Session 3 Cm- Gi-5- Viral Hepatitis

Front 1

What are the five recognized hepatitis viruses

Back 1

A, B, C D, E&G

Front 2

Does acute hepatitis only occur because of hepatitis virus infections

Back 2

no, CMV, EBV, HSV, Yellow Fever virus, Rubella all can cause acute hepatitis

Front 3

What s/sx can help you differentiate cause of acute viral hepatitis between hepatitis viruses and other viral causes

Back 3

actually they present clinically in similar ways and the only way to differentiate them is Lab results

Front 4

What clinicla features will patient with hepatitis present with

Back 4

anorexia, nausea, vomiting, right upper quadrant pain, elevated liver enzymes AST and ALT, headache, malaise, fever, Jaundice, dark urine, pale stool

Front 5

What two hepatitis viruses are from fecal source

Back 5

A and E

Front 6

what is the source of the majority of hep viruses

Back 6

Blood or body fluids

Front 7

What hep viruses cause chronic infection

Back 7

those that are of blood or body fluid source B, C, and D

Front 8

What are the best ways to avoid hep infection

Back 8

immunization and avoiding high risk behaviours

Front 9

What will you likely see on lab eval of pt w/ viral hep

Back 9

WBC normal to low, Lymphocytes (large atypical), Mild protienuria, bilirubinuria (precedes jaundice), elecated AST/ALT early, then ALT/AST, acholic stool

Front 10

What is the hallmark s/sx of viral hep

Back 10

Jaundice, usually develops late in infection

Front 11

Hep called infectious hepatitis, incubation period 2-5 weeks, milder disease than hep B, asymptomatic infections are common especially in kids

Back 11

Hep A

Front 12

What groupd is more likely to develop severe infectious hepatits from Hep A

Back 12

Adults especially pregnant women,

Front 13

Is there a chronic form of Hep A

Back 13

no

Front 14

What is the pathogenesis of HEP A

Back 14

viruses eneter via gut (fecal oral transmission), replicates in alimentary tract then spreads to infect liver hepatocytes, viremia is transient, virus is excreted in stools for 2 weeks preceding onset of s/sx

Front 15

How do you dx Hep A

Back 15

culture of virus from in vitro material or HAV IgM in patients blood

Front 16

How can you prevent Hep A infections

Back 16

passive immunization or active immunization(not in general use)

Front 17

This hepatits has incubation period of 30-40 days acute self limiting hepatits no chronic carrier state and predominantly found in young adults 15-40yrs of age. (not hep A)

Back 17

Hep E

Front 18

What is a major complication associated w/ Hep E

Back 18

Fulminant Hep in preganat women w/ high mortality rate up to 40%

Front 19

What is the pathogenesis of Hep E

Back 19

replicates in gut then invades liver shed in stool prior to s/sx viremia is transient requires large inoculum to establish infection (very similar to Hep A)

Front 20

How can you dx Hep E

Back 20

Specific IgM in serum though no routine lab tests are available

Front 21

This Hepatitis has a incubation period of 1-6 months, insidious onset of s/sx, tend to cause more severe disease than Hep A asymptomatic infections occur frequently

Back 21

Hep B

Front 22

How is Hep B transmitted

Back 22

sexually, parenterally, mucus membrane exposure,

Front 23

What hep is associated with polyarteriitis nodosa (PAN)

Back 23

Hep B and C

Front 24

Patient has an Ab against the surface (coat) protein of Hep B what antigen does it target

Back 24

HBsAG- produced as small spheres and tubules

Front 25

What are HBcAg and HBeAg

Back 25

antigens of Hep B inner core protein (HBcAg) and secreted protein (HBeAg)

Front 26

What is the first marker present in a pt w/ viral Hep B

Back 26

HBsAg

Front 27

Will you find Hep B antigen HBcAg in the pts serum

Back 27

no it does not circulate

Front 28

What is the HBV window period

Back 28

period during which HBsAg is not detectable and Anti HBs is not present but Anti HBc appears. Can last several weeks during this time a pt is likely to test negative but still be able to infect others

Front 29

What is the pathogenesis of HBV

Back 29

infection from blood or body fluid exposure, virus replicates in liver, virus is shed into blood viremia is prolonged, blood is highly infectious of conatminated individual

Front 30

What is the likely course of a HBV infection

Back 30

90% self limited, 1-2% fulminant and 5-7% chronic carriers

Front 31

What group is most likely to become a chronic carrier of HBV

Back 31

infants that get infected, immunocompromised pt, male>female

Front 32

Can HBV be transmitted across the placenta

Back 32

yes 5-10% transmission rate

Front 33

pt has failed to eliminate HBV and have a chronic infection what two ways could this chronic infection go

Back 33

Chronic Persistent- minimal liver damage or Chronic Active- aggressive destruction of liver tissue and rapid progression to cirrhosis or liver failure

Front 34

What are chronic HBV patients at increased risk of developing

Back 34

Hepatocellular Carcinoma (HCC), 80% of pt w/ HCC are HBV carriers, have virus DNA in HCC cells

Front 35

the following are high risk activities for what disease blood transfussions, serum product transfussion, sharing needles, razors, tattooing, acupuncture, renal dialysis, organ donation

Back 35

HBV, Hep C, HIV

Front 36

What 2 hep antigens when found in the blood or serum indicate viral replication is taking place in the liver

Back 36

HBsAg and HGeAg

Front 37

What ab indicates immunity following a hep infection it is detectable for life and is not found in chronic carriers

Back 37

Anti-HBs

Front 38

When does the anti-HBe antibody become detectable

Back 38

when viral replication falls

Front 39

What indicates pt has been exposed to HBV

Back 39

core IgM and core IgG antibodies against core protein

Front 40

How can you prevent HBV infection

Back 40

active immunization with 3 doses of either serum derived or recombinant HBsAg vaccines both are eqully safe and effective

Front 41

What liver condition can chronic viral hepatits B lead to

Back 41

macronodular cirrhosis

Front 42

Your pt was working at a laundry and has never been vaccinated for HBV they got stuck by a needle left in someones clothes what should you order for them as a precaution (assume HIV isn't a problem)

Back 42

Hep B immune Globulin + vaccine if HBsAg negative. Newborns of Hep B mothers should get HBIG as well

Front 43

Your patient is a chronic carrier of Hep B and just gave birth to a baby what should be done for the baby

Back 43

Give baby Hep B immune Globulin

Front 44

This viral hep has an incubation period of 4-8 weeks cases are milder but more people infected develop chronic infection (50%)

Back 44

Hep C

Front 45

What are major complications of Hep C

Back 45

Chronic liver disease and hepatocellular carcinoma

Front 46

How is Hep C transmitted

Back 46

exposure to blood or body fluids of infected individual especially blood transfusion/products, organ donation, IV drug use, sex

Front 47

How can you dx Hep C

Back 47

serology- HCV specific IgG indicates exposure not infectivity, PCR detects viral genome in pt serum, HCV RNA

Front 48

What is chronic viral hepatitis

Back 48

>6months infection with either B,C, or D

Front 49

What tx can you give for chronic HBV carrier

Back 49

interferon alpha 30% long term remission, or Lamivudine reduces HBV-DNA reduces ALT levels and 15-20% seroconvert

Front 50

What tx can you give for chronic HCV

Back 50

Interferon alfa, 15% remit, Interferon/Ribavirin

Front 51

If pt has inflammation extending beyond the portal areas into surrounding hepatic structures w/ extensive necrosis and fibrosis what are they suffering from

Back 51

chronic active hepatitis CAH

Front 52

If pt has chronic inflammatory infiltration of portal areas with little or no fibrosis what are they suffering from

Back 52

chronic persistent hepatitis CPH

Front 53

This hep virus requires comorbid infection with HBV

Back 53

Hep D uses the Hep B capsule so Hep D has HBsAg

Front 54

What are the consequences of Hep D infection in pt

Back 54

increased severity of liver disease in hep B carriers.

Front 55

pt is infected w/ a flavivirus, they present w/ glomerulonephritis, cryoglobulins, porphyria cutanea tarda (PCT), thrombocytopenia, neuropathy, thyroiditis sjorgren's syndrome or inflammatory arthritis name cause

Back 55

Hep G

Front 56

What are the non viral causes of acute hepatitis

Back 56

Drugs, Alcohol, toxins, metabolic and autoimmune

Front 57

What is the leading cuase of Acute Liver Failure in the US

Back 57

drug related hepatotoxicity

Front 58

Pt has liver disease and is taking cascara, chaparral, comfrey, kava and ma-huang (they really like herbal meds) why could this be a problem

Back 58

compound liver disease

Front 59

What drug is most common implication in alcoholic liver

Back 59

acetaminophen it has a syngergistic effect w/ alcohol

Front 60

What are s/sx of alcoholic liver w/ acetaminophen

Back 60

nausea, vomiting, diarrhea abdominal pain and shock alt/ast

Front 61

exposure to this drug can cause a Type I mild hepatitis which is typically benign or self limiting 20-30%, or can causea type II rxn w/ fever, jaundice and increased transaminases mortality of 50%

Back 61

Halothane and the fluranes

Front 62

What effect can INH (isoniazid) have on the liver

Back 62

This drug causes a mild hepatitis toxicity in 20% of patients more men then female more in adults and cannot be distinguished clinically from viral heptatitis

Front 63

This drug accumulate in hepatocytes and rarely causes clinical iver disease liver injury once done may continue for months you will see a transaminase elevation

Back 63

Amiodarone

Front 64

Why do you see liver damage in HIV patients

Back 64

Anti-retroviral therapy has liver toxicity especially in HAART- highly active retroviral therapy

Front 65

what is steatosis

Back 65

fatty liver

Front 66

what is cirrhosis

Back 66

scarring and fibrosis of liver tissue

Front 67

pt test positive for smooth mucle antibody they also have clinical signs of hepatitis what is the likely cause of their hepatitis

Back 67

autoimmune hepatitis AIH

Front 68

What is Gilbert's sndrome

Back 68

glucoronyl transferase deficiency which is a benign chronic disorder w/ asymptomatic hereditary jaundice.