Hepatitis

Front 1

Viral hepatitis that is a sudden illness with a mild to severe course followed by complete resolution

Back 1

acute viral hepatitis

Front 2

Prolonged course of active disease or silent asymptomatic infection

Back 2

chronic viral hepatitis

Front 3

Which hepatitis viridae can cause chronic hepatitis?

Back 3

HBV, HCV, HDV

Front 4

T/F Hepatitis viridae are all RNA viruses

Back 4

F. HBV is DNA.

Front 5

A) Viral hepatitis causes elevations in what enzymes?

B) Why?

Back 5

A) ALT and AST

B) The hepatocytes produce these transaminases. The hepatocytes are what hepatitis infects.

Front 6

A) What enzymes would be elevated with a gallstone?
B) Why?

Back 6

A) Alkaline phosphatase, GGT, and bilirubin

B) The stone would be blocking the bile duct. The cells lining the bile canaliculi produces these enzymes and carry bilirubin.

Front 7

What family is HAV in?

Back 7

picornaviridae

Front 8

What kind of nucleic acid does HAV have?

Back 8

(+) single-stranded RNA

Front 9

How long is HAV incubation period?

Back 9

15-40 days (about 1 month)
2-6 weeks

Front 10

What characterizes the pre-icteric phase of viral hepatitis?

Back 10

(Means preceding jaundice).

Pruritus, rash. Start to feel generally bad.

Front 11

For many viral illnesses, which of AST or ALT will be higher?

Back 11

ALT

Front 12

An increase in what three things characterize an acute viral hep infection?

Back 12

1) ALT (and AST)
2) IgM
3) Viremia

Front 13

Periportal Infiltration: defn

Back 13

On histology, an acute accumulation of neutrophils and monocytes around the portals

Front 14

What is bridging necrosis and when is it seen?

Back 14

confluent necrosis linking terminal venules to portal tracts.

Seen in viral hepatitis

Front 15

Route of HAV transmission

Back 15

fecal/oral

Front 16

T/F HAV is associated with chronic disease/cirrhosis

Back 16

F

Front 17

T/F There is no carrier state in HAV

Back 17

T

Front 18

Before the onset of symptoms, for how long is HAV secreted in stools?

Back 18

2 weeks

Front 19

What is the acute phase antibody?

Back 19

IgM

Front 20

What histological changes are seen in cirrhosis?

Back 20

Lots of space between hepatocytes and fibrosis

Front 21

Which age group is more likely to show jaundice in HAV?

Back 21

>14 years

Front 22

Complications of HAV

Back 22

Fulminant hepatitis Cholestatic hepatitis Relapsing hepatitis

Front 23

How is acute infection of HAV dxed?

Back 23

Detection of HAV-<b>IgM</b> in serum by enzyme immune linked assay.

Front 24

How is past infection of HAV dxed?

Back 24

Detection of HAV-<b>IgG </b>(the "convalescent" phase antibody) in serum by enzyme immune linked assay.

Front 25

Prophylaxis against Hep A

Back 25

1) Vaccine
2) Immune serum globulin/gamma globulin given to infected person's household contacts

Front 26

What kind of virus is Hep B?

Back 26

Hepadnaviridae.

Large virus.

Enveloped icosahedral capsid and (partially) dsDNA that's circular.

There are two ss regions.

Front 27

What are filamentous structures composed of the envelope and some capsid proteins that have disassociated from the intact virion?

Back 27

heptatis B surface antigen (HBsAg)

Front 28

T/F Antibodies against HBsAg are protective

Back 28

T

Front 29

What is the other important Hep B antigen?

Back 29

HBcAg (hep B core antigen)

Front 30

T/F Antibodies against HBcAg are protective

Back 30

F

Front 31

What is HBeAg? What is it a marker for?

Back 31

Soluble component of the core Hep B virus that is released during active infection and viral growth. It's a cleavage product of the viral core structure polypeptide (HBcAG).

<b>It is a marker for active disease and highly infectious state.</b>

Front 32

How is HBV transmitted?

Back 32

blood-to-blood contact (parenteral)

Front 33

fulminant hepatitis

Back 33

severe acute hepatitis with rapid destruction of the liver

Front 34

What are the disease states caused by hepatitis B?

Back 34

1) Acute hepatitis
2) Fulminant hepatitis
3) Chronic hepatitis

Front 35

What are the types of chronic hepatitis B?

Back 35

1) Asymptomatic carrier: Never develops antibodies against HBsAg (anti HBsAg antibodies) and harbors virus without liver injury.

2) Chronic-persistent hepatitis (low grade "smoldering" hepatitis)

3) Chronic active hepatitis: acute hep state that lasts longer than 6-12 months

4) Coinfection with HDV

Front 36

What appears to cause liver injury?

Back 36

Cell-mediated attack on HBV. Viral antigens on surface of infected hepatocytes are targets for cytotoxic T cells

Front 37

Which antibody against HBV is protective?

Back 37

against surface antigen.

HBsAG

Front 38

What is primary hepatocellular carcinoma a complication of?

Back 38

HBV chronic infection.

Front 39

What can be said about the presence of HBsAg?

Back 39

The presence of HBsAg in the blood means disease. Can be acute or chronic

Front 40

What can be said about the presence of anti HBsAg antibodies?

Back 40

HBsAg has disappeared. Person is <b>immune.</b>

Front 41

What can be said about the presence of
A) IgM anti-HBcAg
B) IgG anti-HBcAg

Back 41

A) New infection
B) Old infection

Front 42

What can be said about the presence of
A) HBeAg
b) anti-HbeAg antibodies

Back 42

A) High infectivity - active disease
B) Low infectivity

Front 43

When will anti-HBeAg antibodies start to develop?

Back 43

6 months

Front 44

What is in the vaccine for HBV?

Back 44

The surface envelop and proteins; HBsAg

Front 45

T/F HBV is a retrovirus

Back 45

F. It does use reverse transcription.

Front 46

What is the relationship between HBV and malaria?

Back 46

co-infection can result in tumors

Front 47

What happens after the HBV virus membrane fuses with host cell's membrane?

Back 47

It releases mRNA and core proteins into cytoplasm. Host proteins, Chaperones, transfer viral genomic DNA to cell nucleus

Front 48

Major behaviors associated with transmission of HBV

Back 48

sex, IV drug use

Front 49

What is the Ig prophylaxis against Hep B?

Back 49

1) Pre-exposure: Vaccine
2) Post-exposure: H-BIG (Hepatitis B Immune Globulin) + Vaccine

Front 50

Detection of ______ in blood or serum indicates that serum or blood contains the HBvirus, but says nothing about whether it's acute or chronic

Back 50

HBsAg

Front 51

T/F There is a high amount of HBV detectable in semen, vaginal fluid, and saliva

Back 51

F. Moderate amount in these fluids.

Front 52

Indicates that infection is active, that complete virions are in the blood, and that the patient is highly infectious

Back 52

Hepatitis B e antigen (HBeAg)

Front 53

Appears late during incubation period and disappears when hepatic disease begins
(HBV)

Back 53

DNA polymerase

Front 54

Indicates immunity to HBV
Appears in patients who spontaneously recover from HBV infection
Appearance during viremia results in immune complex disease, polyarteritis nodosa, and membranous glomerulonephritis

Back 54

Anti-HBs antibody

Front 55

Leading cause of chronic hepatitis in US

Back 55

HCV

Front 56

What %age of those with exposure to HCV go on to develop chronic hepatitis?

Back 56

up to 85%

Front 57

Leading indication for liver transplantation in the US

Back 57

Chronic Hep C

Front 58

Primary means of HCV infection

Back 58

IV drug use

Front 59

Incubation period for HCV

Back 59

2-20 weeks with avg of 6-7 weeks

Front 60

T/F Acute infection of HCV is usually asymptomatic

Back 60

T

Front 61

_______% of patients with HCV will go on to develop chronic hepatitis; ___% will develop cirrhosis

Back 61

85%; 20%

Front 62

Classification of HCV

Back 62

Flavivirus

Front 63

How is HCV diagnosed?

Back 63

testing for anti-HCV antibodies (detectable within 6-8 weeks, remain positive thereafter)

Front 64

What changes occur in the levels of ALT over chronic HCV infection?

Back 64

Levels of ALT fluctuate

Front 65

How is HDV transmitted? What is special about it?

Back 65

Parenterally. Can only replicate with help of HBV

Front 66

HDV is also called

Back 66

&delta; agent

Front 67

T/F Antibodies against HBsAg will be protective against both HDV and HBV

Back 67

T

Front 68

What type of genome does HDV/&delta; agent have?

Back 68

Circular RNA

Front 69

What is superinfection?

Back 69

When HDV infects a person with a chronic HBV infection.

This results in acute hepatitis in patient already chronically infected with HBV, leading to a very severe illness.

Higher incidence of fulminant hepatitis,cirrhosis.

Front 70

T/F The patient with chronic HBV cannot make Anti-HBsAg and so remains chronically infected with both HBV and HDV

Back 70

T

Front 71

Tx of HDV

Back 71

None. Best is to control HBV infection

Front 72

Pre or postexposure prophylaxis to prevent HBV infection: does this work in HBV/HDV coinfection or superinfection?

Back 72

Coinfection (when they're acquired at the same time) only!

Front 73

HEV has a low mortality rate except in which group?

Back 73

pregnant women

Front 74

What viral hepatitis infections are transmitted fecal-oral?

Back 74

HAV and HEV

(the VOWELS hit the BOWELS)

Front 75

Where is HEV endemic?

Back 75

<b>Asia</b>, India, Africa, Central America

Front 76

Which hepatitis virus will show the shortest amount of transaminase elevation time?

Back 76

HAV