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Gastrointestinal 1 > Treatment of Hepatitis > Flashcards

Treatment of Hepatitis Flashcards

1
Q

What is the definition of hepatitis?

A

inflammation of the liver.

*can be self-limiting or progress to cirrhosis (fibrosis)

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2
Q

How do you treat Hepatitis A?

A
  • no specific treatment (self-limiting disease )
  • hospitalization not necessary unless acute liver failure
  • therapy is aimed at maintaining nutritional balance (replacement of fluids and electrolytes lost from vomiting and diarrhea).
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3
Q

How do we prevent Hepatitis A?

A
  • improved sanitation= safe drinking water, proper disposal of sewage, hand washing.
  • Hep A vaccine= injectable inactivated virus (2 dose). 100% gain immunity within 1 month of vaccine that lasts 5-8 years.
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4
Q

Who should get the Hep A vaccine?

A

high incidence areas, men who have sex with men, IVDA, occupational risk, chronic liver disease, household members of adopted children from other countries.

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5
Q

What should you do post-exposure with Hep A?

A
  • immunoglobulin injection and hep A vaccine within 2 weeks after exposure.
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6
Q

Does the Hep B vaccine have core antigen?

A

NO just surface antigen, meaning you will only develop antibody against the HBsAg.

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7
Q

What is the treatment for acute Hepatitis B?

A
  • No specific treatment.
  • supportive care and maintaining nutritional balance.
  • can use antivirals in severe acute HBV leading to liver failure.
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8
Q

What is the treatment for chronic Hepatitis B?

A
  • ANTIVIRALS (Tenofovir or entecavir)= nucleotide reverse transcriptase inhibitors, which incorporate into viral DNA, resulting in DNA chain termination.
  • Tenofovir can cause renal failure, so use entecavir in a pt with renal problems.
  • if cirrhosis then LIVER TRANSPLANT
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9
Q

Is interferon used anymore?

A

NO

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10
Q

Can you get hepatocellular carcinoma without cirrhosis from hepatitis B?

A

YES (one of the few diseases that can do that).

*hemochromatosis is another.

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11
Q

** What are the 4 characteristic phases for Hepatitis B? (TEST QUESTION)

A
  1. Immune TOLERANT= HBeAg positive NORMAL ALT, high HBV DNA (>2000 IU/mL).
  2. HBeAg positive immune ACTIVE= ELEVATED ALT, high HBV DNA.
  3. INACTIVE= HBeAg negative, HBeAB positive, NORMAL ALT, low HBV DNA (less than 2000 IU/mL).
  4. HBeAg negative immune ACTIVE= elevated ALT, active inflammation, high HBV DNA.
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12
Q

** Who should be treated from the 4 phases? (TEST QUESTION)

A

only those whom are immune ACTIVE/inflammation (aka have elevated ALT)!!!
*it doesn’t matter what the envelope (HBeAg) status is.

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13
Q

Whom should you consider treating in special circumstances?

A
  • HBsAg persistence > 6 months.
  • compensated cirrhotics= stable bilirubin, no ascites, or esophageal varices. Treat because you don’t want the fibrosis to worsen.
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14
Q

When can you defer treatment in chronic hepatitis B?

A

if they are immune INACTIVE (no inflammation) or immune tolerant.

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15
Q

Is the rate of transmission of HBV from mother to baby during birth high?

A

YES 84%

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16
Q

When should treatment of the pregnant mother be started for HBV?

A

THIRD trimester if HBeAg positive or HBV DNA greater than 200,000 IU/mL

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17
Q

What should we do for all newborns of HBV + mothers?

A

given both the first dose of vaccine and immunoglobulin for prophylaxis
*significantly reduces chance of transmission to 3%

18
Q

Who should receive the HBV vaccine?

A
  • ALL infants soon after birth (3 dose schedule).
19
Q

Other than infants, who else should be vaccinated for HBV?

A
  • children less than 18, frequent blood transfusions, dialysis patients, organ transplant recipients, prisoners, IVDA, household and sexual contacts of those with HBV, health care workers, multiple sexual partners
20
Q

Is screening now recommended for pts born between 1945 and 1964?

A

YES bc CDC didn’t start screening blood prior to 1989.

*Test for HCV AB positive, confirmed by HCV RNA PCR

21
Q

How do we now treat Hepatitis C infection?

A

Harvoni (ledipasvir/sofobuvir)= all oral, once a day treatment for genotype 1. These are direct acting antivirals that effect RNA polymerase, terminating viral replication.

  • treat for 8-12 weeks. NO SIDE EFFECTS :)
  • sustained viral response >90%
22
Q

What drug came out this year for HCV treatment?

A
  • Epclusa (sofosbuvir/velpatasir)= pan-genotypic for all genotypes with an SVR at 12 weeks of 98%!!!
  • we don’t even have to genotype anymore with this.
23
Q

What is the most common cause of liver transplants in the U.S.?

A

HCV cirrhosis

*can have recurrent infection if not eradicated prior to transplant.

24
Q

Is there a vaccine for HCV?

A

NO, so prevention is dependent on avoiding high risk behaviors.

25
Q

How do we treat Hepatitis D?

A
  • no approved antiviral therapy for active infection.
  • treatment is just supportive.
  • treat the HBV with antivirals.
26
Q

How do we prevent HDV infection?

A
  • being immune to HBV
27
Q

How do we treat HEV?

A
  • no treatment; usually self-limited; care is supportive.
28
Q

What are the 3 main non-viral causes of hepatitis?

A
  1. Non-alcoholic Steatohepatitis (NASH)
  2. Acute Alcoholic hepatitis
  3. Drug-Induced Liver Disease (DILI)
29
Q

What is Non-alcoholic Steatohepatitis (NASH)?

A
  • caused by fat deposition in the liver with INFLAMMATION; resembles alcoholic livers.
  • This is distinguished from non-alcoholic fatty liver disease (NAFLD) which does NOT have inflammation.
  • can progress to cirrhosis.
30
Q

What are the risk factors for NASH?

A
  • obesity, T2DM, high cholesterol, and metabolic syndrome
31
Q

How is NASH diagnosed?

A
  • elevated AST/ALT or CT (showing fat in liver).
32
Q

How do we treat NASH?

A
  • lifestyle modifications and long term vitamin E supplement.
33
Q

What is acute alcoholic hepatitis?

A

inflammation of the liver from long term alcohol use.

- liver is the major site of ethanol metabolism and the resultant product is acetaldehyde= injury.

34
Q

** How do we diagnose acute alcoholic hepatitis?

A

classic AST/ALT ratio elevation > 3:1

35
Q

How do we treat acute alcoholic hepatitis?

A
  • alcohol cessation, nutritional support and if DF >32 medicate (prednisolone or pentoxyfylline)
  • liver transplant if bad enough (and must be sober for at least 6 months and been to AA or they won’t make the list).
36
Q

What causes DILI?

A
  • over the counter drugs, prescription meds, and herbal supplements bc the liver is the primary site for drug metabolism.
  • most common cause of acute liver failure in the U.S.
37
Q

What is the unique AST/ALT marker for DILI?

A

AST/ALT > 1000

38
Q

Will you often see moderate liver enzyme elevations with the use of statins?

A

YES, just monitor and they should go back to normal.

39
Q

How do you treat DILI?

A
  • immediately stop the offending drug

- N-acetylcysteine as an antioxidant for acetaminophen toxicity.

40
Q

What is the most common cause of liver transplant now?

A

HCV cirrhosis, but NASH will soon be the most common cause (unless lifestyles change).

Gastrointestinal 1 (21 decks)

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