Gi - Blue - Viral Hepatitis

Front 1

What are the dif. types of Hepatitis?

Back 1

A, B, C, E (also: D and G)

Front 2

What causes Hep A?

Back 2

Picornavirus aka Enterovirus 72

Front 3

How long does Picronavirus aka enterovirus 72 incubate before causing Hep A?

Back 3

15-45 days

Front 4

What are the phases of Hep A infection?

Back 4

Pre-icteric (gastroenteritis, transmission)

Icteric (Jaundice)

Front 5

Whats the significance of there being a single serotype of Hep A?

Back 5

Once infected, you'll develop immunity and not be infected again

Front 6

Whats the Mechanism of Hep A?

Back 6

Ingestion --> Absorption from stomach, sm. intestines --> Replication in Liver --> Secretion into Bile --> Excretion in stool OR Reabsorption

Front 7

Where is Hep A virus concentrated?

Back 7

Feces
Serum
Saliva

Front 8

T/F: Hep A is most common in kids, but its usually asymptomatic

Back 8

TRUE

Front 9

How is Hep A spread?

Back 9

Fecal - Oral

Food: esp. shellfish
Water

Front 10

When do Symptoms of Hep A infection begin?

Back 10

When immune system begins attacking hepatocytes

Inc. in Transaminases + Jaundice + Inc. IgG, IgM

Front 11

How do adults get Hep A?

Back 11

from kids

or shellfish, water-borne

Front 12

Symptoms of Adult with Hep A?

Back 12

Jaundice
Diarrhea
Rash

Front 13

How long is pt still shedding virus ie infectious for with Hep A?

Back 13

2 weeks --> 12 months

Front 14

Who do we target with Hep A vaccine?

Back 14

kids, since they spread it to adults

Front 15

Pt comes in with inc. transaminases, Inc. IgG then inc. IgM a little later, and jaundice. Dx?

Back 15

Hep A

Front 16

What are the vaccines used for Hep A?

Back 16

HAVRIX
VAQTA
GammaGuard =short term protection
Twinrix = BOTH Hep A and Hep B

Front 17

Pt eats shell fish, a develops inc. transaminases, inc IgG then Inc. IgM. Tey become Jaundices with a rash. Dx?

Back 17

Hep A

Front 18

Hep B has what type of genome?

Back 18

ds DNA

= uses DNA pol = a reverse transcriptase

(ds DNA--> ds RNA --> dsDNA)

Front 19

If you see "Dane Particle", what should you be thinking?

Back 19

Hep B

Front 20

What are some of the antigens present on Hep B?

Back 20

Hb-S = surface antigen of outer capsid (detectable in blood)
Hb-E = non-structural (detectable in blood)
Hb-C = Inner capsid (NOT detectable in blood)

Front 21

You see a rise in Hb-S and Hb-E in blood. Which virus?

Back 21

Hep B

Front 22

What gene helps Hep B?

Back 22

Hbx gene = inhibitor of p53

Also inhibits GSK-3b both these are tumor suppressors

Front 23

How do we get Hep B? which body fluids have a lot?

Back 23

Needles, Blood products, Sex

Blood, Serum, wound exudate

ie SAME AS HIV

Front 24

How is Hep B's incubation period diff. than Hep A?

Back 24

Hep A = 2 weeks

Hep B = 30-180 days = LOOONNGG

Front 25

After being infected with Hep B, what are the two courses it can take?

Back 25

Acute Fulminant = sudden onset

Persistent = Cirrhosis, Hepatocellular Carcinoma, Influence of Age

Front 26

What are the symptoms of Hep B?

Back 26

Hepatic Lesions
Immunopathogenic inflamm mechanism
Asymptomatic common

Front 27

Which is more severe Hep A or Hep B?

Back 27

Hep B

Carrier state/ Chronicity can develop

Front 28

Which pts will present with mostly asymtomatic Hep B?

Back 28

Those with a strong immune response

=sub-clinical infection

= can lead to long-term immunity (65% of pts)

Front 29

Outcome of infection with Hep B is related to what?

Back 29

Immune response

Front 30

Pt infected with Hep B has blood drawn. You notice HBs Ag levels rise, then decline, and Anti-HBs levels then inc. What can you say about this pts risk of becoming a carrier of Hep B? (total anti-HBc stays high)

Back 30

LOW because this is an indication of a strong immune response

Front 31

Pt infected with Hep B develops HBs Ag which stays high, not declining, while their total anti-HBc is high as well. What can you say about their risk of becoming a chroic carrier of Hep B?

Back 31

They are a chronic carrier

ie NOT a good immune response b/c HBs Ag stays high

Front 32

You note detectable antigen, but no detectable Abs in pt who was infected with Hep B. Where in disease stage are they?

Back 32

EARLY b/c there's no Abs yet

Front 33

What will we find in the serum of a persistent carrier of Hep B?

Back 33

HBs + HbE antigen (we may or MAY NOT see inc. IgM or IgG)

Front 34

Hep B is most common in
1. adults
2. children

Back 34

ADULTS

due to nature of transmission ie needles, sex, blood products etc

Front 35

T/F: Perinatal transmission of Hep B results in chronic carrier of Hep B on 90%

Back 35

TRUE

Front 36

How do we prevent Hep B?

Back 36

Vaccine
Energix-B, Recombivax HB

Twinrix = Hep A and Hep B

Front 37

How do we treat hep B?

Back 37

Interferon -alpha

Nucleoside Analogs

Front 38

How is delta Hep virus transmitted?

Back 38

"Hitch-Hiker virus"

= uses outer coat protein of Hep B as capsid

Front 39

Pt is co-infected with both Hep B and Delta Hep. What can you say about their Hep B infection?

Back 39

It will be more severe

ie liklihood of acute (fulminant) Hep and chronicity is higher

Front 40

Whats the genome of Delta Hep?

Back 40

RNA genome is a ribozyme = it can self-replicate ie RNA itself acts as the RNA polymerase

Front 41

Hep C creates how many new viral particles each day?

Back 41

10 billion

= high replication rate

Front 42

Which Hep has a high mutation rate?

Back 42

Hep C

=quasispecies, mutant swarm
= immune system will always be a little behind

Front 43

How is Hep C spread?

Back 43

IV drugs, Sex

Front 44

How is a pts. response to Hep C similar to Hep B?

Back 44

every pt will have a different response to being infected

ie could be complete recovery, stable/chronic, variable, severe/progressive

Front 45

Why do pts with Hep C need to give up alcohol?

Back 45

B/c Hep C infects up to 50% of the hepatocytes, damaging them. Alcohol also damages hepatocytes.

Front 46

T/F: Alcohol abuse coupled with Hep C means pt has a 150% chance of developing cirrhosis

Back 46

TRUE

Front 47

Decrease in what two things lead to dec. in Hep C prevalence?

Back 47

IV drug use declined

Transfusions (we checked them for Hep C)

Front 48

Before we had effective means of testing, where did we see Hep C?

Back 48

Hemophilia

Injection Drug users

Front 49

Whats the biggest risk factor for getting Hep C?

Back 49

Illegal drug use

Front 50

How do we treat Hep C?

Back 50

PEG-interferon-alpha

PLUS weight-dosed Ribavirin

(NOTE: we don't have a vaccine)

Front 51

Where is Hep E found?

Back 51

DEveloping countries

E = dEveloping

FECES (so is Hep A..everything else is body-fluid, and thus is NOT transmitted fecal-orally, they are transmitted via things that give them body fluids!)

Front 52

Leading world-wide cause of Water-borne Hepatitis?

Back 52

Hep E

Front 53

Hep E virus disease is similar to what?

Back 53

Hep A (adults = diarrhea, rash, jaundice) (kids = asymtomatic, usually)

Transmission = WATER (food, like shellfish)

Front 54

Symptoms of Hep G infection?

Back 54

Asymptomatic

(related to Hep C...which is more severe infection)

Front 55

Which Hepatitis' can you have a chronic infection from?

Back 55

Hep B, C, D

(NOT A and E)

Front 56

T/F: Hep A, B, and D are the only hep's we have a vaccine for

Back 56

TRUE

Front 57

Which Hep's have good outcomes, and which depend on the response of the host?

Back 57

Hep A and E = good outcomes

Everything else depends on host immune response