Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
31 Cards in this Set
- Front
- Back
|
Hepatitis, inflammation of the liver can have many causes including: |
Common Drugs= Methyldopa, Nitrofurantoin, Isoniazid, Sulfonamides, Propylthiouracil.
Toxins Alcohol Viral infections (A, B, C, D, E) Other infections (parasites, fungi, bacteria)Physical damage Immunologic (Autoimmune) |
|
|
Other Viruses Associated with Hepatitis include:
|
•YellowFever virus •Cytomegalovirus •Epstein-Barrvirus •Measles/Mumps/Rubella •Herpessimplex virus •Varicellazoster virus |
|
|
Viral hepatitis- Historical perspectives: |
Infectious= A, E = Enterically transmitted Serum= BDC= Parenterally or body fluids transmitted |
|
|
Hepatitis A: primary source of virus= primary route of transmission= chronic infection? Prevention= |
- feces - fecal-oral -NO -pre/post exposure immunization, proper hand washing techniques |
|
|
Hepatitis B: primary source of virus= primary route of transmission= chronic infection? Prevention= |
- blood/ blood derived body fluids - percutaneous permucosal - yes - pre/post exposure immunization, blood donor screening, risk behavior modification |
|
|
Hepatitis C: primary source of virus= primary route of transmission= chronic infection? Prevention= |
- blood/ blood derived body fluids - percutaneous permucosal - YES - blood donor screening, risk behavior modification |
|
|
Hepatitis D: primary source of virus= primary route of transmission= chronic infection? Prevention= |
- blood/ blood-derived body fluids
- percutaneous permucosal - YES - Same as Hepatitis B |
|
|
Hepatitis E: primary source of virus= primary route of transmission= chronic infection? Prevention= |
-Feces - fecal-oral - NO - ensure safe drinking water |
|
|
Standard Liver Panel: 1)Albumin (Alb) = 2)Alanine Transaminase (ALT)= 3)Aspartate Transaminase (AST)= |
1) Albumin(Alb) -Albumin is a protein made specifically by the liver. Albumin levels aredecreased in chronic liver disease, such as cirrhosis N= 3.5 to 5.0 g/dL 2) Alaninetransaminase (ALT)- is an enzyme present in hepatocytes (liver cells). When acell is damaged, it leaks this enzyme into the blood, where it is measured. ALTrises dramatically in acute liver damage. N= 9 to 60 IU/L–Serum Glutamic Pyruvic Transaminase (SGPT) 3) Aspartate transaminase (AST) - another enzyme associated with liver parenchymal cells. It is raised in acute liver damage, but is also present in red blood cells, and cardiac and skeletal muscle and is therefore not specific to the liver. N=10 to 40 IU/L Serum Glutamic Oxaloacetic Transaminase(SGOT) The AST/ALT ratio is sometimes useful in differentiating between causes of liver damage When greater than 2.0, it is more likely to be associated with alcoholic hepatitis When less than 1.0, it is more likely to be associated with viral hepatitis |
|
|
Standard Liver Panel: 4) Total Bilirubin (TBIL)= |
4) Totalbilirubin (TBIL)- is a breakdown product of heme (a part of hemoglobin in red bloodcells). The liver is responsible for clearing the blood of bilirubin. It doesthis by the following mechanism: bilirubin is taken up into hepatocytes,conjugated (modified to make it water-soluble), and secreted into the bile,which is excreted into the intestine. N=0.1–1.2 mg/dL .Increased total bilirubin causes jaundice, and can signal a number of problems: –1. Prehepatic:Increased bilirubin production. This can be due to a number of causes,including hemolytic anemias and internal hemorrhage. –2. Hepatic:Problems with the liver, which are reflected as deficiencies in bilirubinmetabolism (e.g. reduced hepatocyte uptake, impaired conjugation of bilirubin,and reduced hepatocyte secretion of bilirubin). Some examples would becirrhosis and viral hepatitis. –3. Posthepatic:Obstruction of the bile ducts, reflected as deficiencies in bilirubinexcretion. (Obstruction can be either within the liver or in the bile duct.) |
|
|
Standard Liver Panel: 5) Alkaline Phosphatase (ALP)= 6) Prothrombin Time (PT) |
5) Alkaline phosphatase (ALP) - is an enzymein the cells lining the biliary ducts of the liver. ALP levels in plasma willrise with large bile duct obstruction, intrahepatic cholestasis or infiltrativediseases of the liver N=30 to 120 IU/L 6) Prothrombin time(PT)–Measures how much time it takes for bloodto clot. The normal time needed for blood to clot is between 10 and 15 seconds –Many factors necessary for blood clottingare made in the liver –When liver function is impaired, bloodclotting factor synthesis and its secretion into the blood is diminished. |
|
|
Hepatitis A: Antigen= Corresponding Antibody= Comments= |
Antigen= Hepatitis A Virus Corresponding Antibody= Hepatitis A Antibody Comments= RNA virus, present in stool and serum early in course |
|
|
Hepatitis B: Antigen= Corresponding Antibody= Comments= |
Antigen= Hepatitis B surface antigen (HBsAg)Hepatitis Bcore antigen (HBcAg) HepatitisB protein antigen (HBeAg) Corresponding Antibody= Hepatitis B surface antibody (anti-HBs) HepatitisB core antibody (anti-HBc) HBprotein antibody (anti- Hbe) Comments= DNA virus, found in serum and body fluids. |
|
|
Hepatitis C: Antigen= Corresponding Antibody= Comments= |
Antigen= Hepatitis C virus (HCV) Corresponding Antibody= Hepatitis C Antibody (anti-HCV) Comments= RNA virus, found in serum and body fluids. |
|
|
Hepatitis D: Antigen= Corresponding Antibody= Comments= |
Antigen= Hepatitis D virus Corresponding Antibody= Hepatitis D antibody (anti-HDV) Comments= Defective RNA virus. |
|
|
HBV Complexity: |
•The HBV genome produces a nucleocapsid thatcontains the hepatitis B core antigen (HBcAg). This nucleocapsid isencompassed with an outer envelope referred to as the hepatitis B surfaceantigen (HBsAg) •The hepatitis B e-antigen (HBeAG) isa protein produced and released into the blood by actively replicating virus |
|
|
Serologic Evaluation in Presumed Hepatitis B: |
•Testing for hepatitis D antibody (antiHDV) should also be performed in patients with hepatitis B to evaluate thepossibility of coexisting delta hepatitis. |
|
|
Five Stages of Viral Hepatitis: |
•Incubation– 3 weeks to 6 months •Pre-ictericPhase – 3 to 10 days •IctericPhase – 7 to 21 days •Convalescence– 3 to 6 weeks •ChronicCarrier State - Years |
|
|
Incubation Stage: |
•Incubationtime within the body depends on the organism causing the infection •Duringthis time, virus is capable of being transmitted despite patient beingasymptomatic |
|
|
Signs and Symptoms associated with acute viral Hepatitis: Preicteric Phase= Icteric Phase= Convalescence Phase= |
1) Preicteric phase= Influenza likesymptoms, Fever, sore throat, cough,headache, anorexia, malaise, nausea,vomiting; Right upper quadrant abdominal painand mild hepatomegaly 2) Clinical jaundice of sclera and skin. Dark urine and Pale stools. Liver is enlarged, tender (hepatomegaly). Pruritus (intense itching) Labs:Elevated bilirubin Elevations inAST and ALT liver enzymes PT elevations 3) Convalescence Phase= Resolution of symptoms but patient still remains tired and weak. |
|
|
Chronic Carrier Stage: |
•HepatitisB and C only •Patientremains positive and can transmit virus •Cirrhosisoccurs as the disease progresses to decompensated cirrhosis which caneventually progress to hepatocellular carcinoma (HCC) in a small percentage ofpatients |
|
|
Prevalence of antibodies against Hepatitis A: |
High in South America and Africa. |
|
|
Hepatitis A Clinical Features: 1) Incubation Period= 2) Jaundice by age group= 3) Complications = 4) Chronic Sequelae= |
1) Incubation period= Average 30 days, Range 15-50 days 2) Jaundice by Age group: less than 6 yrs= less than 10% 6-14 yrs= 40-50% over 14 yrs= 70-80% 3) Complications: Fulminant Hepatitis, Cholestatic Hepatitis, Relapsing Hepatitis 4) Chronic Sequelae= none |
|
|
Hepatitis A Virus Transmission: |
-Person to person contact -Homosexual contact -Contact with contaminated food or water -Raw or undercooked shellfish (oysters, clams, mussels) -Foods contaminated by infected food handlers -Persons in daycare centers (Children pose a particular threat because they often remain clinically asymptomatic) - Persons in institutions - Military personnel - Transmission through blood transfusions (rare; early in course) - Transmission via intravenous drug use (rare; early in course) - No identifiable risk factor |
|
|
Concentrations of Hepatitis A virus in various body fluids: |
Mostly in feces, Serum, saliva. |
|
|
Hepatitis A: 1) Treatment= 2) Prevention= |
1) Treatment= –Self-limited –No specific antiviral treatment optionsexist –Management is primarily supportive (IVfluid and electrolyte replacement; avoid acetaminophen in acute hepatitisphase) 2) Prevention= –Avoid exposure through proper personalhygiene practices including good hand-washing techniques –Vaccine (active immunity) –Immune globulin (passive immunity) |
|
|
Immune Globulin: |
•A solution of globulins dried from theplasma or serum of selected human donors containing high titers of antibodiesversus specific diseases •Provides temporary passiveimmunity byincreasing the antibody titer and antigen-antibody response potential in contrast to a vaccine which provides activeimmunity •In some events BOTH vaccine and IG aregiven |
|
|
ACIP Recommendations= Prophylaxis with IG 1) Persons at increased risk of infection: |
•Thosein close contact with an HAV-infected person, all staff and attendees ofdaycare centers when HAV is documented •Closepersonal contact with an HAV-infected patient in schools, hospitals and worksettings •Ifinvolved in a common source exposure (such as food-borne outbreak) •Travelersto endemic areas (hepatitis A vaccine is preferred but efficacy increases ifadministered > 14 days before travel) |
|
|
HAV IG (Immune Globulin) 1) Pre-Exposure Prophylaxis: 2) Post-Exposure Prophylaxis: |
1) Pre-Exposure Prophylaxis: –HAV vaccine is preferred (first dose >94% seroconversion rate with additionalbooster shot needed to achieve highest antibody titers) –Administer both IG and vaccine if traveldeparture is < 14 days in older patients, immunocompromisedpatients or patients with chronic liverdisease or other chronic medical conditions –A single dose of 0.02mL/kg IM fortravelers within 14 days before leaving to high risk areas < 3 months stayand 0.06mL/kg if longer stay (lasts up to 5 mo.) 2) Post-Exposure Prophylaxis: •Itis most effective during the incubation phase of infection •Persons who have recently been exposed toHAV and who have not beenvaccinated previously should be administered a single dose of single-antigenHepatitis A vaccine or IG (0.02 mL/kg)as soon as possible, within 2 weeks after exposure.(Contacts who have received a dose of the vaccine at least 1 month beforeexposure do not need IG) •The guidelines vary by age and healthstatus: –For healthy persons aged 12 months–40years, single-antigen Hepatitis A vaccine at the age-appropriate dose ispreferred to IG because of the vaccine’s advantages, including long-termprotection and ease of administration, as well as the equivalent efficacy ofvaccine to IG. –For persons aged 41 years and older, IGis preferred because of the more severe manifestations of Hepatitis A in olderadults (can be given together with the HAV vaccine ) and in infants younger than 1 year. |
|
|
Recommendationsfor Hepatitis A Vaccination: |
•ALLchildren at 1 year of age •Catchup vaccination of children ages 2-18 years •Forany person aged 2 years and older who has not already received the HepAvaccine series, 2 doses of HepA vaccine may be administered if immunityagainst hepatitis A virus infection is desired (i.e high risk patients) –Persons traveling to or working inendemic countries –Homosexual and bisexual men –Illegal IV drug use –Persons who have occupational risk forinfection (HAV-laboratory research) –Persons with recent outbreak exposure –Persons who have clotting-factordisorders –Persons who have chronic liver disease |
|
|
Hepatitis A Vaccine: |
Havrix® and Vaqta® arethe two commercially available U.S. vaccines. Both products are consideredinterchangeable. The schedule is 2 doses separate by at least 6 months.Patients with past “natural” infections have a much higher antibodyconcentration than those who receive the vaccine (may need booster dose laterin life especially if immunocompromised). |
