EXAM #2: VIRAL HEPATITIS

Question 1

Describe the histologic appearance of hepatitis.

Answer 1

• Blue= bad, lymphocytes

- Pink= good

Question 2

What are the complications of hepatitis?

Answer 2

1) Cirrhosis

2) Hepatocellular carcinoma

Question 3

How does cirrhosis appear histologically?

Answer 3

• Fibrosis (blue) with islands of normal liver tissue (pink)
• Regenerative nodules

Question 4

What are the signs and symptoms of hepatitis?

Answer 4

• Majority of patients are asymptomatic

- Some with acute hepatitis have vague flu-like symptoms

Question 5

What is self-limiting hepatitis?

Answer 5

Hepatitis that is self-resolving

Question 6

What is fulminant hepatitis?

Answer 6

Overwhelming liver inflammation that leads to liver failure

Question 7

List the etiologies of hepatitis.

Answer 7

1) Infectious
2) Immune related
3) Chemicals/toxins
4) Medications
5) Ischemia
6) Hereditary
7) Pregnancy
8) Alcohol
9) NAFLD

Question 8

What are the immune related causes of hepatitis?

Answer 8

1) PBC–primary biliary cirrhosis
2) Primary Sclerosing Cholangitis (complication of UC)
3) Autoimmune

Question 9

What are the self-limited causes of viral hepatitis?

Answer 9

HAV and HEV

Question 10

What patient population is autoimmune hepatitis most common in?

Answer 10

Middle aged females

Question 11

What antibodies are positive in autoimmune hepatitis?

Answer 11

1) Antinuclear antibody (ANA)
2) Anti-smooth muscle antibody (ASMA)
3) Anti-LKM

Question 12

How is autoimmune hepatitis treated?

Answer 12

• Steroids

- Immunomodulators–Azathioprine

Question 13

What is the classic histologic finding in autoimmune hepatitis?

Answer 13

Severe inflammation of the portal triads

Question 14

What is Primary Biliary Cirrhosis?

Answer 14

Immune mediated destruction of the BILE CANALICULAE

Question 15

What antibody is associated with PBC?

Answer 15

Anti-mitochondrial antibody (AMA)

Question 16

What are patients with PBC at risk for?

Answer 16

1) Hyperlipidemia

2) Osteoporosis

Question 17

What is the treatment for PBC?

Answer 17

Urso (bile acid supplement)

Question 18

What is PSC?

Answer 18

Immune mediated destruction of the large bile ducts leading to stricture/ obstructive jaundice

Question 19

What disease is PSC strongly associated with?

Answer 19

UC

Question 20

How is PSC treated?

Answer 20

Currently there is no effective therapy

Question 21

What is the most common cause of non-hepatitis virus infection causing hepatitis?

Answer 21

EBV (mononucleosis)

Question 22

What is unique about the liver reaction to Isoniazid (INH)?

Answer 22

• Undetected hepatitis from INH can lead to cirrhosis

- Mandated that INH administration is followed with LFT measuring

Question 23

What four chemicals will cause a dose-dependent liver destruction?

Answer 23

1) Tylenol*
2) Amanita Phalloides (mushroom)
3) White phosphorus
4) Carbon Tetrachloride

Question 24

What type of virus is HAV?

Answer 24

Picornoviridae–ssRNA

Question 25

What is HAV infection associated with?

Answer 25

Traveling is considered classic - South America - Africa - SE Asia - Greenland* *****HOWEVER, in the US, DAYCARE is the most common*****

Question 26

How is HAV transmitted? What are the unusual modes of transmission?

Answer 26

Fecal-oral - Homosexual activity - IVDA

Question 27

What lab test is associated with symptomatic HAV infection?

Answer 27

ALT elevation is associated with symptomatic HAV

Question 28

What are the worrisome variants of HAV infection?

Answer 28

1) Cholestatic hepatitis 2) Relapsing hepatitis 3) Fulminant hepatitis

Question 29

What type of virus is HBV?

Answer 29

Hepadnaviridae--dsDNA

Question 30

Is HBV enveloped?

Answer 30

Yes

Question 31

How is HBV transmitted?

Answer 31

Parenterally: - IVDA - Transfusion - Sex *Most of the transmission world-wide happen via the mucosa at birth*

Question 32

What population in the US has the most HBV?

Answer 32

Immigrants from Asia - Africa is 2nd - Both together= 80% *Note this data comes from Olmsted Count, MN (Mayo Clinic)

Question 33

How is the transmission of HBV from mother to child described?

Answer 33

"Vertical transmission"

Question 34

What is the risk of HBV infection becoming chronic? How is the risk different between infants and adults?

Answer 34

Infants= 90% likelihood Adults= 5% likelihood

Question 35

What is the most likely outcome of HBV infection in adults? What are the treatment implications?

Answer 35

- Self-limited recovery occurs 95% of the time | - Don't treat

Question 36

When is HBV infection "chronic"?

Answer 36

Six months

Question 37

When is HBV infection treated?

Answer 37

Once it is chronic

Question 38

What are the complications of chronic HBV infection?

Answer 38

1) Cirrhosis | 2) HCC

Question 39

What does HBsAg indicate?

Answer 39

Current infection

Question 40

What does HBsAB IgG ALONE indicate?

Answer 40

Confirms vaccination

Question 41

What is the integral component of the HBV vaccination?

Answer 41

HBsAg

Question 42

What is HBV immune tolerance?

Answer 42

The baby's reaction to HBV - Tons of HBV DNA present - No immune system reaction

Question 43

What antibody markers the carrier/ infective state of HBV infection?

Answer 43

HBe

Question 44

In Taiwan, what was the impact of HBV vaccination on HCC?

Answer 44

Vaccination lowered the incidence of HCC

Question 45

What is the only treatment for HBV that is definitive in its elimination?

Answer 45

Interferon--but it has major adverse side effects

Question 46

What are the oral medications for HBV that has little adverse effects?

Answer 46

1) Lamivudine - Nucleoside analog - Prevents viral replication by incorporating in replicating DNA strand 2) Adefovir - Used to treat Lamivudine mutants

Question 47

What is the only medication that is safe for HBV infection in pregnancy?

Answer 47

Lamivudine

Question 48

What does HDV require for infection?

Answer 48

HBV

Question 49

When is HDV infection seen in the U.S?

Answer 49

IDVA

Question 50

What is worse, coinfection or superinfection of HDV?

Answer 50

Superinfection | - HBV infection with HDV added ontop

Question 51

When can HEV cause fulminant hepatitis?

Answer 51

Pregnant women

Question 52

What is the reservoir for HEV in the US?

Answer 52

Swine i.e. pigs in the midwest