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Emma GI > Viral Hepatitis I/II > Flashcards

Viral Hepatitis I/II Flashcards

1
Q

hepatitis leads to failure to excrete _____

A

bilirubin –> jaundice

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2
Q

prodrome

A

2-10 days

flu-like, fever, N/V

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3
Q

HAV in children presentation

A

mild, non-specific sx

infection often not diagnosed

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4
Q

HBV extra-hepatic manifestations

A

skin rash
arthritis
glomerulonephritis
cyroglobulinemia

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5
Q

jaundice is minimal in H__

A

HCV

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6
Q

transaminase elevations may be <500-1000 in H__

A

HCV

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7
Q

most common acute hepatitis

A

HBV

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8
Q

most common chronic hepatitis

A

HCV

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9
Q

HAV

A
  • picornavirus, ssRNA
  • enteric, fecal-oral
  • endemic in developing countries
  • incubation: 4 weeks (SHORT)
  • self-limited infection (no chronic)
  • vaccine >90% efficacious
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10
Q

self-limiting (no chronic disease) hepatitides

A

HAV

HEV

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11
Q

HAV pre-exposure prophylaxis

A

HAV vaccine at 0 and 6 mo

immunity in ~3wk after first vax

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12
Q

HAV post-exposure prophylaxis

A

within 2 weeks of exposure

single dose of HAV vaccine or IgM dependent on age

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13
Q

HEV

A
  • ssRNA
  • enteric, feca-oral
  • asia, Middle East, N. Africa
  • genotypes 1 and 2
  • incubation- 4 weeks (SHORT)
  • self-limited
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14
Q

enteric viruses

A

HAV
HEV

(vowel=bowel)

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15
Q

HEV vs. HAV

A

HEV

  • acute hepatitis in young adults
  • zoonotic w/ reservoirs in swine (genotypes 3 and 4
  • no vaccine commercially available
  • cases of chronic infection reported in immunosuppressed hosts
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16
Q

HBV transmission

A

-blood borne (IDU, sex, HIV coinfection, med equipment, VERTICAL TRANSMISSION 90% if mother has HBV in 3rd trimester, hemodialysis, correctional facilities

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17
Q

HBV inculation

A

2-3 mo. (LONG)

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18
Q

Out comes of HBV w/ %

A

90% –> RECOVERY (anti-HBs+)

10% –> chronic (HBsAg+)

1% fulminant hepatitis

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19
Q

risk of hepatocellular CA

A

chronic HBV or HCV

viral replication (HBV-DNA + or HCV-RNA +)

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20
Q

HBV pre-exposure prophylacis

A

vaccine at 0,1,6 mo.

recombinant HBsAg so vaccinated pt has protective Ab, anti-HBs

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21
Q

acute HBV exposure

A
  • pre-exposure-HBV Ig +HBV vaccine for intimate contacts only
  • acute exposure - infants: HBIg + HBV vaccine started <12 hr after birth, + antivirals for mom
  • chronic exposure- HBV vaccine
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22
Q

chronic HBV infection

immune active phase

A

HBsAg +
HBV-DNA +
high ALT

fibrosis and inflammation on liver biopsy

–> TREAT

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23
Q

HBV tx

A

lamivudine (RESISTANCE)
endeavor
tenofovir
combos

not curative

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24
Q

HDV

A
  • defective RNA virus
  • envelope: HBV surface antigen
  • need HBV for infection/replication
  • where HBV is present, (mediterranean, Russia, Africa, Amazon)
25
Q

HDV transmission

A

blood borne
-IDU, sexual

COINFECTION (acute infec w/ HBV and HDV)

SUPERINFECTION (chronic HBV carrier gets acute HDV –> chronic HDV … small amount get fulminant hepatitis

26
Q

HDV tx

A

none but prevented via HBV vaccination

no specific tx/complex

27
Q

HCV

A
  • flavivirus
  • ssRNA
  • genotypes 16-6
  • incubation: 2 mo. (LONG)
  • clinically mild infections
28
Q

HCV transmission

A

-blood borne (IVDU, medical/dental practices, sexual, transfusions, vertical mother–> child

29
Q

Which has vertical transmission more commonly

HCV or HBV

A

HBV

30
Q

acute hepatitis C outcomes w/ %

A

acute hepatitis –> 70% chronic HCV

30% recovery

31
Q

Everyone born between this time period should be screened for hep C

A

between 1945 and 1965

32
Q

when should HBV carriers w/ chronic hep C

A

treatment if in immune active phase

33
Q

HCV tx/vaccine

A

tx: yes
vaccine: NO

34
Q

past infection immunoglobulin

A

IgG

35
Q

IgM –> IgG shift around _ months

A

4 months

36
Q

Anti-HBs

protective or non-protective?

A

protective

via vaccination with HBsAg

37
Q

Anti-HCV

protective or non-protective?

A

non-protective

no vaccine against HCV

38
Q

viral antigens in blood means

A

virus is present in body

39
Q

anti-HAV is a combined capture assay of both

A

IgM

IgG

40
Q

HEV assays

A

poorly standardized

41
Q

HBV

A
  • dsDNA virus
  • blood borne
  • chronic infection: 5-10% of adults)
42
Q

Dane particle

A

HBV

  • outer lipoprotein envelope made of HBsAg
  • inside: genome, HBcAg, HBeAg
43
Q

window period

A

Both HBsAg and anti-HBs are in the blood but in immeasurably low amounts

check anti-HBc IgM

44
Q

What is the best way to dx early HBV infection?

A

test for anti-HBc IgM Abs

earliest host response to HBV infection, present during window period

45
Q

Anti-HBc IgM

A

first antibody to be positive AND positive during the “window period” when HBsAg has disappeared and Anti-HBs has not yet appeared

46
Q

Acute HBV outcomes w/ %

A

90% –> recovery (Anti-HBs+)

10% –> chronic HBV (HBsAg) ***age-dep

1% –> fulminant

47
Q

Anti-HBc IgG

protective or non-protective?

A

non-protective

48
Q

The presence of ____ in the blood is the main marker of HBV infection. It appears during the _______ period and remains positive as long as there is _______.

A

HBsAg

appears during the latter part of the incubation

+ as long as there is active infection

49
Q

HDV dx

A
  • HDV-RNA in blood
  • rare to find HDAg
  • anti-HDV IgM and IgG
50
Q

exception when dx HDV

A

Ant-HDV IgM is present in acute and chronic HDV

51
Q

dx of HCV

2 tests

A

anti-HCV by EIA

HCV-RNA

52
Q

HCV tx

A

interferon-free therapy

53
Q

acute viral hepatitis histo

A
  • portal and lobular mononuclear inflammation
  • ballooning degeneration
  • apoptosis
  • macrophage/kupffer cells
  • cholestasis
  • no fribrosis
54
Q

chronic viral hepatitis histo

A
  • portal and periportal predominant inflammation (lobular component variable)
  • development of FIBROSIS
55
Q

interface hepatitis

A

hallmark of active and progressive diseae

56
Q

stage of chronic viral hepatitis is based on

A

degree of fibrosis

57
Q

cirrhosis histo

A
  • diffuse fibrosis/scarring w/ regenerative nodules
  • altered vascular architecture –> portal HTN
  • regression/revversible?
  • histo –> non-specific once cirrhosis establishments
  • HCC risk
58
Q

activated stellate cells

A 
myofibroblast
proliferation
contraction
chemotaxis 
fibrogenesis

Emma GI (18 decks)

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