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58 Cards in this Set
- Front
- Back
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What is hepatitis?
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necrosis of hepatocytes with inflammatory response
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When do you get Hep D?
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over Hep B infection
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Where do you get Hep E?
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India, Mexico
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What is Hep A?
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RNA picornavirus
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How id Hep A transmitted?
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fecal-oral, virus is shed into bile before it's symptomatic
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What is the incubation period of Hep A?
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2-6 weeks
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What causes injury in Hep A?
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immune response
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What is the prognosis of Hep A?
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most people have a complete recovery, never produces chronic hepatitis
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What is Hep B?
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DNA virus with core, e, surface antigens
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How is Hep B transmitted?
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parenteral, close contact, vertical
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What is the incubation period of Hep B?
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4-26 weeks
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How do you diagnose Hep A?
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antibody titers
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What causes injury in Hep B?
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immune response, cytotoxic T cells
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What are the extrahepatic manifestations of Hep B?
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arthritis, membranous nephropathy
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What happens to most people with Hep B?
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subclinical disease
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What happens if you have acute hepatitis?
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99% recover, 1% get fulminant hepatitis and die
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What happens to people with chronic hepatitis B?
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cirrhosis, hepatocellular carcinoma, death
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What is elevated with acute Hep B?
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HBeAg, HBV-DNA, HBsAg
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How long does acute Hep B last?
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4-12 weeks
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What gets elevated towards the end of acute disease?
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IgM-anti-HBc, anti-HBc
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What kind of virus is Hep E?
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single, unenveolped RNA virus
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How is Hep E transmitted?
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enterically, water-borne, shed in stool
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What is the prognosis of Hep E?
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mortality in prenant women, most cases self-limited, no chronic
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How do you diagnose Hep #?
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serology
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What are the manifestations of preicteral acute viral hepatitis?
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malaise, fatigues, nausea, anorexia,fever, headaches, muscle and joint pain, diarrhea, rash
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What is the pathology of acute hepatitis?
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pan-lobular hepatocyte necrosis, mononuclear inflammation in portal triads and lobules, ballooning degeneration, bridging necrosis
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What is fulminant hepatitis?
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liver failure develops within 2-3 weeks from onset
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What is the pathology of fulminant hepatitis?
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necrosis of entire lobules or parts of lobules with hepatocyte regeneration
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What can cause fulminant hepatitis?
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viral hepatitis, drugs, toxins, autoimmune, Wilsons
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How do you ID an asymptomatic infectino of hepatitis?
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minimal elevations of transaminases or antiviral antibodies
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What is the carrier state?
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pt harbors organisms, can transmitt he infection, no symptoms or transaminase abnormalities
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Who gets the carrier state for Hep B?
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vertical transmission or early infection
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What is the pathology of Hep B carrier state?
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DNA is integrated, minimal inflammatory response, hepatocytes with finely granular cytoplasma, HBsAg in ER
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Which hepatitis viruses produce a carrier state?
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B & C
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What is chronic hepatitis?
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at least 6 months based on biochemical or clinical findings
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What is the pathology of chronic hepatitis?
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portal inflammation, involves lobule at limiting plate, periportal hepatocyte necrosis, portal fibrosis
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What is specific portal pathology of chronic hep C?
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lymphoid aggregates, bile duct injury
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What is specific lobular pathology of chronic hep C?
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acidophilic bodies, sinusoidal lymphocytosis, steatosis
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Which hepattitis has the most fulminant?
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hep C
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What is the carrier state of Hep A?
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none
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Is there a hepatocellular Ca risk for Hep A?
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no
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Is there a hepatocellular ca risk for Hep B?
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yes +/- cirrhosis
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Is there a hepatocellular ca risk for Hep C?
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yes, + cirrhosis
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What does autoimmune hepatitis look like in histo?
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plasma cells prominent, indistinguishable from chronic viral hepatitis
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How do you diagnose autoimmune hepatitis?
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serologic testing
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Who gets autoimmune hepatitis?
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women, HLA B8, DRw3
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What are the autoantibodies of autoimmune hepatitis?
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ANA, anti-smooth muscle, anti-liver/kidney microsomal
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How do you treat autoimmune hepatitis?
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immune suppressants
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How does drug induced hepatitis appear?
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acute or chornic, clinically indistinguishable from acute viral or chronic hepatitis
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What are predictable toxins?
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cause direct liver injury in proportion to dose of the agent in most/all subjects, direct physiochemical effect, interferes with metabolic pathways
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What is an example of a predictable toxin?
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carbon tetrachloride, antimetabolites in cancer chemo
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What are idiosyncratic toxins?
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indirectly toxic, affect few subjects with unusual susceptibility
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What is an idiosyncratic toxin example?
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fluothane, isoniazid
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Which tons cause primary necorsis?
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carbon tetrachloride, mushrooms, aflatoxins, halothane, drugs
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Which toxins cause steatosis?
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alcohol acutely, tetracycline, salicylates, amiodarone, methotrexate
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what causes cholestatsis?
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anabolic or contraceptive steroids, chlorpromazine
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What causes cholestatic hepatitis with bile duct injury?
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amoxicillin and clavulanate
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Which drugs cause hepatic venous occlusion?
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anti-neoplastic agents, vitamin A in toxic doses
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