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32 Cards in this Set

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What are the most common pathogens involving the liver?
Viruses
What kind of effect on the liver does CMV have?
Usually mild transaminasemia
What kind of effect on the liver does EBV have?
Usually mild transaminasemia
What are the symptoms of clinical hepatitis (6)?
malaise, nausea, vomiting, abdominal pain, hepatomegaly, and jaundice
Is Hepatitis A worse in children or adults?
generally is milder in young children, many of whom are asymptomatic carriers or have nonspecific symptoms of gastroenteritis
Incubation period for hepatitis A?
typically 2 to 6 weeks
What percentage of children younger than age 14 years develop jaundice from hepatitis A infection?
less than 50%
What percentage of adults with Hepatitis A develop fulminant liver failure?
1% to 2%
Symptoms of fulminant liver failure (3)?
severe jaundice, coagulopathy, and encephalopathy
Does hepatitis A cause chronic infection?
No, but some patients (<10%) may experience a relapsing course characterized by recurrent viremia, symptoms, and elevations in alanine aminotransferase concentrations.
How long do relapses go on?
typically resolve within 12 months of the initial infection.
Which unimmunized patients require prophylaxis?
Been in close personal contact with a person who has had hepatitis A infection in the previous 2 weeks
What is post-exposure prophylaxis for Hepatitis A infection?
1- immune serum globulin (0.02 mL/kg) and 2-hepatitis A vaccine if over 1 year
What ingestions are likely to result in Hepatitis?
prescription (eg, valproate, isonicotinic acid, hydrazide) or over-the-counter medications (eg, acetaminophen), or any other potential toxin exposure (ie, wild mushrooms)
Initial studies for evaluation of Hepatitis?
CBC with differential, total and fractionated serum bilirubins, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl-transferase (GGT), and prothrombin time (PT)
Which IGs should be tested first?
immunoglobulin M (IgM) anti-hepatitis A virus (HAV), hepatitis B surface antigen (HbsAg), IgM anti-hepatitis B core (HBc), and anti-hepatitis C virus (HCV).
What other studies may be done?
If first round of immune studies negative, test for EBV and CMV
What is chronic Hepatitis?
Lasting longer than 6 months
Name 4 inherited causes of chronic liver disease:
Wilson disease, CF, tyrosinemia, alpha-1-antitrypsin deficiency
Testing for Wilson disease?
serum ceruloplasmin and 24-hour urinary copper excretion
Liver disease in neonate?
Exclude biliary atresia
Test for CF?
sweat electrolyte levels
Test for tyrosinemia?
urinary succinyl acetone
Test for alpha-1-antitrypsin deficiency?
serum alpha-1-antitrypsin and by phenotyping protease inhibitor
How is autoimmune hepatitis evaluated?
suggested by the presence of hypergammaglobulinemia.
How do you distinguish acute Hepatitis B infection from chronic?
Acute hepatitis B infection always is associated with the presence of IgM anti-HBc.
When is it necessay to test for IgM anti-HDV?
When patient has Hepatitis B
What does IgG anti-HBc positivity indicate?
a resolving infection or chronic hepatitis B
What does the presence of HBeAg indicate?
active viral replication and high infectivity
What does the presence of Anti-HBe indicate?
It appears when viral replication ceases.
What does anti-HBs indicate?
Immunity resulting either from infection or immunization
How is Hepatitis C diagnosed?
First by detection of anti-HCV but then must substantiate with another test e.g. HCV RNA by PCR