EXAM #2: VIRAL HEPATITIS Flashcards Preview

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Flashcards in EXAM #2: VIRAL HEPATITIS Deck (52)
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1
Q
Describe the histologic appearance of hepatitis.
A
- Blue= bad, lymphocytes
- Pink= good
2
Q
What are the complications of hepatitis?
A
1) Cirrhosis
2) Hepatocellular carcinoma
3
Q
How does cirrhosis appear histologically?
A
- Fibrosis (blue) with islands of normal liver tissue (pink)
- Regenerative nodules
4
Q
What are the signs and symptoms of hepatitis?
A
- Majority of patients are asymptomatic
- Some with acute hepatitis have vague flu-like symptoms
5
Q
What is self-limiting hepatitis?
A
Hepatitis that is self-resolving
6
Q
What is fulminant hepatitis?
A
Overwhelming liver inflammation that leads to liver failure
7
Q
List the etiologies of hepatitis.
A
1) Infectious
2) Immune related
3) Chemicals/toxins
4) Medications
5) Ischemia
6) Hereditary
7) Pregnancy
8) Alcohol
9) NAFLD
8
Q
What are the immune related causes of hepatitis?
A
1) PBC--primary biliary cirrhosis
2) Primary Sclerosing Cholangitis (complication of UC)
3) Autoimmune
9
Q
What are the self-limited causes of viral hepatitis?
A
HAV and HEV
10
Q
What patient population is autoimmune hepatitis most common in?
A
Middle aged females
11
Q
What antibodies are positive in autoimmune hepatitis?
A
1) Antinuclear antibody (ANA)
2) Anti-smooth muscle antibody (ASMA)
3) Anti-LKM
12
Q
How is autoimmune hepatitis treated?
A
- Steroids
- Immunomodulators--Azathioprine
13
Q
What is the classic histologic finding in autoimmune hepatitis?
A
Severe inflammation of the portal triads
14
Q
What is Primary Biliary Cirrhosis?
A
Immune mediated destruction of the BILE CANALICULAE
15
Q
What antibody is associated with PBC?
A
Anti-mitochondrial antibody (AMA)
16
Q
What are patients with PBC at risk for?
A
1) Hyperlipidemia
2) Osteoporosis
17
Q
What is the treatment for PBC?
A
Urso (bile acid supplement)
18
Q
What is PSC?
A
Immune mediated destruction of the large bile ducts leading to stricture/ obstructive jaundice
19
Q
What disease is PSC strongly associated with?
A
UC
20
Q
How is PSC treated?
A
Currently there is no effective therapy
21
Q
What is the most common cause of non-hepatitis virus infection causing hepatitis?
A
EBV (mononucleosis)
22
Q
What is unique about the liver reaction to Isoniazid (INH)?
A
- Undetected hepatitis from INH can lead to cirrhosis
- Mandated that INH administration is followed with LFT measuring
23
Q
What four chemicals will cause a dose-dependent liver destruction?
A
1) Tylenol*
2) Amanita Phalloides (mushroom)
3) White phosphorus
4) Carbon Tetrachloride
24
Q
What type of virus is HAV?
A
Picornoviridae--ssRNA
25
Q
What is HAV infection associated with?
A
Traveling is considered classic
- South America
- Africa
- SE Asia
- Greenland*

*****HOWEVER, in the US, DAYCARE is the most common*****
26
Q
How is HAV transmitted? What are the unusual modes of transmission?
A
Fecal-oral
- Homosexual activity
- IVDA
27
Q
What lab test is associated with symptomatic HAV infection?
A
ALT elevation is associated with symptomatic HAV
28
Q
What are the worrisome variants of HAV infection?
A
1) Cholestatic hepatitis
2) Relapsing hepatitis
3) Fulminant hepatitis
29
Q
What type of virus is HBV?
A
Hepadnaviridae--dsDNA
30
Q
Is HBV enveloped?
A
Yes
31
Q
How is HBV transmitted?
A
Parenterally:
- IVDA
- Transfusion
- Sex

*Most of the transmission world-wide happen via the mucosa at birth*
32
Q
What population in the US has the most HBV?
A
Immigrants from Asia
- Africa is 2nd
- Both together= 80%

*Note this data comes from Olmsted Count, MN (Mayo Clinic)
33
Q
How is the transmission of HBV from mother to child described?
A
"Vertical transmission"
34
Q
What is the risk of HBV infection becoming chronic? How is the risk different between infants and adults?
A
Infants= 90% likelihood

Adults= 5% likelihood
35
Q
What is the most likely outcome of HBV infection in adults? What are the treatment implications?
A
- Self-limited recovery occurs 95% of the time
- Don't treat
36
Q
When is HBV infection "chronic"?
A
Six months
37
Q
When is HBV infection treated?
A
Once it is chronic
38
Q
What are the complications of chronic HBV infection?
A
1) Cirrhosis
2) HCC
39
Q
What does HBsAg indicate?
A
Current infection
40
Q
What does HBsAB IgG ALONE indicate?
A
Confirms vaccination
41
Q
What is the integral component of the HBV vaccination?
A
HBsAg
42
Q
What is HBV immune tolerance?
A
The baby's reaction to HBV
- Tons of HBV DNA present
- No immune system reaction
43
Q
What antibody markers the carrier/ infective state of HBV infection?
A
HBe
44
Q
In Taiwan, what was the impact of HBV vaccination on HCC?
A
Vaccination lowered the incidence of HCC
45
Q
What is the only treatment for HBV that is definitive in its elimination?
A
Interferon--but it has major adverse side effects
46
Q
What are the oral medications for HBV that has little adverse effects?
A
1) Lamivudine
- Nucleoside analog
- Prevents viral replication by incorporating in replicating DNA strand
2) Adefovir
- Used to treat Lamivudine mutants
47
Q
What is the only medication that is safe for HBV infection in pregnancy?
A
Lamivudine
48
Q
What does HDV require for infection?
A
HBV
49
Q
When is HDV infection seen in the U.S?
A
IDVA
50
Q
What is worse, coinfection or superinfection of HDV?
A
Superinfection
- HBV infection with HDV added ontop
51
Q
When can HEV cause fulminant hepatitis?
A
Pregnant women
52
Q
What is the reservoir for HEV in the US?
A
Swine i.e. pigs in the midwest