VIral Hepatitis

Question 1

What is the difference between chronic persistent hepatitis and chronic active hepatitis?

Answer 1

Persistent: lymphocytic infiltration confined to portal triad

Active: lymphocytic infiltration into the hepatic lobule

Question 2

What is the treatment of fulminant hepatitis with any etiology?

Answer 2

Liver Transplant: occurs so rapidly that cirrhosis is inevitable and liver function is minimal.

Question 3

Prophylaxis for HAV.

Answer 3

HAV vaccine and globulins

Question 4

Why is HBV oncogenic?

Answer 4

Incorporates into the hepatocyte cell DNA and runs the risk of altering cell division regulation leading to HCC.

Question 5

What do high serum HBV DNA levels mean?

Answer 5

Viremia

>10,000 means active replication

Question 6

What is the window period and how can a physician avoid missing an HBV diagnosis?

Answer 6

Window Period: point in an HBV infection when the HBV sAg and sAb are below detectable levels and the patient appears not infected or exposed at all the the virus.

To avoid missing the diagnosis: check for HBV core IgM which still indicates acute infection.

Question 7

How do you monitor the risk of HCC in patients with HBV?

Answer 7

With HBV, cirrhosis does not have to precede HCC like in most other disease states.

HCC hepatocytes release the higher alpha-feto protein and this level can be monitored.
Imaging like sonograms can also monitor the liver.

Question 8

Treatment for chronic HBV infection.

Answer 8

Pegylated INF and protease inhibitors (entecavir)

Question 9

Treatment for a child born with a mother infected with HBV.

Answer 9

HBV vaccine and immune globulins

Question 10

Histologic characteristic of hepatocytes infected with HBV.

Answer 10

Ground glass appearance

Question 11

What is the new rule regulating who should be tested for HCV?

Answer 11

Test everyone in the baby boomer era.

‘45-‘65

Question 12

What is different in HCC caused by HBV vs. HCV?

Answer 12

HBV: HCC can occur without cirrhosis
HCV: HCC only occurs after cirrhosis

Question 13

Common derm condition associated with HCV.

Answer 13

Porphyria cutanea tarda: skin blisters due to hemolysis. Normally this condition is genetic but in the case of Hep C it is acquired.

Question 14

Screening test and confirmatory test for HCV.

Answer 14

ELISA II: screen

RIBA II: confirmation

Question 15

One condition that must be addressed before treating a HepC infection with INF-alpha.

Answer 15

Psychotic-related illness,

-symptoms exacerbated by INF-a

Question 16

What is pegylated interferon alpha?

Answer 16

Just INF-alpha with a Polyethylene Glycol (PEG) group added on to increase the half-life of the drug while in the body.

Question 17

Contraindication for using Ribavirin.

Answer 17

Teratogenic

Question 18

Treatment for Type 1 genotype HCV infection.

Answer 18

PEG-INF-a + ribavirin + telaprevir (or boceprevir)

Question 19

What is the function of each of the 3 different types of drugs used to treat Hep C?

Answer 19

INF-a: interfererons act naturally in the body to fight viral infected cells and encourage production and division of new cells to replace the destroyed viral cells.

Ribavirin: a nucleotide RNA analog that interferes with viral genetic material replication

Protease Inhibitor: inhibits viral serine proteases

Question 20

Treatment for Herpes virus hepatitis.

Answer 20

IV Acyclovir

Question 21

Histological characteristic of hepatocytes infected with HSV.

Answer 21

Giant cell granulomas