Pod Hepatitis Elder

Front 1

Who am I
Lymphocytic inflammation of the liver; following injury to the liver associated with an influx of acute of chronic inflammatory cells.

Back 1

Hepatitis

Front 2

When is hepatitis frequently the result of destruction of antigen expressing liver cells by cytotoxic lymphocytes?

Back 2

When it is virally induced

Front 3

List some of the causes of hepatitis: (5)

Back 3

Viral infection
Bacteria (salmonella, syphilis)
Parasites
Drugs/Chemical toxicity
Mushrooms/toxins
Autoimmune diseases

Front 4

What are the types of hepatitis virus? How are they detected?

Back 4

A,B,C,D,E,G
Serological testing

Front 5

Besides Hepatitis virii, what are some viruses that can cause hepatitis?

Back 5

Epstein Barr
Cytomegalovirus
Yellow Fever Virus
Rubella/adeno/HSV/entero

Front 6

How can the viral Hepatitis's be differentiated clinically?

What are common characteristics of all the variations of Hepatitis??

Back 6

Trick question: they can't be.

Liver enzymes will be elevated(ALT, AST), except for alkaline phosphatase which will be normal.

Front 7

What effect will hepatitis have on liver enzymes, be specific.

Back 7

Hepatic enzymes will be elevated.
Alanine aminotransferase (ALT)
is the highest.
Aspartate aminotransferase (AST) will be elevated.
Alkaline phosphatase will be normal.

Front 8

How and why is viral Hepatitis divided into mild, moderate and severe?

Back 8

Mild-quiescent lymphocytes collect in portal tracts.
Moderate-activated lymphocytes spill over into the periportal perenchyma.
Severe-activated lymphocytes suffuse the entire parenchyma.

Front 9

What types of Hepatitis can be spread fecal-oral route? Which are spread via blood and body fluids?

Back 9

fecal-oral: A and E
Body fluid/Bld: B,C,D

Front 10

Why is Hep A considered to be an odd picornovirus?

Back 10

Because it is not cytolytic as all of the other picornoviruses are.

Front 11

In the spectrum of Hepatitis, which are DNA and which are RNA viruses?

Back 11

A,C, and E are RNA
B is DNA
D is a viral parasite

Front 12

In the spectrum of Hepatitis viruses, how are they spread?

Back 12

Fecal-oral A and E
Blood/Body Fluids B and C

Front 13

How many serotypes does Hep A have?
Who are the natural hosts?
Is it enveloped? What does that mean?

Back 13

1
Humans
Non-enveloped, ss, so very hardy and resistant to extremities.

Front 14

How long is the incubation period for each of the Hepatitis viruses?

Back 14

A 28 days
B >45 days
C ??

Front 15

When is Hep E a major problem?
How was Hep E first described?
Hep E's symptoms and mode of transmission are similar to?

Back 15

In pregnant women.
Noro-like virus.
Hep A

Front 16

What is the biggest risk factor for contracting Hep C?

Back 16

Injection Drug Use

Front 17

What forms of Hep can be treated with Interferon Alpha?

Back 17

B and C
C will additionally be treated with ribavarin

Front 18

How do you treat Hep A?

Back 18

Supportive care only.

Front 19

What might result from an insufficient T cell response in a Hep B infection? In what age group is this most common?

Back 19

Mild symptoms, unresolved infection, chronic Hep.
Infants and young children

Front 20

HbsAg and anti-Hbs can result in:
What can this cause?

Back 20

Immune complexes, type III hypersensitivity.
Rash, vasculitis, arthralgia and kidney damage.

Front 21

In which Hep infection, might you see ground-glass hepatocytes du to viral replication?

Back 21

Hep B

Front 22

How long, from the time of entry, does it take for Hep B to begin replicating in the liver?

Back 22

3 days.

Front 23

Explain the replication of Hep B?

Back 23

Attachment to receptor, completion of ds circle in nucleus, transcription of neg stranded template, translation of mRNA (RTase), completion of virus, packaging, released by exocytosis.

Front 24

What may happed if T cell response is massive, to Hep B infection?

Back 24

Fulminant hep

Front 25

Hep B can be stable for extended periods of time on environmental surfaces, so what is surprising then about the virus?

Back 25

It is enveloped

Front 26

What is a Dane particle?

Back 26

the complete Hep B viron

Front 27

What types of vaccine do the Hep strains have?

Back 27

A Inactivated whole virus & immunoglobulin
E None
B Recombinant (use for D) HepB Immune globulin too
C None

Front 28

How long does it ake for Hep B symptoms to reslove?

Back 28

1-3 months

Front 29

In Hep B:
What can be measured in the window phase?
Indicates recovery?
Indicates a lot of viral rep?
Overall indicator of infectivity in Hep B?

Back 29

ab to hep B core antigen (IgM)
ab to hep B surface antigen
Hep B e antigen
Hep B surface antigen

Front 30

What is used for Hep B therapy? What is used to monitor therapy?

Back 30

Interferon alpha, nucleoside analoges (RT inhibitors)
Molecular assay used to monitor viral load

Front 31

The HbsAg Hep B vaccine is now being used in:

Back 31

all infants in the US. 3 dose sequence, it is also used to vaccinate preadolescents.

Front 32

Hep D (delta virus) can only be contracted if:
Hep D is responsible for 40% of all _________cases of hep.
D+B=

Back 32

You already have Hep B, or along with Hep B

Fulminant
80% mortality

Front 33

Describe the Hep D virus?

Back 33

Viral parasite, small circular ss RNA virus. Delta antigen on core and HbsAg antien on envelope. It requires HBV to complete its life cycle.

Front 34

How can you detect Hep D?
Is Hep D cytotoxic?
When does Hep D infection resolve?

Back 34

Serologic detection of IgM or total antibody against Hep delta antigen.
Hep D is cytotoxic and causes immune mediated damage.
It resolves when Hep B infection resloves.

Front 35

Which strains of Hep are flaviviruses?

Back 35

C and G

Front 36

Describe the Hep C virus?
Where does it bind?
# of genotypes?
Typical type in USA and Europe?

Back 36

Enveloped, + strand RNA
Binds to hepatocytes via LDL or VLDV receptors on lymphocytes.
6 genotypes
1a and 1b are most common

Front 37

What percentage of Hep C infections become chronic?

Back 37

80-85%

Front 38

Viral clearance of Hep C occurs in a lucky few of those infected. What factors contribute to this possibility?

Back 38

Very strong immune system, and people who have less viral diversity.

Front 39

Hep C
Most infected persons have persitent _______, variable degrees of __________ _______ and _________.

Back 39

Hep C
Most infected persons have persitent viremia, variable degrees of hepatic inflammation and fibrosis.

Front 40

Hep C
During replication HCV proteins inhibit _____ and IFN alpha action: promotes ________ __________.

Back 40

During replication HCV proteins inhibit apoptosis and IFN alpha action: promotes persistent infection.

Front 41

List two factors that decrease and three factors that increase the rate of progression of Hep C infection.

Back 41

Decrease: Female, young
Increase: Male, ETOH use, coinfection.

Front 42

Infections in the US of Hep C dropped in the early 90's primarily due to?

Back 42

Blood donation screening

Front 43

What are you looking for in serology exam for Hep C? What is another option? Why is it important to genotype asap? What must be done first?

Back 43

Hep C antibody.
Molecular testing for Viral nucelic acid.
Firs you must use reverse transcriptase. The genotype is important bc it will tell you about treatment and severity expected.

Front 44

What strains of Hep C are least responsive to therapy? Who is therapy recommended for? What is the last resort?

Back 44

1a and 1b
Pt w/ viremia and progressive liver damage.
Liver transplant

Front 45

Clonorchis sinesis =
Fasciola hepatica =
Leptospirosis =

Back 45

Chinese Liver Fluke via fish
Sheep Liver Fluke via plants
Spirochete, contracted via urine

Front 46

Identification
Clonorchis sinesis =
Fasciola hepatica =
Leptospirosis =

Back 46

Clonorchis sinesis = ova in feces
Fasciola hepatica = ova in feces if chronic, otherwise, serology.
Leptospirosis = found in blood, then CSF, then urine.

Front 47

What can cause jaundice?

Back 47

Hepatitis and Leptosporosis

Front 48

What are the three spirochetes we have learned?

Back 48

Borellia
Syphilis
Leptosporosis

Front 49

Which of the following can be treated with praziquantel?
Leptospirosis
Chinese liver fluke
Sheep Liver Fluke

Back 49

Clonorchis sinensis (Chinese liver fluke)

Front 50

Indirect life style, infection via planst w/ metacercaria, adults in hepatic parenchyma

Back 50

Fasciola hepatica (sheep liver fluke)

Front 51

Is Fasciola hepatica more or less pathogenic than Clonorchis sinensis?

Back 51

More

Front 52

Humans accidental host, via water contaminated by urine.
Can penetrate skin via minor breaks in epidermis.
100-200 cases/yr in USA.
Can cause kidney damage.

Back 52

Leptospirosis

Front 53

How long is the incubation period of Leptospirosis?
Is damage from immune rxns or immune complex formation?
Where is the organism found?
What may develop?
Does everyone recover?

Back 53

1-2wks
Both
Blood, CSF, Urine
Weil's disease
No

Front 54

What are the following associated with?
Headache, myalgia, chills, abdominal pain, conjunctival reddening, vascular colapse, thrombocytopenia, hemorrhage, hepatic and renal dysfunction.

Back 54

Weil's disease associated with Leptospirosis