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ABOG Exam - OB > Viral Hepatitis in Pregnancy > Flashcards

Viral Hepatitis in Pregnancy Flashcards

1
Q

Hepatitis A - type of virus

A

Small RNA virus

Incubation period 28 days

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2
Q

Hep A - transmission

A

Fecal-oral
Most often in household/extended family settings (children under age 6)
Poor hygiene/poor sanitation

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3
Q

Hep A - prognosis

A 
Serious complications uncommon
- 1% overall case-fatality ratio
- 2% in adults >50
Does not lead to chronic infection
- Can have prolonged/relapsing disease up to 6 months
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4
Q

Hepatitis B - type of virus

A

Small DNA virus (Dane particle)

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5
Q

Hep B - antigens

A

Surface antigen
Core antigen
e antigen

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6
Q

Hep B - surface antigen

A

Present on surface of virus

Circulates freely in serum in spherical and filamentous forms

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7
Q

Hep B - core antigen

A

Middle portion of Dane particle

Present only in hepatocytes, does not circulate in serum

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8
Q

Hep B - e antigen

A

Encoded by same portion of viral genome that codes for core antigen
Presence indicates extremely high viral inoculum and active virus replication

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9
Q

Hep B - transmission

A

Parenteral and sexual contact
- Serum, semen, saliva
Can be transmitted from surfaces up to 7 days

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10
Q

Hep B - risk of transmission w/ blood transfusion

A

1 in 137,000 units

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11
Q

Hep B - prognosis

A

Mortality from acute hep B - 1%
Adults - 85-90% have complete resolution
- 10-15% become chronically infected

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12
Q

Hep B - chronic infection

A

10-15% will have chronic infection

  • Most asymptomatic, no lab evidence of hepatic dysfunction
  • 15-30% of those - viral replication continues, persistence of e antigen
  • Risk development of chronic hepatitis and cirrhosis
  • 4-5k die annually of complications of chronic liver disease (including hepatocellular carcinoma)
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13
Q

Hepatitis C - type of virus

A

Small RNA virus
6 distinct genotypes identified
Incubation period 30-60 days

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14
Q

Hep C - transmission

A

Parenteral and sexual contact

- Blood transfusion, IV drugs

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15
Q

Hep C - risk of transmission w/ blood transfusion

A

1 in 1,000,000 units

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16
Q

Hep C - prognosis

A

Asymptomatic infection - 75%
50% progress to chronic infection
- Increased risk of developing B-cell lymphomas, cryoglobulinemia
- 20% lead to chronic active hepatitis or cirrhosis
- Unclear link to hepatocellular carcinoma

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17
Q

Hepatitis D - type of virus

A

Incomplete viral particle (RNA) that causes disease in presence of hep B
- Simultaneously (coinfection)
- After hep B (superinfection)
20-25% of chronic HBV will have HDV

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18
Q

Hep D - transmission

A

Blood

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19
Q

Hep D - prognosis

A

More severe disease
70-80% of those w/ chronic hep D develop cirrhosis and portal HTN
- 15% - rapid progression to cirrhosis w/in 2 years
Mortality from hepatic failure = 25%

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20
Q

Hepatitis E - type of virus

A

RNA virus

Incubation period 40 days

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21
Q

Hep E - transmission

A

Waterborne (fecal-oral)

Rarely in the US

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22
Q

Hep E - prognosis

A

Self-limited viral infection followed by recovery

Mortality rate w/ HIV 100%

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23
Q

Hep A - vaccine

A 
Recommended for adults at risk for HAV or its adverse consequences
- Chronic liver disease
- MSM, illegal drugs
- Travel or work in endemic countries
Inactivated virus
2 doses
94-100% immunogenic, highly effective
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24
Q

Hep A - post-exposure prevention

A

HAV immune globulin

HAV vaccination

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25
Hep B - vaccine
Healthcare workers, dialysis patients, drug users, high-risk sexual activity, international travel Antibody screening prior to vaccination not indicated Inactivated virus 3 doses 95% seroconversion rate
26
Hep B - post-exposure prevention
Hep B immune globulin (HBIG) | HBV vaccine within 24 hours
27
Symptoms of acute hepatitis
``` Malaise Fatigue Anorexia Nausea RUQ or epigastric pain ```
28
Physical findings of acute hepatitis
``` Jaundice Upper abdominal tenderness Hepatomegaly Dark urine Gray or acholic stool Fulminant hepatitis - signs of coagulopathy or encephalopathy ```
29
Symptoms of chronic hepatitis/cirrhosis
``` Jaundice Muscle wasting Ascites Spider angioma Palmar erythema Hepatic encephalopathy ```
30
Treatment of acute hepatitis - inpatient
Encephalopathy, coagulopathy, or severe debilitation Nutrition Correct fluid and electrolyte abnormalities Correct coagulopathy - PRBCs, platelets, FFP/cryo Limit activity, protect from upper abdominal trauma
31
Treatment of acute hepatitis - outpatient
Reduce level of activity, avoid upper abdominal trauma Maintain good nutrition Avoid intimate contact w/ household members, sexual partners
32
Acute hepatitis - general lab tests
``` Marked increase in AST/ALT Elevated bilirubin Coagulation abnormalities Hyperammonemia Liver biopsy (rarely indicated) - extensive hepatocellular injury and inflammatory infiltrate ```
33
Hep A - specific tests
IgM antibodies | IgG antibodies can persist after previous infection or vaccination
34
Hep B - specific tests
HBsAg - appears 4 weeks before clinical symptoms, detectable for 1-6wks Chronic carriers - persistence of HBsAg (>20wks), absence of anti-HBs antibody - Non-carriers have slowly increasing titer of anti-HBs 10-12m after sAg has been cleared - Do not coexist in serum Core IgG antibody - only from natural infection, not protective Core IgM antibody - present for 6 months
35
HBsAg negative Anti-HBc negative Anti-HBs negative
No infection, susceptible to infection
36
HBsAg negative Anti-HBc positive Anti-HBs positive
Immune due to natural infection
37
HBsAg negative Anti-HBc negative Anti-HBs positive
Immune due to vaccination
38
HBsAg positive Anti-HBc positive IgM anti-HBc positive Anti-HBs negative
Acutely infected
39
HBsAg positive Anti-HBc positive IgM anti-HBc negative Anti-HBs negative
Chronically infected
40
HBsAg negative Anti-HBc positive Anti-HBs negative
4 interpretations: - Recovering from acute infection - Distantly immune - can't detect low level of anti-HBs - Susceptible with false-positive anti-HBc - Undetectable HBsAg in serum, actually chronically infected
41
Hep C - specific tests
Antibody to virus using ELISA - 6-10wks after onset of clinical illness Can test for specific RNA genotyping
42
Hep D - specific tests
D antigen in hepatic tissue or serum IgM antibody Viremia and end-organ damage can continue despite antibody
43
Hep E - specific tests
Antibody in those w/ risk factors
44
Treatment of chronic carriers in pregnancy
Referral to GI - counseling and targeted treatment after delivery Inform contacts of status, use methods to reduce risk of transmission Report to health department
45
Rate of vertical HBV transmission without prophylaxis
10-20% of women HBsAg positive | 90% of women HBsAg and HBeAg positive
46
Risk of chronic HBV if acquired perinatally
85-95% | 25-30% risk of serious or fatal liver disease
47
Timing of acute HBV infection and vertical transmission rates
1st trimester - 10% | 3rd trimester - 80-90%
48
Infant HBV vaccination timing
If mother negative - before discharge or <2 months - Preterm or <2000g - delay until 1 month If mother positive - HBIG and HBV vaccine w/in 12 hours of birth - 2 more HBV vaccine before 6 months
49
Efficacy of immunizations to prevent perinatal transmission
85-95%
50
Prevalence of HCV in pregnant women worldwide
0.6-6.6%
51
Rate of vertical HCV transmission
2-8% | Rare if mother HCV RNA negative
52
Rate of vertical HCV transmission if coinfected with HIV
44%
53
Risk factors for vertical HCV transmission
Higher maternal HCV viral titer Prolonged ROM (>6 hours) Internal fetal monitoring during labor
54
Prevention of vertical HCV transmission
No available prevention measures
55
Indications for HCV screening
Ever injected illegal drugs Received blood products before 1987 or from a donor who tested positive for HCV Received transfusions or organ transplants, especially before July 1992 Long-term hemodialysis Persistently elevated LFTs or other evidence of liver disease Seeking evaluation or care for an STI, including HIV
56
Mode of delivery for HCV
Not an indication for C/S
57
Amniocentesis in HBV and HCV
Small studies show low risk of transmission, however limited | Should discuss non-invasive options
58
Breastfeeding in patients with hepatitis
HAV - permissible w/ appropriate hygiene HBV - not contraindicated if infant receives ppx HCV - not contraindicated
59
HAV exposure in pregnancy
HAV immune globulin - as soon as possible - Protection up to 3 months with 80-900% efficacy HAV vaccine
60
HBV treatment in pregnancy
No specific therapy | - Current investigations into lamivudine or HBIG to prevent in utero HBV infection
61
HCV treatment in pregnancy
No current therapy | - Current investigations into interferon
62
Occupational exposure to HBV
HBV has highest concentrations in blood and requires much smaller volumes for transmission Risk of infection w/ injury is 20-30% All health care workers should be vaccinated
63
Occupational exposure to HCV
Risk is lower than HBV but higher than HIV

ABOG Exam - OB (4 decks)

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