Flashcards in 5 - Viral Hepatitis Deck (61)
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1
What is Hepatitis?
Inflammation of the liver
Almost always implies elevation in liver enzymes
2
Key liver enzymes
AST and ALT
3
Other liver enzymes of consequence in hepatitis
Bilirubin
Albumin
Alkaline Phosphatase
GGT
4
Causes of Acute Hepatitis
Viruses A through E (hepatotrophic)
CMV & EBV (non-hepatotrophic)
Other infectious etiologies (TB, MAI, Fungus)
Alcoholic hepatitis
Drug hepatitis
Ischemic hepatitis
Biliary disease (Choledocholithiasis)
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Human Hepatitis Viruses
HAV
HBV
HCV
HDV
HEV
6
RNA Hepatitis Viruses
HAV
HCV
HDV
HEV
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Double Stranded DNA Hepatitis Viruses
HBV
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Hepatitis A
ssRNA
7.5 kb Genome
No Envelope
Picornaviridae Hepatovirus
One Serotype
Multiple Genotypes
Acid/Heat Stable
9
Hepatitis B
dsDNA
3.2 kb Genome
Envelope
Hepadnaviridae
Multiple serotypes and genotypes (A - F)
10
Hepatitis C
ssRNA
9.6 kb Genome
Envelope
Flaviviridae Hepacivirus
Genotypes - 1 to 6
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Hepatitis D
ssRNA
1.7 kb Genome
Envelope
Unclassified (viroid) delta virus
12
Hepatitis E
ssRNA
7.5 kb Genome
No Envelope
Unclassified togavirus and alpha virus-like
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Other infectious etiologies of Acute Hepatitis
CMV - Immunocompromised Host
EBV - Mononucleosis, lymphadenopathy, splenomegaly
TB & M. Avium Intracellurare
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Symptoms of Acute Viral Hepatitis
Complaint: Intense Fatigue, Nausea, Anorexia
Yellow Eyes/Skin, Dark Urine
Low Grade fever, Abdominal Pain
Arthralgia, myalgia, headache
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Signs of Acute Viral Hepatitis
Jaundice
Hepatomegaly w/ RUQ tenderness
Fever - Low Grade
Splenomegaly - infrequent
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Liver Blood Test Abnormalities - Acute Viral Hepatitis
AST & ALT: 500 - 5000 IU
Bilirubin: Generally elevated, both conjugated and unconjugated
Alkaline Phosphatase: Minimally elevated
Bilirubin and Urobilinogen in Urine: Increased (Coca cola color)
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Normal AST/ALT
40 +/- 5 or 10
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What is Alkaline Phosphatase elevation associated with?
Biliary Disease
Infiltrative Disease
Not so much viral
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Outcomes of Acute Viral Hepatitis
Chronic Hepatitis
OR
Cure
OR
Fulminant Hepatitis
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Fulminant Hepatitis
Overwhelming inflammatory response directed by the immune system against the body
Patient gets very sick
75% - 85% Mortality
Seen with HAV, HBV, HCV
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Hepatitis A Virus - In Vitro
Monkey & Human Cell Cultures
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Hepatitis A Virus - In Vivo Replication
In Cytoplasm of Hepatocyte
(Human and other primates)
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Hepatitis A - Transmission
Oral Fecal
Excreted in stool 2 weeks PRIOR to clinical illness
Therefore it spreads in the military
1 month incubation period
Children often asymptomatic
NEVER causes chronic hepatitis
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Serologic Course
1st Month - Fecal excretion
2nd Month - Symptoms & Increase in ALT
2nd - 6th month IgM Antibody spikes
3rd - 4th month, symptoms resolve
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Marker for acute HAV infection
IgM anti-HAV spike
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Hepatitis A - Prevention and Treatment
No treatment available
Passive immunity with Gamma Globulin can ameliorate disease in early stages of the infections
Gamma Globulin can prevent disease pre-exposure
Vaccine available to induce active immunity
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Hepatitis B - In Vitro
Primary hepatocyte culture and transfection of cloned HBV DNA
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Hepatitis B - In Vivo Replication
In cytoplasm, cccDNA in nucleus
Hepatocyte and other tissues
(Human and other primates)
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Diagnosing Hepatitis B - Useful
E Antigen
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