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Semester 4 > case 5 - hepatitis > Flashcards

case 5 - hepatitis Flashcards

(95 cards)

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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
what can hepatitis D lead to
liver failure
26
what is the treatment for hepatitis D
pegylated interferon alpha and treatment has a high failure rate
27
what is hepatitis E
is an RNA virus in the family Hepevirdae
28
what is the incubation period for hep e
50 days
29
how is hepatitis E spread
through fecal oral route, contaminated water or uncooked meat
30
what does it resemble
Hepatitis A but could be asymptomatic
31
what can hepatitis E produce
neurological symptoms and impair kidney function
32
what is the treatment course for hepatitis E
ribavarin and pegylated interferons
33
what is hepatitis triggered by
many microorganisms such as CMV, EBV, and HSV
34
what do these viruses do
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
35
what is different in Hepatitis B and C
they can continue this process over and over for years
36
what virus family does hep d come from
deltavirus
37
which types of hepatitis have envelopes and which do not
B, C,D all have envelopes A and E do not have envelopes
38
which hepatitis are self limited
A and E
39
which hepatitis must u be co infected with in hepatitis D
must be co infected with hepatitis B
40
which hepatitis lead to chronic infection
B,C,D
41
what does enteral route of transmission mean
that it involves the GI tract. the route of transmission can be either oral or faecal
42
what is the parenteral route of transmission
this involves areas other than the GI tract
43
which viruses have an enteral route of transmission
hepatits A and E
44
which viruses have a parenteral route of transmission
hepatitis B,C,d
45
which hepatitis is double stranded
hepatitis B virus
46
what antigen will be present in hepatitis D
HBsAg
47
what do the chronic forms lead to
cirrhosis and hepatocellular carcinoma
48
what does self limiting mean
that the colony of these viral cells self regulate their growth - infection resolves itself
49
what is a surface antigen (sAg)
the presence of these indicates the presence of the virus in the body
50
what is a core antigen (cAg)
indicates the body is producing antibodies against the virus
51
what is the modified core antigens (eAg)
the presence of these indicates the viral cell is actively replicating. this means the person has higher infectability
52
what is the immediate response antigen
IgM
53
what is the chronic response antigen
IgG
54
what is the surface antigen found on the envelope of HBV
HBsAg
55
what is the core antigen found around the nucleus of HBV
HBcAg
56
what is the modified c antigen that appears when the viral cell is actively replicating
HBeAg
57
the presence of what would give the person immunity against HBV
anti-HBs antibody
58
what antibody can be HBc IgM or HBc IgG
anti-HBc antibody
59
the presence of what would reduce infectability
anti-HBe antibody
60
what are the risk factors for hepatitis A
Travel to endemic areas Household contact Contaminated food (Salads/ Berries/ Tomatoes sundried) Sex risk (especially male homosexuals
61
what are the investigations carried out for hepatitis 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
what is given as prevention of hepatitis A
human normal immunoglobulin
63
what is the hepatitis A vaccination
harvix
64
what are the symptoms of Hepatitis B
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 and abdominal pain.  Often these symptoms last a few weeks and rarely does the initial infection result in death.
65
what is a current infection of hepatitis B indicated by
the presence of HBsAg in the blood
66
what is a past infection of Hepatitis B indicated by
the presence of anti-HBs antibodies in the blood
67
what is the replication steps of hepatitis B
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
what does it mean if someone as the HBsAg antigen
current infection (acute or chronic)
69
what does it mean if someone has the anti-HBc antibody
infection at some time (current or past)
70
what does it mean if someone has the anti-HBc IgM+ antigen
recent acute infection
71
what does it mean if someone has the anti-HBs antibody
past infection: anti HBc+ vaccination: if no other HBV markers
72
how to tell if someone has ever been exposed to hepatitis B
total antibody to hepatitis B core antigen (Anti-HBc)
73
what is an acute infection indicated by
IgM antibody to core antigen anti-HBc-IgM
74
how to tell how infectious the patient is to their contacts
positive for e antigen (HBeAg) and/or high levels of HBV DNA
75
summary of the antigens and antibodies for Hepatitis B
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
what is the Hepatitis B virus life cylce
immune tolerance immune clearance low replication inactive carrier reactivation
77
what are the aims of HBV therapy
to convert HBV from high replication phase to a low replication phase HBeAg+ to anti-HBe ALT normalisation reduced hepatic inflammation
78
what are the antiviral agents active in hepatitis B
interferon - if HBeAg+ low HBV DNA, more chance of losing HBsAg but side effects nucleoside analogues lamivudine (3 TC) - Adefovir + Entecavir + Tenofovir
79
what happens if the mother is HBeAg positive
active infection, high HBV viral load hepatitis B immunoglobulin plus hepatitis B vaccine (accelerated schedule)
80
what happens if the mother is anti-HBe positive
hepatitis B vaccine only
81
describe the HCV antibody test
total antibody slow response - 8-12weeks no IgM assay
82
describe the HCV PCR
appears early marker of infectivity and active infection monitor HCV RNA viral load for treatment response
83
what is included in the HCV therapy
combination therapy 24-48 wees pegylated interferon alpha weekly ribavirin
84
what is ribavirin
RNA-dependent RNA polymerase inhibitor reduces GTP pool RNA mutagen giving defective HCV immunomodulator
85
what are the aims of HCV therapy
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
what are telaprevir and bocepravir
protease inhibitors
87
what is an example of a polymerase inhibitor
Sofusbuvir
88
what are the interferon-free treatments
daclatasvir + asunaprevir ombitasvir–ABT-450/r and dasabuvir with ribavirin sofosbuvir + simepravir
89
what are the two different forms of hepatitis D infection
coinfection with HBV superinfection
90
what is co infection with HBV
HDV is acquired at same time as HBV increase in fulminant hepatitis
91
what is a superinfection
HDV acquired by hepatitis B carrier high risk of progression to corrhosis high risk of hepatocellular carcinoma
92
what are some of the symptoms of hepatitis E
jaundice abdominal pain nausea and vomiting anorexia
93
what does anicteric mean and who is common in
without jaundice and common in children
94
what is the most common cause of sporadic hepatitis in adults in endemic areas
hepatitis E
95
what do stellate cells turn into
myofibroblasts

Semester 4 (80 decks)

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