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61 Cards in this Set
- Front
- Back
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****WHAT FORM OF HEPATITIS IS TRANSMITTED VIA FECAL ORAL ROUTE
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A
E |
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****WHAT FORM OF HEPATITIS IS TRANSMITTED VIA BLOOD BORNE ROUTE
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B
D C |
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how are some ways that HAV can be transmitted
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person to person
contaminated water/food |
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what are some risk factors for HAV
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MSM
international travel Injection drug users children |
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what form of hepatitis can undergo enterohepatic cycle and replicates in the liver
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HAV
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what is the course of the HAV infection
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infection occurs
viral shedding begins (SSx peak) pre icteric phase icteric phase IgG mediated immunity |
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what are the SSx of preicteric phase
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flu like symptoms- muscle pain, N/V, fever, fatigue, HA, loss of appetitie
children < 6 are asymptomatic |
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what are the SSx of icteric phase
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jaundice
dark urine acholic stool pruritis |
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when do pts typically become noninfectious/immune in HAV
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1 week after jaundice
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what are the physical findings of someone who has HAV
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hepatomegally
icteric sclera or skin |
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what are the lab findings of someone who has HAV
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positive serum IgM antiHAV
increase total bilirubin and transaminases (AST/ALT) |
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why would you see an increase in ALT/AST in hepatitis
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viral replication inside hepatocytes
immune system attacks hepatocytes hepatocytes upon death spill out AST/ALT |
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why is Hepatitis not DIRECTLY cytotoxic to hepatocytes
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viral replication inside hepatocytes
immune system attacks hepatocytes to try to clear the virus hepatocytes upon death spill out AST/ALT |
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what Ig_ is seen in acute infection
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IgM
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what are the treatment options for HAV
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there are none
liver transplant if liver failure occurs main goal is to try to prevetion and post exposure prophylaxis |
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what is done to prevent HAV and what is done as post exposure prophylaxis
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prevent: HAV vaccine, hand hygene
post exposure prophylaxis: HAV immunoglobulin |
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what are adverse effects seen from hepatitis A and B vaccination
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redness soreness at injection site
pain headache ANAPHYLAXIS ENCEPHALOPATHY GUILLAIN BARRE SYNDROME |
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what are the indications for HAV vaccine
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all children 1 year
CLD, MSM, injection drug user, traveling |
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when is the HAV immunoglobulin most effect
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if given during incubation period of disease (difficult to do since pt usually unaware they have Hep till symptoms present)
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what is a major downfall of the HAV immunoglobulin
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NO LIFELONG IMMUNITY - it goes away once the virus is cleared
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what does each abbreviation mean
HBsAg HBsAb (anti HBs) HBcAb (anti HBc) HBeAg HBeAb (anti HBe) |
HBsAg - surface antigen
HBsAb (anti HBs) - surface antibody HBcAb (anti HBc) - core antibody HBeAg - e antigen HBeAb (anti HBe) - e antibody |
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what serological factors are used in diagnosis of HBV
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HBsAg
HBsAb HBcAb |
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what serological factors are used in tx
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HBeAg
HBeAb |
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what kind of carrier is this:
HBsAg positive > 6 months. no significant hepatic inflammation. |
inactive HBV carrier
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what is HBeAg seroconversion
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negative of HBeAg and positive Anti HBe
good marker that tx is working |
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what is a marker of successful treatment in a pt with Hep B
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HBeAg seroconversion
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what are some risk factors for HBV
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MSM
injection drug users sexual activity blood transfusion occupational |
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why is it better for a pt to be symptomatic when they have a hepatitis infection
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this means that they are putting up an immune response, lack of symptoms indicates a likely hood that the infection can become chronic
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what are symptoms of Acute HBV
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flu like symptoms, N/V, abdominal pain, jaundice, acholic stool, dark urine, icteric symptoms
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what is the serology of Acute HBV
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HBsAg
HBeAg Anti HBc IgM HBV DNA |
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what is the relationship b/t HBsAg and Anti HBs
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as Anti HBs increases HBsAg decreases
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what is total Anti HBc composed of
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Anti HBc IgM
Anti HBc IgG - persists |
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what are the clinical outcomes of chronic HBV
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cirrhosis > hepatocellular carcinma
heptocellular carcinoma disease goes from being active to inactive v.v. |
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in Acute HBV infection what promotes immune cell mediated death and draw in the immune system to attack the infected hepatocytes
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HBcAg
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what is the serology of Chronic HBV
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HBsAg persists since no HBsAb was made to clear it
anti HBc IgG high serum HBV-DNA levels |
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what is a key marker of pt diagnosed with chronic HBV
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HBsAg > 6 months
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what are the labs of Chronic HBV pt
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HBV -DNA > 10^5 copies/ml
persistant HBsAg > 6 months ACTIVE CARRIERS MAY BE HBeAg NEGATIVE OR POSITIVE intermittent elevation of ALT/AST liver biopsy with moderate to sever inflammation |
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what is the difference in active and inactive carriers when it comes to lab values
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ACTIVE:
HBeAg negative or positive intermittent increase or decrease in ALT/AST HBV-DNA > 10^5 copies/ml Inactive: HBeAg negative normalized ALT/AST HBV-DNA < 10^5 copies/ml HBeAb positive (SEROCONVERSION) |
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what would a liver biopsy show in an active carrier
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active carrier:
moderate to severe liver inflammation |
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what are the signs and symptoms of Chronic HBV
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same as acute (jaundice, icteric symptoms, acholic stool, dark urine, flu like symptoms, N/V, abdominal pain, HA) AND
ascites hepatic encephalopathy asterixis |
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long term remission is common in what type of HBV pts
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inactive carrierers
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what are the lab findings of inactive chronic HBsAg carriers
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HBsAg > 6 months
HBV-DNA < 10^5 copies/ml ALT/AST normal HBeAg negative, HBeAb positive (SEROCONVERSION) |
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what are complications of chronic HBV
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jaundice
hepatocellular carcinoma ascites hepatic encephalopathy cirrhosis coagulopathy |
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what are indications for HBV vaccine
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people < 19
HIV pt IV drug users infants occupational exposure international travel (>6 months) chronic dialysis/ESRD recipients of clotting factors |
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Egerix is a vaccine for what form of hepatitis
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B
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Recombivax is a vaccine for what form of hepatitis
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B
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Havrix is a vaccine for what form of hepatitis
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A
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Vaqta is a vaccine for what form of hepatitis
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A
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what is the HAV/HBV combo vaccine and how old must you be to get it
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Twinrix
>= 18 years |
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what individuals are more likely to be unresponsive to HBV vaccine
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obese
immunocompromised pt receiving hemodialysis |
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what do you check for after completing the HBV vaccine and what do you do if you can't detect it
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Anti HBs titer
if not detectable do 4th dose or repeat full course |
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HBsAg negative
Anti HBc positive Anti HBs positive has this pt received a vaccination, recovered from infection, recent acute infection, or chronic active infection |
recovered from infection
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HBsAg negative
Anti HBc negative Anti HBs positive has this pt received a vaccination, recovered from infection, recent acute infection, or chronic active infection |
vaccination
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HBsAg positive
Anti HBc positive IgM anti HBc positive Anti HBs negative has this pt received a vaccination, recovered from infection, recent acute infection, or chronic active infection |
recent acute infection
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HBsAg positive
Anti HBc positive IgM anti HBc negative Anti HBs negative has this pt received a vaccination, recovered from infection, recent acute infection, or chronic active infection |
chronic active infection
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pt is automatically immune if they have what
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HBsAb
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what are the HBV-DNA levels in pt with chronic HBV and inactive HBV
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low in inactive
high in chronic |
