Viral Hepatitis And Acetaminophen Hepatotoxicity

Question 0

Course of hepatitis?

Answer 0

1. Constitutional symptoms, arthralgias, myalgias, pharyngitis
2. Visible jaundice, enlargement of the liver, dark urine

Question 1

Transaminase levels more than 1000 may lead to? Causes?

Answer 1

Extensive hepatic necrosis. Causes: toxic injury, viral hepatitis, ischemia

Question 2

Hepatitis A and E are transmitted by?

Answer 2

Fecal oral route. By contaminated food or water and daycare

Question 3

Most common cause of acute viral hepatitis in the US?

Answer 3

Hepatitis A

Question 4

Worst-case scenario after hepatitis A infection?

Answer 4

A few patients get fulminant disease resulting in liver failure

Question 5

Worst-case scenario after hepatitis E infection?

Answer 5

Pregnant women can develop severe hepatic necrosis and fatal liver failure

Question 6

Adult vs Newborns infected with hepatitis B. Chance of chronic infection?

Answer 6

5% versus 90%

Question 7

Hepatitis most likely to be sexually-transmitted?

Answer 7

B (C to lesser extent)

Question 8

Hepatitis transmitted by blood transfusions or IV drug use?

Answer 8

C

Question 9

Fulminant hepatic failure is usually caused by? Prognosis?

Answer 9

Hepatitis B and D or drug-induced. Poor prognosis.

Question 10

How to diagnose hepatitis A,B,C?

Answer 10

A: Anti-hepatitis A IgM
B: hepatitis B surface antigen
C: hepatitis C RNA assay or anti-hepatitis C antibody

Question 11

Window period?

Answer 11

Interval between the disappearance of HBsAg and the appearance of anti-HBsAb

Question 12

Describe hepatitis A vaccine. Efficacy?

Answer 12

Two doses given six months apart. Exceeds 90%.

Question 13

Postexposure prophylaxis to contacts of patient with hepatitis A or B?

Answer 13

If not vaccinated: Hepatitis A/B immunoglobulin along with the first injection of the vaccine

Question 14

Hepatitis B vaccine: delivery and efficacy?

Answer 14

Given in three doses over six months. Over 90%.

Question 15

Hepatitis C immunization and postexposure prophylaxis?

Answer 15

None

Question 16

Treatment for patients with chronic hepatitis B? B or C?

Answer 16

Lamividine. Interferon

Question 17

Hepatotoxicity by acetaminophen results after acute ingestion of?

Answer 17

10 g or more (lower in patients with existing liver disease especially those who abuse alcohol)

Question 18

Acetaminophen metabolism? Neutralization? Increased risk of injury if?

Answer 18

Metabolized by P450 enzymes. Produces toxic metabolite which is detoxified by glutathione.

Increasing injury:

1. P450 induction (from alcohol or phenobarbital)
2. Decreases in glutathione from alcoholism, malnutrition or AIDS

Question 19

Treatment of acetaminophen toxicity? Mechanism of treatment? Duration of treatment?

Answer 19

Decontamination with charcoal and N-acetylcysteine. N-acetylcysteine provide cysteine to replenish glutathione stores. Start within the first 10 hours to prevent liver damage continue for 72 hours.