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124 Cards in this Set
- Front
- Back
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Symptoms of hepatitis?
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Liver inflammation
Jaundice, fatigue, N/V Abdominal pain |
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Non-infectious causes of hepatitis?
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ETOH, drugs
Ischemia Inherited dz Toxins |
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Infectious causes of hepatitis?
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Viral hepatitis
Other virus Many bacteria Parasites |
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Types of Viral hepatitis?
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Hep A-E (liver specific)
Non-liver specific: YF, EBV, CMV |
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How do you culture hepatitis viruses?
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Tissue culture
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Which hepatitis viruses are DNA viruses?
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Hep A, C, D, G
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Which hepatitis viruses are RNA viruses?
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Hep B, Hep F?
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Which viral hepatitis are fecal oral
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A and E (vowels in the bowels)
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How are non-fecal oral Hepatitis spread?
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Bood
Sex Vertical |
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Which viral hepatitis are endemic to USA?
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A, B, C, D
NOT E |
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What is the most common cause of acute viral hep in USA?
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Hep B (50%)
Hep A (32%) |
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When do you see Hep E in the USA?
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Travellers returning from endemic areas
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What is a simple screeing test for hepatitis in the non-icteric patient?
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Urine bilirubin (vs. liver enzyme panel)
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What happens to alk phos in hepatitis?
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Usually is normal
If elevates, no higher than 2x normal |
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What does prolonged PT indicate in viral hepatitis?
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Grave finding
Indicates severe liver malfunction |
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What does impaired renal function suggest in viral hepatitis?
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Fulminant hepatitis
(multi-organ system failure) |
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What happens to LFTs in hepatitis?
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Elevated ALT/AST
Normal Alk phos, GGT |
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What happens to LFTs in obstructive liver dz?
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Elevated Alk phos and GGT
Normal transaminases (opposite of hepatitis) |
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What happens when you have mixed liver dz (obstruction and hepatitis)?
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Elevation of all enzymes
ALT, AST, GGT, Alk Phos |
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What is included in the "acute hepatitis panel"?
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Hep A: IgM anti HAV
Hep B: HepBsAg, IgM anti-HepBc (core antigen) Hep E: IgM anti-HepE |
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What is strongly suggestive of acute Hep B infection?
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Elevated HepBsAg (hep b surface antigen)
Does not rule out chronic HBV with acute superinfection by another hep virus |
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What is the most specific and earliest test for hep C?
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PCR
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How is Hep A spread
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Person to person
Fecal oral |
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What is the incubation period for hep A
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2-6 weeks
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Rosk factors for Hep A?
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Contaminated shellfish
Contaminated water Travel to endemic areas Poor hygiene Caregiver/contact of acute hep a case Daycare centers International travel Secondary infection in households = 20% |
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Where is high anti-HAV prevalence?
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Middle east, africa
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How severe is hep a in childhood?
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Mild
>80% asymptomatic |
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What age commonly has symptomatic hep a?
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Adults
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What's true about jaundice in hep A?
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Risk of jaundice increases with age
10% in children 80% in young adults |
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How long are you immune if you get hep a?
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Lifelong
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When do you see rise in transaminases/bili in Hep A?
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2 weeks post infection
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Blood test: what is present in acute phase of Hep A
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Hep A IgM (diagnostic)
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Blood test: what is present during the convalescent phase of Hep A?
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IgG
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How long is Hep A shed in feces?
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4 weeks
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When is the highest risk of shedding hep A in stool?
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1-2 weeks efore onset of symptoms! (max at end of incubation period, which lasts 2-7 weeks)
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What % of patients recover completely from hep A?
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99%
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Who dies of Hep A?
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Extremes of age -- 0.01% mortality
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Is there a chronic liver carrier state of hep A?
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No
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When to give Human Immunoglobulin to prevent Hep A?
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Exposed to person shedding
Travel within 4 weeks < 2 years old Allergic to vaccine |
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When to give Hep A vaccine (killed whole virus)?
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>2 years old (CDC says at 1 year)
95% protection from infection |
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Who should get Hep A vaccine?
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Health care workers
Day care workers Military Travellers abroad Liver dz Immunocompromised Sewage/wastewater workers Vets working with primates ?children ?food handlers |
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How long does the Hep A vaccine protect?
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20+ years
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What are the 2 Hep a vaccines?
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Vaqta
Havrix |
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Which hep a vaccine has more seroconversion in 15 days?
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Havrix (80-98%) -- after 1 month, 96-100%
Vaqta (69%) -- after 1 month, 94-97% Both are 100% 1 month after second dose |
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What is twinrix?
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Combo hep a and b vaccine
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Who can get twinrix?
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> 18 y/o
0,1,6 mos or 0,7,21, 1 year |
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How do you inactivate Hep A virus?
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Boil water or cook food to 85C/185F for 1 minute
Chlorine |
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What are the chronic sequelae of Hep B
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Chronic infection
Liver cirrhosis Highly fatal liver cancer |
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Where does liver cancer from Hep B rank in endemic areas?
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In the top 3 deadly cancers
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How much more infectious is Hep B (vs HIV)?
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50-100x
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Who should get Hep A vaccine?
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Health care workers
Day care workers Military Travellers abroad Liver dz Immunocompromised Sewage/wastewater workers Vets working with primates ?children ?food handlers |
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How long does the Hep A vaccine protect?
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20+ years
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What are the 2 Hep a vaccines?
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Vaqta
Havrix |
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Which hep a vaccine has more seroconversion in 15 days?
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Havrix (80-98%) -- after 1 month, 96-100%
Vaqta (69%) -- after 1 month, 94-97% Both are 100% 1 month after second dose |
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What is twinrix?
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Combo hep a and b vaccine
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Who can get twinrix?
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> 18 y/o
0,1,6 mos or 0,7,21, 1 year |
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How do you inactivate Hep A virus?
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Boil water or cook food to 85C/185F for 1 minute
Chlorine |
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What are the chronic sequelae of Hep B
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Chronic infection
Liver cirrhosis Highly fatal liver cancer |
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Where does liver cancer from Hep B rank in endemic areas?
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In the top 3 deadly cancers
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How much more infectious is Hep B (vs HIV)?
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50-100x
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How many carriers of Hep B worldwide?
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350 million
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How many deaths annually from Hep B
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1 million
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What is the hep B viral particle called?
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Dane particle
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What does the Hep B virus look like?
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It has a core with a nuclear capsid in which DNA is found,
an outer membrane and surface antigens that look like lollypops coming off of the core |
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What are the 3 antigens seen in Hep B?
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Surface antigen (HBsAg)
Core antigen (HBcAg) E antigen (HBeAg) -- never seen in blood; seen in tissues during active viral replication |
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How is hep b spread?
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Blood
Sex Vertical IVDU Hemodialysis Transfusions Organ transplants Needlestick Saliva/serum/semen ?breastmilk |
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What is the incubation period for hep B?
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4-22 weeks (average 10)
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What kind of HBV spread predominated before immunization in developed world?
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Vertical (maternal to child)
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Now that there is HBV vaccine, who gets most infection in developed world?
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Young adults
Sex and IV drug use |
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What is most common form of HBV spread in developing world?
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Mother to child
Child to child (playing/scratching/etc.) Reused needles |
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What are the 2 phases of hep b infection?
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Preicteric
Icteric |
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What is the preicteric phase of Hep B?
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Prodrome
Anorexia, malaise, fatigue Elevated LFTs Some have fever, arthritis, arthralgia, rash |
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What is seen in the icteric phase of hep B?
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Tender liver, jaundice
Dark urine from elevated bili N/V Pruritis |
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What percent of HBV infection go on to compete recover?
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95%
5% become carriers |
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What percent of HBV get fulminant infection?
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1%
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What are the possible features of those who are chronic hep B carriers?
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Healty carrier
Chronic hepatitis Cirrhosis Hepatocellular carcinoma |
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What kind of cancer do you get with Hep B?
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Hepatocellular carcinoma
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What are the markers of active HBV replication?
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HBeAg adn HBV DNA level
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What is the best marker of acute Hep B infection?
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HBcAg IgM
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If a mom is HBsAg+, what is the risk of vertical transmission?
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10%
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If a mom is HBeAg+, what is the risk of transmission to fetus?
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90% (because active viral infection)
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If an infant is infected with HBV, what percent develop chronic infection?
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90%
25% die of chronic liver dz |
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What is the first antigen to rise in HBV infection?
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HBsAg
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What is the most reliable antibody of acute HBV infection?
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IgM anti-HBc
(anti-HBs start to show up 32 weeks after exposure) |
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What blood finding do you see in chronic HBV infection (and not in recovery?)
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HBsAg peaks and drops in recovery, but persists in carrier state
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Where does the HBV vaccine work?
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On the surface antigen, so will cause Anti-HBs to be positive
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If you are anti-HBc and anti-HBs positive, what does that mean?
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You are immune to HBV due to natural infection
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If you are anti-HBs positive, but anti-HBc negative, what does that mean?
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YOu are immune to HBV due to immunization (which works on the surface antigens)
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If you are anti-HBs negative but anti-HBc positive, what does that mean?
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If you are also Anti-HBcIgM positive, you are in acute infection
If you are also Anti-HBcIgM negative, you are in chronic infection Either way, you are infected |
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How do you treat chronic hbv?
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Interferon
Lamivudine Adefovir Dipivoxil (ADV) Liver translant for cirrhosis/failure |
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What vaccines are available for Hep B prevention?
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Twinrix
Recombivax HB Engerix B (this one can do accellerated schedule of 1,2,3,12 mos) |
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Who should get Hep B vaccine?
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All infants
Health care workers/lab workers Travellers who will live > 6 months or more in areas with >2% HBsAg prevalence |
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What do you do for a baby born to an actively infected mom (HBeAg+)
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HBIG and HB vaccine
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What is wierd about HepD?
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It is a defective virus
Only a coinfection with Hep B Uses HBsAg as its protein coat It increases the mortality/morbidity of HBV |
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Where do you find high rates of HepD?
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Amazon
Central Africa Southern Italy Middle East |
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What happens to HepD when HBsAg clears from serum?
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HepD disappears
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What is the treatment for Hep D?
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Interferon
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Is Anti-HDV testing reliable?
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No (low titre, appears late)
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How common is HCV?
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170 million revalence
3-4 million new cases/year |
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How is HCV spread?
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Blood
Percutaneous (body piercings, tattoos) STD but not a major mode |
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Where is high Hep C prevalence?
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Africa
Western Pacific E. Mediteranean |
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What's the US incidence of Hep C?
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35,000/year
1.8% prevallence Sex workers/MSM: 4-6% Homeless/incarcerated: 15-50% IDU, hemophilia: 70-90% |
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What percent of Hep C infected will develop chronic infection?
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60-85% (vs 5% of hep B)
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Who is more likely to spontaneously clear hep C?
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Young
Women |
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What percent of Hep C carriers will have cirrhosis at 20 years?
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10-15%
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Is Hep C cirrhosis related to viral load?
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No
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What increases risk for Hep C cirrhosis?
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ETOH
HIV Male HBV coinfection |
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How to Dx Hep C?
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EIA (sensitive for chronic, but 50-70% for acute)
Confirmatory RIBA blood test PCR is most specific, positive sooner than serology |
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What blood test is used to determine response to treatment in HCV
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PCR
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How to treat HCV?
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Interferon plus ribavirin
Pegylated interferon is better for genotype 1 Either is used in genotype 2 |
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How many HCV genotypes are there
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Looks like 3
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Which genotypes of HCV respond best to therapy?
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2 and 3
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What % of hepatocellular CA is caused by HCV?
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33%
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Is there a vaccine for Hep C?
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No
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What's a bummer about use of Immunoglobulin for hep C?
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Ig is not protective
It has resulted in the TRANSMISSION of hep C! |
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How is Hep E spread?
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Most from fecal contamination of drinking water
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Is there person to person transmission of Hep E?
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Rare (unlike hep A)
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What happens with Hep E in pregnancy?
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High maternal mortality
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Do you get durable immunity from Hep E infection?
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No
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How to kill hep E in water?
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Boil
? no mention of chlorine/filter/etc.... |
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What normally causes death from viral hepatitis?
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Fulminant hepatitis (rapid)
Get hepatic encephalopathy within 8 weeks of sx/within 2 weeks of jaundice |
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What is the predictor for fulminant hepatitis?
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NOT elevated transaminases
Elevated PT |
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What are the mean incubation periods for the different Hep viruses?
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A 30
B 80d C 50d D variable E 40d |
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What is the only hep virus that has vertical transmission?
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Hep B
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