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Semester 4 > case 5 - hepatitis > Flashcards

case 5 - hepatitis Flashcards

1
Q

what are the three stages of symptoms of hepatitis

A

prodromal
icteric
convalescent

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2
Q

what happens in the prodromal phase

A

In the prodromal stage, the virus is in the blood and will release chemicals. These chemicals will create symptoms such as fever, headache, fatigue, nausea, vomiting, skin rashes and joint pains

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3
Q

what happens in the icteric stage

A

In the icteric stage, conjugated bilirubin and transaminases spills into the blood because of damage of bile ducts and hepatocytes. The conjugated and unconjugated bilirubin make the patient appear yellow and present with dark urine. The liver may become enlarged in this state as well which is termed hepatomegaly

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4
Q

what happens in the convalescent stage

A

the symptoms become better or the patient returns to normal

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5
Q

what is hepatitis A

A

an RNA virus of the family Picornaviridae

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6
Q

how is Hep A spread

A

via fecal or oral route, transfusion of blood or MSM

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7
Q

how do the symptoms appear

A

like food poisoning symptoms.

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8
Q

is hepatitis A chronic

A

no

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9
Q

what is the best prevention for Hepatitis A

A

The best prevention is washing hands, wearing gloves and keeping meticulous hygiene

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10
Q

what is hepatitis B

A

a DNA virus with 8 different genotypes

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11
Q

how long is the incubation period for hepatitis B

A

3 to 8 week incubation period

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12
Q

how is hepatitis B transmitted

A

parenterally, sexually or through mother to baby

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13
Q

how does mother to baby only occur

A

if the mother was exposed to the virus during the third trimester of preganany

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14
Q

what can the disease cause

A

The disease can cause liver injury low grade fever, inflammation, risk for Hepatitis C, risk for cirrhosis, risk for liver failure and risk for hepatocellular carcinoma

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15
Q

is the disease severe or chronic

A

the disease could be severe and chronic

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16
Q

what treatment is given for hepatitis B

A

Treatment is with nucleotide analogs and interferons and a preventative vaccination is available

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17
Q

what is hepatitis C

A

a RNA virus with 10 genotypes

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18
Q

how long is the incubation period

A

40 days incubation period

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19
Q

how is hepatitis C spread

A

via parenteral route

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20
Q

what are the symptoms

A

Sometimes there may not be any symptoms to aid in diagnosis but liver enzymes will be elevated

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21
Q

what can hepatitis C increase

A

the risk for chronic liver disease, cirrhosis, hepatocellular carcinoma, oesophageal varices and potential need for liver transplant

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22
Q

what is the treatment for hepatitis C

A

Treatment is with antivirals drugs and sometimes drug resistance can develop when disease becomes more severe. There is no vaccination

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23
Q

what is hepatitis D

A

a defective single stranded RNA virus and usually occurs with Hepatitis B

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24
Q

how is hepatitis D spread

A

parenterally

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25
Q

what can hepatitis D lead to

A

liver failure

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26
Q

what is the treatment for hepatitis D

A

pegylated interferon alpha and treatment has a high failure rate

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27
Q

what is hepatitis E

A

is an RNA virus in the family Hepevirdae

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28
Q

what is the incubation period for hep e

A

50 days

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29
Q

how is hepatitis E spread

A

through fecal oral route, contaminated water or uncooked meat

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30
Q

what does it resemble

A

Hepatitis A but could be asymptomatic

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31
Q

what can hepatitis E produce

A

neurological symptoms and impair kidney function

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32
Q

what is the treatment course for hepatitis E

A

ribavarin and pegylated interferons

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33
Q

what is hepatitis triggered by

A

many microorganisms such as CMV, EBV, and HSV

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34
Q

what do these viruses do

A

they enter the blood stream and spread to the liver. they infect the hepatocytes and multiply. they change the antigen structure on the virus site. the body begins to use self-mediated immune response attempting to damage the hepatocytes

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35
Q

what is different in Hepatitis B and C

A

they can continue this process over and over for years

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36
Q

what virus family does hep d come from

A

deltavirus

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37
Q

which types of hepatitis have envelopes and which do not

A

B, C,D all have envelopes

A and E do not have envelopes

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38
Q

which hepatitis are self limited

A

A and E

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39
Q

which hepatitis must u be co infected with in hepatitis D

A

must be co infected with hepatitis B

40
Q

which hepatitis lead to chronic infection

A

B,C,D

41
Q

what does enteral route of transmission mean

A

that it involves the GI tract. the route of transmission can be either oral or faecal

42
Q

what is the parenteral route of transmission

A

this involves areas other than the GI tract

43
Q

which viruses have an enteral route of transmission

A

hepatits A and E

44
Q

which viruses have a parenteral route of transmission

A

hepatitis B,C,d

45
Q

which hepatitis is double stranded

A

hepatitis B virus

46
Q

what antigen will be present in hepatitis D

A

HBsAg

47
Q

what do the chronic forms lead to

A

cirrhosis and hepatocellular carcinoma

48
Q

what does self limiting mean

A

that the colony of these viral cells self regulate their growth - infection resolves itself

49
Q

what is a surface antigen (sAg)

A

the presence of these indicates the presence of the virus in the body

50
Q

what is a core antigen (cAg)

A

indicates the body is producing antibodies against the virus

51
Q

what is the modified core antigens (eAg)

A

the presence of these indicates the viral cell is actively replicating. this means the person has higher infectability

52
Q

what is the immediate response antigen

A

IgM

53
Q

what is the chronic response antigen

A

IgG

54
Q

what is the surface antigen found on the envelope of HBV

A

HBsAg

55
Q

what is the core antigen found around the nucleus of HBV

A

HBcAg

56
Q

what is the modified c antigen that appears when the viral cell is actively replicating

A

HBeAg

57
Q

the presence of what would give the person immunity against HBV

A

anti-HBs antibody

58
Q

what antibody can be HBc IgM or HBc IgG

A

anti-HBc antibody

59
Q

the presence of what would reduce infectability

A

anti-HBe antibody

60
Q

what are the risk factors for hepatitis A

A

Travel to endemic areas
Household contact
Contaminated food (Salads/ Berries/ Tomatoes
sundried)
Sex risk (especially male homosexuals

61
Q

what are the investigations carried out for hepatitis A

A

The HAV carries a HAV antigen.
Individuals infected by HAV make an antibody against the HAV antigen (anti-HAV).

Anti-HAV of the IgM type = indicates a primary immune response (diagnostic of an acute HAV infection).

Anti-HAV of the IgG type = this antibody persists for years after infection (no diagnostic value), but it can be used as a marker of previous HAV infections. Its presence indicates immunity to HAV.

62
Q

what is given as prevention of hepatitis A

A

human normal immunoglobulin

63
Q

what is the hepatitis A vaccination

A

harvix

64
Q

what are the symptoms of Hepatitis B

A

Many people have no symptoms during the initial infection but some develop a rapid onset of sickness with vomiting,yellow skin, feeling tired, dark urine andabdominal pain.
Often these symptoms last a few weeks and rarely does the initial infection result in death.

65
Q

what is a current infection of hepatitis B indicated by

A

the presence of HBsAg in the blood

66
Q

what is a past infection of Hepatitis B indicated by

A

the presence of anti-HBs antibodies in the blood

67
Q

what is the replication steps of hepatitis B

A
  1. HBV binds to the NTCP bile receptor on hepatocytes. this allows the virus to enter the cell
  2. the HBV DNA is partially double stranded
  3. the viral DNA enters the host cell nucleus and uses the host cell’s DNA to complete its DNA from partially double-stranded to a covalently closed circular DNA - cccDNA
  4. the viral DNA is now transcribed into viral RNA
  5. this is then translated to produce viral antigens and other viral proteins
  6. the viral RNA undergoes reverse transcription in the viral nucleocapsid to form its partially double stranded DNA once again
  7. this is now packaged within the viral antigens
  8. this is then exocytosed and infects other cells
68
Q

what does it mean if someone as the HBsAg antigen

A

current infection (acute or chronic)

69
Q

what does it mean if someone has the anti-HBc antibody

A

infection at some time (current or past)

70
Q

what does it mean if someone has the anti-HBc IgM+ antigen

A

recent acute infection

71
Q

what does it mean if someone has the anti-HBs antibody

A

past infection: anti HBc+
vaccination: if no other HBV markers

72
Q

how to tell if someone has ever been exposed to hepatitis B

A

total antibody to hepatitis B core antigen (Anti-HBc)

73
Q

what is an acute infection indicated by

A

IgM antibody to core antigen
anti-HBc-IgM

74
Q

how to tell how infectious the patient is to their contacts

A

positive for e antigen (HBeAg) and/or high levels of HBV DNA

75
Q

summary of the antigens and antibodies for Hepatitis B

A

HBsAg = this is the surface antigen found on the envelope of HBV.
HBcAg = this is the core antigen found around the nucleus of HBV.
HBeAg = this is the modified c antigen that appears when the viral cell is actively replicating.

Anti-HBs antibody = the presence of this would give the person immunity against HBV
Anti-HBc antibody = this can be HBc IgM (immediate) or HBc IgG (chronic)
Anti-HBe antibody = the presence of this would reduce infectability.

Anti-HBc IgG + HBsAg = the presence of this combination indicates a chronic infection.
Anti-HBc IgG + Anti-HBsAg = the presence of this combination indicates complete immunity against the infection.

76
Q

what is the Hepatitis B virus life cylce

A

immune tolerance
immune clearance
low replication inactive carrier
reactivation

77
Q

what are the aims of HBV therapy

A

to convert HBV from high replication phase to a low replication phase

HBeAg+ to anti-HBe
ALT normalisation
reduced hepatic inflammation

78
Q

what are the antiviral agents active in hepatitis B

A

interferon - if HBeAg+ low HBV DNA, more chance of losing HBsAg but side effects

nucleoside analogues

lamivudine (3 TC) - Adefovir + Entecavir + Tenofovir

79
Q

what happens if the mother is HBeAg positive

A

active infection, high HBV viral load
hepatitis B immunoglobulin plus
hepatitis B vaccine (accelerated schedule)

80
Q

what happens if the mother is anti-HBe positive

A

hepatitis B vaccine only

81
Q

describe the HCV antibody test

A

total antibody
slow response - 8-12weeks
no IgM assay

82
Q

describe the HCV PCR

A

appears early
marker of infectivity and active infection
monitor HCV RNA viral load for treatment response

83
Q

what is included in the HCV therapy

A

combination therapy 24-48 wees
pegylated interferon alpha weekly
ribavirin

84
Q

what is ribavirin

A

RNA-dependent RNA polymerase inhibitor
reduces GTP pool
RNA mutagen giving defective HCV
immunomodulator

85
Q

what are the aims of HCV therapy

A

Sustained Viral Response
Undetectable HCV RNA 6months post-treatment
40-80% of cases with IFN/ribavirin
Important to test:
Ever injected illegal drugs
Received clotting factors made before 1987
Received blood/organs before July 1992
Ever on chronic haemodialysis
Evidence of liver disease

Early treatment
Blood exposure eg Health Care Workers, baby

86
Q

what are telaprevir and bocepravir

A

protease inhibitors

87
Q

what is an example of a polymerase inhibitor

A

Sofusbuvir

88
Q

what are the interferon-free treatments

A

daclatasvir + asunaprevir
ombitasvir–ABT-450/r and dasabuvir with ribavirin
sofosbuvir + simepravir

89
Q

what are the two different forms of hepatitis D infection

A

coinfection with HBV

superinfection

90
Q

what is co infection with HBV

A

HDV is acquired at same time as HBV
increase in fulminant hepatitis

91
Q

what is a superinfection

A

HDV acquired by hepatitis B carrier
high risk of progression to corrhosis
high risk of hepatocellular carcinoma

92
Q

what are some of the symptoms of hepatitis E

A

jaundice
abdominal pain
nausea and vomiting
anorexia

93
Q

what does anicteric mean and who is common in

A

without jaundice
and common in children

94
Q

what is the most common cause of sporadic hepatitis in adults in endemic areas

A

hepatitis E

95
Q

what do stellate cells turn into

A

myofibroblasts

Semester 4 (80 decks)

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