5 - Viral Hepatitis Flashcards Preview

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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)

5

Human Hepatitis Viruses

HAV
HBV
HCV
HDV
HEV

6

RNA Hepatitis Viruses

HAV
HCV
HDV
HEV

7

Double Stranded DNA Hepatitis Viruses

HBV

8

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

11

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

13

Other infectious etiologies of Acute Hepatitis

CMV - Immunocompromised Host
EBV - Mononucleosis, lymphadenopathy, splenomegaly
TB & M. Avium Intracellurare

14

Symptoms of Acute Viral Hepatitis

Complaint: Intense Fatigue, Nausea, Anorexia

Yellow Eyes/Skin, Dark Urine
Low Grade fever, Abdominal Pain
Arthralgia, myalgia, headache

15

Signs of Acute Viral Hepatitis

Jaundice
Hepatomegaly w/ RUQ tenderness
Fever - Low Grade
Splenomegaly - infrequent

16

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)

17

Normal AST/ALT

40 +/- 5 or 10

18

What is Alkaline Phosphatase elevation associated with?

Biliary Disease
Infiltrative Disease

Not so much viral

19

Outcomes of Acute Viral Hepatitis

Chronic Hepatitis

OR

Cure

OR

Fulminant Hepatitis

20

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

21

Hepatitis A Virus - In Vitro

Monkey & Human Cell Cultures

22

Hepatitis A Virus - In Vivo Replication

In Cytoplasm of Hepatocyte
(Human and other primates)

23

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

24

Serologic Course

1st Month - Fecal excretion
2nd Month - Symptoms & Increase in ALT
2nd - 6th month IgM Antibody spikes
3rd - 4th month, symptoms resolve

25

Marker for acute HAV infection

IgM anti-HAV spike

26

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

27

Hepatitis B - In Vitro

Primary hepatocyte culture and transfection of cloned HBV DNA

28

Hepatitis B - In Vivo Replication

In cytoplasm, cccDNA in nucleus
Hepatocyte and other tissues
(Human and other primates)

29

Diagnosing Hepatitis B - Useful

E Antigen

30

Hepatitis C - Replicates in

Cytplasm