Hepatitis And Enteric Viruses

Front 1

Are viruses living? Can they be killed?

Back 1

They are not living therefore they cannot be killed however they can be inactivated or re activated

Front 2

Most of the common diseases are...

Back 2

from viruses

Front 3

Where is the best place to see jaundice?

Back 3

In the sclera of the eye and this is true for all racial backgrounds

Front 4

How are Hepatitis A and Hepatitis E transmitted?

Back 4

they are transmitted fecal orally

Front 5

What hepatitis viruses have a envelope and what hepatitis viruses don't?

Back 5

Hepatitis A and E do not have a envelope

Hepatitis B,C,D do have a lipid envelope

Front 6

Why is not having a envelope important for hep A and hep E that transmit the virus focal orally?

Back 6

Its important for the transmission because it allows HAV and HEV to be stable in bile

-They are harder to destroy and easier to pass along. Whereas enveloped are very easily destroyed.

Front 7

What are some risk factors for Hep A?

Back 7

The most common risk factor is being in close contact with someone who has an active case of Hep A

others include:

-sexual behaviour

-Food and water borne transmission

-Travelling to another country with high prevalence of hep A

Front 8

How can you prevent Hep A?

Back 8

Getting vaccinated especially if your going on a trip to a place where there is a high prevalence of Hep A

Front 9

Who are the people you should be worried about?

Back 9

Many viruses are shed in large numbers before the person is symptomatic; therefore, its not the coughing and sneezing person that you have to be worried about its the people that are going to start sneezing and coughing the following day or the next and this is what can cause explosive outbreaks

Front 10

What family does Hep A belong to?

Back 10

Its a member of the Hepatovirus genus of the Picornavirus family

(pico - small ran virus)

Front 11

What is the incubation period of Hep A?

Back 11

15-45 days but the virus is present in the blood and is shed in the stools within a few days of exposure increasing just before the onset of symptoms

Front 12

What are the symptoms of Hep A?

Back 12

symptoms usually begin abruptly

-fever, myalgia, malaise, anorexia, nausea and vomiting and occasion RUQ pain

-Dark coloured urine, light clay coloured stools and frank icterus (jaundice)

Front 13

How do you diagnose Hep A?

Back 13

the first thing the doctor usually sees is an increase in HAV IgM antibodies then they will see an increase in AST ALT and Bilirubin -- obviously after the patient has all these symptoms

Front 14

Who is Hep A usually almost never recognized in?

Back 14

Hep A is usually never recognized in children under the age of two (d/t being mildly ill or asymptomatic)

Front 15

What if someone has a high antibody levels of HAV but have no history of hepatitis?

Back 15

It probably reflects infection at an early as that went unrecognized

Front 16

People over 40 are at increased risk of developing what?

Back 16

Fulminant hepatits A and transplantation may be indicated (fulminant = severe and sudden)

Front 17

How long are Hep A shots good for?

Back 17

1 shot of Hep A is good for 3 years

2 shots of Hep A is good for life

Front 18

What is Hep E?

(what kind of virus and similar to, and incubation period, enveloped, transmission?)

Back 18

it is a calicivirus similar to Hep A

Incubation period is longer than Hep A (about 40 days)

not enveloped and enteric transmission (focal oral)

Front 19

How do you diagnose Hep E?

Back 19

is made by detecting HEV IgG antibody in the absence of other markers for other hepatitis viruses

Front 20

Is there a vaccine available for Hep E?

Back 20

No

Front 21

What does Hep E cause during pregnancy?

Back 21

If a women gets infected with Hep E during her third trimester of pregnancy there is a 15-20% case of fatality rate.

Front 22

What is Hep C?

(what type of virus, progression)

Back 22

it is a flavivirus

It is indolent (lazy) and slowly progressive liver disease that is asymptomatic until the late development of decompensated liver disease and often liver cancer

Front 23

How many people have symptoms for Hep C?

Back 23

only 5% of cases of hep C have symptoms

Front 24

How many people develop chronic infection of Hep C?

Back 24

70% develop chronic infection but then about 40% resolve spontaneously

Front 25

How is Hep C usually detected?

Back 25

Usually detected by elevated serum transminidase and confirmed by HCV antibodies

Front 26

Anitbodies are a marker of what?

Back 26

antibodies are a marker of infection NOT immunity

Front 27

What usually causes Hep C?

Back 27

due to intravenous drug use often in the past or due to one single episode

you used to be able to get it from untreated or non heat treated blood products prior to the 1980s - can't get it now because its all treated

Front 28

What are risk factors for Hep C liver fibrosis?

Back 28

age >40

male sex

alcohol consumption >50mg a day

immune status

genotype of the virus

Front 29

Whats important for hep C treatment?

Back 29

abstinence from alcohol (less than 4 drinks weekly)

safe sex councelling

interferon a and ribovirin

liver transplant if indicated for end stage liver disease or some cases of hepatocellular carcinoma

Front 30

When is heptocellular carcinoma rarely seen?

Back 30

its rarely seen prior to 15 years of infection and also rarely seen in the absence of liver cirrhosis

Front 31

Is there a vaccine for Hep C?

Back 31

no

Front 32

Hep C and alcohol ....

Back 32

progress liver cirrhosis and liver cancer

Front 33

What family us Hepatitis B from?

Back 33

Hepadnaviridae

Front 34

Why is this virus different from all other viruses?

Back 34

Hep B is the only virus known to have both DNA and RNA. Usually a virus will have one or the other

Front 35

Where is Hep B an endemic?

Back 35

subsaharan africa and pacific rim

Front 36

What do we hope in terms of hep B?

Back 36

This disease we can eliminate if we can get enough money and determination we are hoping it will be the 4th eliminated disease.

Front 37

What can Hep B range from?

Back 37

it can be asymptomatic or fulminant (sudden and severe)

Front 38

Whats the percent of chronic infections in people with Hep B?

Back 38

1% of healthy adults will have chronic infection from Hep B

Front 39

How many people with chronic Hep B infection?

Back 39

350 million

Front 40

What is the pathogenesis of Hep B?

Back 40

It is mainly due to cell mediated immune response to the host - virus triggers an auto immune response

Front 41

Whats the incubation period for Hep B?

Back 41

50-150 days

Front 42

What is the marker for infectivity for Hep B? And ____ becomes positive before an elevation in _______.

Back 42

HBSAg - this is not an infectious particle itself

And HBSAg becomes positive before elevation in serum transaminase

Front 43

How do you know someone is recovering from Hep B?

Back 43

Normally HBSAg will disappear and HBSAb will appear which is a marker of immunity and recovery

Front 44

What can you do during the short window period when the HBSAg and HBSAb are absent?

Back 44

You can check the HB core antigen IgM antibody

(through liver biopsy) - this is not routinely ordered

Front 45

What other thing will be high in the blood if infected with Hep B?

Back 45

E antigen along obviously with HBSAg

Front 46

What other tests can you do to diagnose Hep B?

Back 46

HBe antigen - high infectivity

HBe antibody -marker of recovery

HB DNA - marker of infectivity that can also be used to monitor therapy

Front 47

What are specific symptoms of Chronic Hep B?

Back 47

usually mild and nonspecific - lack of energy and malaise

myalgia, artralgias, skin rash and glomerulonephritis may occur when circulating immune complexes are present

Front 48

What can happen if you have chronic hep B?

Back 48

it may go unnoticed until you have cirrhosis and even end stage live disease

Front 49

what is a characteristic of chronic hep B?

Back 49

characterized by persistent HBSAg and failure to develop HBSAb for 6 months

Front 50

how many percent per year spontaneously become immune?

Back 50

1% per year spontaneously become immune

Front 51

What should you do in terms of the travelling?

Back 51

usually if you go on a short trip you don't need a vaccine as usually you won't be having sex with multiple people or injecting drugs

Hep A vaccine is more important than Hep B

Front 52

Does the vaccine work after you've been exposed to Hep B?

Back 52

Yes

Front 53

How is Hep B transmitted?

Back 53

primarily through blood, serum, plasma but all body fluids are infectious including ejaculate, vaginal recreations and saliva

sharing needles, razors and sexual contact

Front 54

Explain how Hep B can infect you

Back 54

intact skin is impermeable to HBV however if it touches mucosal surfaces, abrasions, open wounds it can facilitate transmission

Also a baby can get vertical transmission at placental seperation

Front 55

How can a baby get infected with vertical transmission at placental separation

Back 55

during pregnancy blood for the mother is separate from the blood for the baby and when the baby is born there is chance it will get Hep B.

Front 56

Does it take a lot of a little bit of "stuff" to give you hep B?

Back 56

only takes a TINY TINY amount of blood or bodily fluid to get you infected

Front 57

How can you prevent Hep B?

Back 57

Vaccines especially those with lifestyle risk factors (sexual partners, medical personals, household contacts with hep b, infants of mothers with hep B)

Front 58

What is Hep D?

Back 58

An RNA virus dependant on upon the enveloped proteins produced by hep B - therefore it can only exist with hep B

Front 59

How is it primarily transmitted?

Back 59

like hep b it must coexist with it is blood borne however sexual and perinatal transmission is rare

Front 60

How many people are affected world wide from hep D?

Back 60

25 million

Front 61

Is there a vaccine for Hep d?

Back 61

no; however, there is a vaccine for hep B and that can help prevent hep D

Front 62

Diarrhoea is defined as

Back 62

is defined by the passage of more than 300 grams of stool per day

Front 63

What is the main weight of the stool and whats the main cause of diarrhea?

Back 63

60-90% of stool weight is water, excretion of excess focal water is the main cause of diarrhea

Front 64

What is the term acute diarrhea mean?

Back 64

is means two weeks duration or less and is often associated with infectious causes

Front 65

When is the term acute gastroenteritis used?

Back 65

when vomitting is also present along with diarrhea

Front 66

What can be other causes of diarrhea?

Back 66

stress, extra spicy food ect

Front 67

What family does rota virus belong to?

Back 67

it belongs to reoviridae family

Front 68

What is Rotavirus a common cause of ?

Back 68

common cause of outbreaks of diarrhea in 6 months to 2 years of age

Front 69

what percent of toddlers by the age of 4 are seropositive ?

Back 69

90% of infants by the age of 4 are seropositive for rotavirus

Front 70

What is the incubation period of rotavirus?

Back 70

incubation period of 1-3 days then abrupt onset of vomiting followed with watery diarrhea

Front 71

how long does the vomiting and diarrhea usually last?

Back 71

vomiting last for 1-3 days but then the diarrhea continues for about a week

Front 72

What can be very dangerous in young children?

Back 72

Vomiting and watery diarrhea can be dangerous cause of dehydration.

the younger the kids are and the more they vomit and have diarrhea the more likely they will die of dehydration -- its important to keep them well hydrated!

Front 73

Where does the rotavirus localize?

Back 73

It localizes in the duodenum and proximal jejunem and results in the destruction of villous epithelium

Front 74

How do you diagnose rotavirus?

Back 74

electron microscopy of stool or detection of antigen via latex agglutination or enzyme immunoassay

Front 75

How do you treat rotavirus?

Back 75

primarily oral rehydration

and an oral vaccine is available

Front 76

What are three keys things you need to remember about rotavirus?

Back 76

it affects kids

can vaccinate

takes a long malabsorption period after you've had rotavirus

(usually takes 3-8 weeks to recover from malabsorption)

Front 77

Whats norovirus ?

(aka, what family)

Back 77

aka small around viruses of diarrhea

RNA virus in the caliciviridae family

Front 78

Who is it more common in?

Back 78

Adults and older children

Front 79

What does it usually cause?

Back 79

large outbreaks of diarrhea

Front 80

What percent of adults by the 5th decade are seropositive?

Back 80

50%

Front 81

What is the incubation period of the Norwalk virus?

Back 81

10-52 hours

Front 82

What are the symptoms of Norwalk?

Back 82

abrupt onset of vommiting and diarrhea

Front 83

How long does the illness last ?

Back 83

1-2 days

Front 84

how do you diagnose Norwalk?

Back 84

electron microscopy of the stool

Front 85

how is normal virus transmitted?

Back 85

fecal oral

Front 86

How can you break transmission

Back 86

Good hygiene is required to break the transmission

Front 87

When does viral shedding occur?

Back 87

viral shedding occurs for 3-4 days after the onset of illness

Front 88

3 things about Norwalk virus

Back 88

big outbreaks

doesn't last long

but severe

Front 89

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Back 89

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