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GI > 13. Viral Hepatitis > Flashcards

13. Viral Hepatitis Flashcards

1
Q

Acute viral hepatitis in the US is most commonly due to

A

HepB (51%)

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2
Q

What is the most common cause of chronic viral hepatitis in the US?

A

HepC

**B is the second MCC

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3
Q

What kind of genome does HAV have? Transmission?

A

RNA virus
Fecal-oral
**single serotype, only infects humans

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4
Q

Incubation period of HAV

A

Mean 4 wk

2-6 wk range

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5
Q

Who gets symptomatic HAV infection?

A

Adults 70-80%

Only 10% children with infectious are symptomatic

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6
Q

Fatality with HAV infection

A

Overall 0.3%

1.8% over 50 yo

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7
Q

Chronicity with HAV and HEV?

A

NO

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8
Q

Where is there a high prevalence of HAV infectious?

A

South America
Africa
Southeast asia

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9
Q

What body fluid have the highest concenrtation of HAV?

A

Feces **
Serum
Saliva

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10
Q

What is the most common method of transmission of HAV?

A

Personal contact **
Day care centers
Foreign travel
Food outbreaks not very common

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11
Q

Who is more at risk for HAV infection?

A

Children

Though adults are at lower risk for infection, they have higher mortality

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12
Q

What rises first following HAV, aside from fecal HAV?

A

ALT level spikes

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13
Q

What are the two components of the anti HAV antibody and what is their trajectory?

A

IgM anti-HAV: rises and falls, marks acute infection

IgG anti-HAV: rises and persists, resistance

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14
Q

Transmission of HEV

A

Fecal oral
Contaminated drinking water
Minimal person to person contact

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15
Q

What is the incubation period for HEV?

A

40 days

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16
Q

What is the general fatality for HEV? Who has a higher fatality rate?

A

1-3%

Pregnant women 15-45%

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17
Q

Where is HEV most common?

A

Northern Africa

SE asia

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18
Q

What does the IgM increase in HEV infectious coorespond to?

A

Acute bout of hepatitis

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19
Q

What kind of genome does HBV have? What does it infect?

A

DNA virus

Humans, some primates

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20
Q

What is the incubation period of HBV?

A

60-90 days

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21
Q

Acute case fatality for HBV

A

0.5-1%

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22
Q

What determines the chronicity of HBV infection?

A

Age of exposure

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23
Q

What is HBV infection the leading cause of worldwide?

A

Hepatocellular carcinoma

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24
Q

What is the distribution of HBV

A

Africa
SE Asia
Alaska

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25
Q

What is the difference between children and adults being exposed to HBV?

A

Children: VERY HIGH chance of chronicity
Adults: Low risk of developing chronicity, but more likely to have a symptomatic infection

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26
Q

What body fluids have a high concentration of HBV? Moderate? Low?

A

High: blood, serum, wound exudates
Moderate: semen, vaginal fluid, saliva
Low: urine, feces, sweat, tears, breastmilk

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27
Q

What is the #1 risk factor for transmission of HepB?

A

Heterosexual transmission

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28
Q

What two levels rise and then fall with acute HBV infection with recovery? Which one does not fall in a chronic infection?

A

HBsAg **doesn’t fall in chronic infection

IgM anti-HBc

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29
Q

What increases 8 weeks after HBsAg levels disappear?

A

anti-HBs

**window period between

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30
Q

The presence of ___ indicates immunity to HBV

A

Anti-HBs

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31
Q

What defines chronicity of HBV infection?

A

Presence of HBsAg for over 6 months

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32
Q

In HBV infection, what indicates infectivity?

A

HBeAg

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33
Q

What is the term for development of anti-HBe in HBV infection without immunity?

A

Seroconversion

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34
Q

What two components remain high in a chronic HBV infection?

A

Total anti-HBc (high in recovery too)

HBsAg

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35
Q

What is a key difference between the development of cancer from HBV vs HCV?

A

HBV: Cancer can develop from cirrhosis or directly from chronic infection
HCV: Chronic infection must progress through cirrhosis to cause cancer

36
Q

Risk for children vs adults to develop chronic from acute HBV infection

A

Children >90%

Adules <5%

37
Q

What % of people with chronic infection develop cirrhosis? Liver cancer directly?

A

30%

5-10%

38
Q

What are two potential consequences of cirrhosis from HBV infection?

A

Liver failure 23% in 5 yr
Liver cancer
**both make patients candidates for transplant

39
Q

When is the only time you can get HDV

A

In conjugation with HBV infection

40
Q

What are the two ways that HDV infection can occur?

A

Coinfection: more severe, but less likely to become chronic
Superinfection: greater risk of chronic disease

41
Q

What happens to IgG in HDV infection

A

Typically cleared from the bloodstream

42
Q

HCV has both ___ and ___ genes

A

Structural

Non-structural

43
Q

What type of genome does HCV have? half life? daily virion production

A

RNA
2.7 hr
10^12 virions (very rapid replication)

44
Q

What is the most common genotype of HCV in the US?

A

Type 1A: 37% **
Type 1B: 30% **
Type 2: 10%
Type 3: 6%

45
Q

Why are different HCV genotypes important?

A

Respond differently to therapy

46
Q

What is the most common type of HCV transmission?

A

IV drug abuse

47
Q

When does the ALT spike in HCV infection?

A

203 months

48
Q

What confirms the dx of HCV infection?

A

HCV RNA

49
Q

What affects rate of progression to fibrosis in HCV infection?

A

Factors like alcohol, obesity, etc

50
Q

After the acute phase of HCV infection, what % is resolved and what % is chronic?

A

Resolved: 15%
Chronic: 85%

51
Q

What % of chronic HCV infection progresses to cirrhosis?

A

20%

52
Q

What are two possible progressions from cirrhosis in HCV infection?

A
  1. ESLD (6%/yr)

2. HCC (4%/yr)

53
Q

What is the #1 indication for transplant in the US?

A

ESLD or HCC due to HCV

54
Q

Does HepC have a fulminant hepatitis stage?

A

No–damage takes time

55
Q

What are the clinical manifestations of acute viral hepatitis?

A 
Fever
Malaise
Anorexia
Nausea/vomiting
Jaundice
Abdominal/RUQ pain
Hepatomegaly
56
Q

What does it mean if a person is + for HepA antibody by negative for IgM?

A

Person had pervious exposure and is immune

57
Q

How can HepA be prevented?

A

Hygiene
Sanitation
Immune globulin (pre and post exposure)
Hepatitis A vaccine (pre exposure)

58
Q

What 4 types of people should get the HepA vaccine?

A
  1. Infants
  2. People traveling to endemic areas
  3. People with chronic liver disease
  4. People working with HAV
59
Q

Who should get pre-exposure immune globulin for HAV?

A

Travelers going to endemic areas who are leaving within two weeks, making the vaccine ineffective

60
Q

Who should get post-exposure immune globulin?

A

People with household or intimate contacts
Outbreaks in institutions
Common source exposure (Taco Bell)

61
Q

What does it mean if a patient is IgM + for HEV?

A

Acute HepE infection

62
Q

What is consistant with acute disease in HBV infection?

A

IgM anti-HBc

63
Q

What must be used for dx of HBV infection in the window period?

A

IgM anti-HBc

64
Q

What does HBsAg + indicate?

A

Current HepB infection, acute or chronic

65
Q

What does anti-HBs + indicate?

A

Immunity

**cant tell if this is from vaccine or natural infection

66
Q

How do you tell if anti-HBs is from vaccine or a natural infection?

A

Presence of core antibody–will only be present with natural infection
IgM–recent exposure
IgG–old exposure (>6mo)

67
Q

What is the most important indication for HBV vaccine?

A

People occupationally exposed to blood or body fluids

68
Q

What makes the HBV vaccine less effective?

A

Old age and debilitation

69
Q

What are two options for hepatitis B exposure in unvaccinated patients?

A
  1. Giving hepatitis B immune globulin within 24 hr, up to a week after–>second dose 1 mo after the first
  2. HepB vaccine within 24 hr, up to a week after –>second dose 1 mo after and third dose 6 mo after
70
Q

What should be done in the case of a HBsAg + mother giving birth?

A

Newborn should get boths HBIG and vaccine

**90% risk of vertical transmission without treatment

71
Q

What are the goals of HepB therapy?

A
  1. Repress HBV replication
  2. Prevent cirrhosis and HCC
  3. ALT normalizaiton
  4. Histologic improvement
  5. Loss of HBeAg and seroconversion to anti-HBe
  6. Loss of HbsAg ****
72
Q

What are the two modes of tx of chronic HBV infection?

A

Interferon:cytokines released by host cells, activate the immune system
Antiviral therapy: block reverse transcriptase which is needed for HBV replication

73
Q

What is the main drawback of interferon tx?

A

Flu like sx: headaches, fevers, and muscle aches

74
Q

What are the two first line tx for HBV therapy?

A

Entecavir and Tenofovir: associated with low levels of resistance (anti virals)

75
Q

What treatment can be used along with entecavir and tenofovir in a very specific population of people with HBV infection (low viral load, high ALT/AST)

A

Peg-IFN

76
Q

What are the SEs of Peg-IFN?

A

Flu-like sx
Neuropsychiatric sx and depression
Bone marrow depression

77
Q

When is HepD IgG more likely to persist

A

With superinfection

78
Q

What indicates acute HepD infection? Previous exposure?

A

IgM

IgG **NOT PROTECTIVE

79
Q

What will be the HCV antibody level and viral RNA level if the infection is cleared? Uncleared?

A

Cleared: anti-HCV + and viral RNA negative
Uncleared: anti-HCV + and viral RNA positive

80
Q

In the case of HCV, ___ is present with all exposures while ___ is present only in those that are viremia

A

HepC antibody

HepC RNA

81
Q

What is the standard of care for HCV therapy?

A

Interferon-based therapy (immune activation)

82
Q

Eradication rate for genotype 1? Genotype 2/3?

A

50-60%

80-90%

83
Q

Eradiation rates for HCV are based on:

A

Undetectable virus 6 months after completion of therapy

84
Q

What is the next step for a patient with high transferrin saturation?

A

HEF testing

85
Q

What antibody will most likely be high in a woman with dry eyes and elevated liver enzymes with VERY HIGH ALP?

A

Anti-mitochondrial antibody

86
Q

What tx is appropriate for a patient with AIH?

A

Prednisone

Azothioprine

87
Q

How do you determine the long term prognosis of a patient with liver disease?

A

INR

GI (28 decks)

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