCV
Acute hepatitis B
50
(+) HBsAg
(+) IgM Anti-HAV
(-) IgM Anti-HBc
(-) Anti-HCV
Acute hepatitis A superimposed on chronic hepatitis B
51
(+) HBsAg
(+) IgM Anti-HAV
(+) IgM Anti-HBc
(-) Anti-HCV
Acute hepatitis A and B
52
(-) HBsAg
(-) IgM Anti-HAV
(-) IgM Anti-HBc
(+) Anti-HCV
Hepatitis C
53
HBsAg
(+) IgM Anti-HAV
IgM Anti-HBc
Anti-HCV
Acute hepatitis A
54
Sequelae of acute viral hepatitis
Fulminant hepatitis
| progression to chronic liver disease
55
Most feared complication of viral hepatitis
Fulminant hepatitis
56
Fulminant hepatitis is primarily seen in
Hepatitis A, B, D, E
57
Fulminant hepatitis
| Clinical manifestations
Signs and symptoms of encephalopathy that may evolve into deep coma
58
Terminal events of fulminant hepatitis
```
Brainstem compression
GI bleeding
Sepsis
Respiratory failure
Cardiovascular collapse
Renal failure
```
59
Massive hepatic necrosis
Fulminant hepatitis
60
When will chronic hepatitis E occur
In immunocompromised patients
61
Criteria to diagnose chronic hepatitis B
Persistence of HBeAg for >3 months or
| HBsAg > 6 months
62
For acute HCV infection, the likelihood of remaining chronically infected approaches ___%
90%
63
```
(+) HBsAG
(-) Anti-HBS
(+) IgM Anti-HBc
(+) HBeAg
(-) Anti-HBe
```
Acute Hepatitis B , high-infectivity
64
```
(+) HBsAG
(-) Anti-HBS
(+) IgG Anti-HBc
(+) HBeAg
(-) Anti-HBe
```
Chronic Hepatitis B, high infectivity
65
```
(-) HBsAG
(-) Anti-HBS
(+) IgM Anti-HBc
(+/-) HBeAg
(+/-) Anti-HBe
```
Anti-HBC "window"
66
```
(-) HBsAG
(-) Anti-HBS
(+) IgG Anti-HBc
(-) HBeAg
(+/-) Anti-HBe
```
Hepatitis B in remote past
67
```
(-) HBsAG
(+) Anti-HBS
(+) IgG Anti-HBc
(-) HBeAg
(+/-) Anti-HBe
```
Recovery from Hepatitis B
68
```
(-) HBsAG
(+) Anti-HBS
(-) IgM Anti-HBc
(-) HBeAg
(-) Anti-HBe
```
Immunization with HBsAg
69
Sequelae of Chronic Viral Hepatitis
```
Liver cirrhosis
Hepatocellular carcinoma (Hepatitis B & C), esp if Hepatitis B is acquired perinatally
```
70
Will treatment with antivirals decrease risk of HCC
Yes. But will not eliminate it
| Surveillance for HCC should continue even after treatment
71
HCC is mainly associated with
Hep B and C
72
Factors that affect decision to treat and or Duration of treatment for Hepatitis B
```
Clinical status (presence of cirrhosis, compensated vs decompensated, liver mass/ hepatocellular carcinoma)
Fam Hx of hepatocellular carcinoma
HBeAg status
HBV DNA titers
ALT levels
```
73
Factors that affect decision to treat and or Duration of treatment for Hepatitis C
Detectable HCV RNA in serum
HCV genotype
Presence of significant fibrosis , cirrhosis
74
Treatment for HBV (with doses)
High genetic barrier to resistance drugs
1. Entecavir 0.5 mg PO OD, Tenofovir 300 mg PO OD)
2. Pegylated Interferon once weekly SC injection
3. Lamivudine 100 gm PO OD - first successful oral antiviral agent ; no longer recommended as first line except in short-term therapy such as cancer chemotherapy
75
Treatment Hepatitis C (detailed)
DAAS: Daclatasvir, Sofobuvir, Telaprevir, Boceprevir, Dasabuvir, Ledipasvir
Pegylated Interferon + Ribavirin
a. Genotype 1 : 48 weeks
B. Genotype 2 : 24 weeks
76
Most pronounced side effectof ribavirin is
Hemoylsis
77
Diagnostic test for Acute Hep B infection
HBsAg
| IGM Anti-HBc
78
Chronic Hep B infection
HBsAg
| IgG anti-HBc
79
Markers of Hepatitis B replication
HBeAg
| HBV DNA
80
Hepatitis C
| Diagnostic Test
Anti-HCV
| HCV RNA
81
Hepatitis D
| Diagnostic test
HBsAg, anti-HDV
82
HBV/HDV coinfection
| Diagnostic test
IgM anti-HBc
| IgM Anti-HDV
83
HDV superinfection
IgG anti-HBc
| IgM anti-HDV
84
Hepatitis E infection
| Diagnostics
Anti-HEV
85
Diagnosis of Hepatitis A during acute illness and persists for several months
Anti-HAV (IgM)
| Detected when aminotransferase activity is elevated and fecal HAV shedding is still occuring
86
After acute illness fo HAV, remains detectable indefinitely
anti-HAV (IgG)
87
Predominates during convalescence of HAV
| Marker of IMMUNITY to reinfection
Anti-HAV (IgG)
88
First virologic marker detectable in the serum within 1 -12 weeks after infection with HBV
HBsAg
89
After HBsAg disappears, this becomes detectable and remains detectable indefinitely thereafter (protective antibody)
Anti-HBs
90
The only serologic marker that appears after vaccination with HBV recombinant vaccine
Anti-HBs
91
IgM anti-HBc predominates during the ____ months after acute infection
1st 6 months and anti-HBc window period
92
Predominates the class of anti-HBc 6 months after acute infection
IgG anti-HBc
93
An isolated reactive anti-HBc can be seen in
Gap or window period of acute Hepatitis B
Occult infection
Remote infection
False positive
94
Appears concurrently with shortly after HBsAg
HBeAg
95
Qualitative marker of HBV replication and relative infectivity
HBeAg
96
Its diappearance may be a harbinger of clinical improvement and resolution of infection of Hepatitis B
HBeAg
97
Its appearance coincides with a period of relatively lower infectivity
Anti-HBeq
98
More sensitive and quantitative indicator of HBV replication
HBV DNA
99
Diagnosis of hepatitis C
Anti-HCV
100
Most sensitive test for HCV infection
| Gold standard for diagnosis of HCV
HCV RNA
101
Testing for anti-HDV is useful in those with hepatitis B and severe/ fulminant disease
Anti-HDV
