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Gastrointestinal > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

What is the definition of hepatitis?

A

Inflammation of the liver parenchymal tissue and hepatocytes

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2
Q

What are the components of the portal triad?

A

Artery, vein and bile

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3
Q

Where are zone three hepatocytes?

A

Right next to the central vein

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4
Q

What are the general histological characteristics of hepatitis?

A

Collagenous deposits surrounding hepatocytes

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5
Q

Why do we care if patients have hepatitis w/o symptoms?

A

Chronic inflammation can lead to cirrhosis and HCC

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6
Q

What are the ssx of hepatitis?

A 
Malaise
N/v
HA
Myalgias
Abdo pain
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7
Q

What is fulminant hepatitis?

A

Condition where there is so much inflammation in the liver, that it fails

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8
Q

What are the three main immune related caused of hepatitis?

A

Autoimmune
Primary biliary cirrhosis
Primary sclerosing cholangitis

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9
Q

What are the three hereditary causes of hepatitis?

A

Wilsons
Hemochromatosis
A1ATD

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10
Q

Which hepatitis viruses are self limited diseases?

A

A and E

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11
Q

Which hepatitis strains can cause chronic disease?

A

BCD

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12
Q

What are the abs that are found in autoimmune hepatitis?

A

ANA
ASM
LKM

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13
Q

What is the treatment for autoimmune hepatitis?

A

Steroids or immunomodulators

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14
Q

What are LFTs like in autoimmune hepatitis?

A

Increased ALT/AST

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15
Q

In which gender more commonly has autoimmune causes of hepatitis?

A

Women

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16
Q

What is the classic histological characteristic of autoimmune hepatitis?

A

Portal triad inflammation

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17
Q

What are the ssx of autoimmune hepatitis?

A

Asymptomatic, until cirrhosis overwhelms the liver

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18
Q

What is primary biliary cirrhosis? Which antibody is elevated in this disease?

A

Immune mediated destruction of the bile canaliculi

AMA (80% sensitive)

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19
Q

What happens to cholesterol in primary biliary cirrhosis?

A

Increases

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20
Q

Which disease has an increased chance of developing with primary biliary cirrhosis?

A

Osteoporosis

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21
Q

What is the treatment for primary biliary cirrhosis?

A

Urso (bile acid supplement)

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22
Q

What is primary sclerosing cholangitis? What is the antibody that is elevated in this disease?

A

Immune mediated stricturing of the biliary tree (macroscopically), that can involve intra and extrahepatic duct systems

ANCA+

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23
Q

What IBD is associated with primary sclerosing cholangitis?

A

UC

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24
Q

What is the treatment for primary sclerosing cholangitis?

A

None

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25
Q

How fast does primary sclerosing cholangitis progress?

A

decades

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26
Q

What are the viral infections of the liver besides classic hepatitis viruses? (6)

A 
CMV
Herpes
EBV
Yellow fever
Adenovirus
HIV
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27
Q

What are the parasitic infections that can cause hepatitis?

A

Toxoplasmosis
Leptospirosis
Q fever
Rocky mountain spotted fever

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28
Q

What is the cause of Q fever?

A

Coxiella burnetii

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29
Q

What two abx can cause hepatitis?

A

Amox

Nitrofurantoin (macrobid)

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30
Q

What antiarrhythmic can cause hepatitis?

A

Amiodarone

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31
Q

What antineoplastic agent can cause hepatitis?

A

Methotrexate

32
Q

What anesthetic gas can cause hepatitis?

A

Halothane

33
Q

What drug requires that you follow the patient for hepatitis?

A

INH

34
Q

What are the four toxin-induced hepatitis causes?

A

Tylenol
Amanita phalloides
White phosphorus
Carbon tetrachloride

35
Q

What is the death cap mushroom? MOA?

A

Amanita Phalloides

Alpha-amantin inhibits RNA pol II

36
Q

What is the use of CCl4?

A

Refrigerant/cleaning

37
Q

What are the diseases that can cause hepatitis secondarily?

A 
SLE
Scelorderma
Sjogrens
UC/CD
Hemolytic anemia
Glomerulonephritis
38
Q

What is the viral family and genetic makeup of hep A? Is it enveloped?

A

Picornaviridae
+ssRNA
Non-enveloped

39
Q

When does ALT rise in hep A infection?

A

Early, then drops down in a few months

40
Q

What happens to IgM anti-HAV throughout the course of infection?

A

Parabolic

41
Q

What is the route of infection for Hep A?

A

Fecal-oral route, but also homosexual activity

42
Q

What is the most common place to get Hep A infection in the US?

A

Day care centers

43
Q

What are the three clinical variants of HAV infections?

A

Cholestatic hepatitis
Relapsing hepatitis
Fulminant hepatic failure

44
Q

What are the ages that Hep A infection usually occurs in?

A

5-14 year old

45
Q

What is the reservoir for Hep A in the US?

A

Children

46
Q

How many doses are needed for the Hep A infection? Is this a live attenuated virus, or a killed virus?

A

2 doses

There is both a live-attenuated and a killed version

47
Q

What is the viral family and genetic makeup of Hep B? Is it enveloped?

A

Hepadnaviridae
dsDNA
Enveloped

48
Q

What is the only hepatitis virus that can integrate itself in the liver DNA and cause chronic hepatitis?

A

Hep B

49
Q

What is the route of transmission for HBV?

A

Parenteral (IV drug use, sex, mucosal contacts)

50
Q

What is the most common cause of hepatitis B in the world?

A

Transplacental (vertical) Transmission

51
Q

Why is HBV endemic in africa and asia?

A

Vertical and horizontal transmission from mothers

52
Q

What happens to the risk of developing a chronic infection from HBV as we age?

A

Lowers

53
Q

Is the HBV vaccine live attenuated or killed? How many doses?

A

Contains just the surface protein

x3 doses

54
Q

When do we start treating HBV infections? Why?

A

greater than 6 months, since most likely will resolve on its own

55
Q

When does HBV infection become problematic? Why?

A

When it develops into a chronic infection d/t chronic inflammation

56
Q

What are the serological markers for HBV?

A

HBsAg
Anti-HBc IgM
HBeAg

57
Q

If a patient has a surface antigen positive for HBV, what does this indicate?

A

Active infection

58
Q

IgM to antibody to hep B core protein indicate what?

A

Recent infection or “flare” of chronic HBV

59
Q

What happens if there is a positive surface antibody to HBV (what does this indicate)?

A

Patient was immunized (never exposed)

60
Q

IgG anti-HBc indicates what?

A

Remote infection

61
Q

Isolated Anti-HBc is caused by what? (4)

A

Low level HBV carrier
Recovered Hep B
False positive
Window phase

62
Q

What is the treatment for HBV infection?

A

Interferon
Lamivudine
Adefovir dipivoxil

63
Q

What is the only treatment that can wipe out HBV in the body?

A

Interferon

64
Q

What is the effect of interferon on hepatocellular CA?

A

Lowers it

65
Q

What is Lamivudine? MOA?

A

Orally administered nucleoside that inhibits DNA polymerase for HBV infections

66
Q

What are the side effects of Lamivudine? Problems?

A

Negligible

Huge cost, and develop resistance

67
Q

Does lamivudine kill the virus?

A

No, just controls it

68
Q

What is the MOA of adefovir?

A

Reverse transcriptase inhibitor of Hep B

69
Q

What is the only medication for HBV infection in pregnancy?

A

Lamivudine

70
Q

What is the viral family and genetic composition of Hep D? Enveloped?

A

Deltavirus
-ssRNA
Enveloped (with HBV envelope)

71
Q

Which Hep virus required another? Which Hep virus does it need?

A

D needs HBsAg

72
Q

What is a coinfection of Hep D?

A

B and D occur at the same time in an otherwise healthy individual

73
Q

What is a superinfection of Hep D?

A

Patient with chronic Hep B infection is infected with Hep D. Causes real bad outcome

74
Q

Why is Hepatitis E concerning?

A

causes fulminant hepatic failure in pregnant women

75
Q

What is the viral family and genetic makeup of hepatitis E? Enveloped? Transmission?

A

Hepeviridae
+ssRNA
Non-enveloped
Fecal-oral route

76
Q

What group of animals have Hep E?

A

Swine pig farmers

77
Q

Which hepatitis virus is the most common cause of liver transplant?

A

Hep C

Gastrointestinal (42 decks)

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