EXAM #2: VIRAL HEPATITIS Flashcards Preview

Gastrointestinal System > EXAM #2: VIRAL HEPATITIS > Flashcards

Flashcards in EXAM #2: VIRAL HEPATITIS Deck (52):
1

Describe the histologic appearance of hepatitis.

- Blue= bad, lymphocytes
- Pink= good

2

What are the complications of hepatitis?

1) Cirrhosis
2) Hepatocellular carcinoma

3

How does cirrhosis appear histologically?

- Fibrosis (blue) with islands of normal liver tissue (pink)
- Regenerative nodules

4

What are the signs and symptoms of hepatitis?

- Majority of patients are asymptomatic
- Some with acute hepatitis have vague flu-like symptoms

5

What is self-limiting hepatitis?

Hepatitis that is self-resolving

6

What is fulminant hepatitis?

Overwhelming liver inflammation that leads to liver failure

7

List the etiologies of hepatitis.

1) Infectious
2) Immune related
3) Chemicals/toxins
4) Medications
5) Ischemia
6) Hereditary
7) Pregnancy
8) Alcohol
9) NAFLD

8

What are the immune related causes of hepatitis?

1) PBC--primary biliary cirrhosis
2) Primary Sclerosing Cholangitis (complication of UC)
3) Autoimmune

9

What are the self-limited causes of viral hepatitis?

HAV and HEV

10

What patient population is autoimmune hepatitis most common in?

Middle aged females

11

What antibodies are positive in autoimmune hepatitis?

1) Antinuclear antibody (ANA)
2) Anti-smooth muscle antibody (ASMA)
3) Anti-LKM

12

How is autoimmune hepatitis treated?

- Steroids
- Immunomodulators--Azathioprine

13

What is the classic histologic finding in autoimmune hepatitis?

Severe inflammation of the portal triads

14

What is Primary Biliary Cirrhosis?

Immune mediated destruction of the BILE CANALICULAE

15

What antibody is associated with PBC?

Anti-mitochondrial antibody (AMA)

16

What are patients with PBC at risk for?

1) Hyperlipidemia
2) Osteoporosis

17

What is the treatment for PBC?

Urso (bile acid supplement)

18

What is PSC?

Immune mediated destruction of the large bile ducts leading to stricture/ obstructive jaundice

19

What disease is PSC strongly associated with?

UC

20

How is PSC treated?

Currently there is no effective therapy

21

What is the most common cause of non-hepatitis virus infection causing hepatitis?

EBV (mononucleosis)

22

What is unique about the liver reaction to Isoniazid (INH)?

- Undetected hepatitis from INH can lead to cirrhosis
- Mandated that INH administration is followed with LFT measuring

23

What four chemicals will cause a dose-dependent liver destruction?

1) Tylenol*
2) Amanita Phalloides (mushroom)
3) White phosphorus
4) Carbon Tetrachloride

24

What type of virus is HAV?

Picornoviridae--ssRNA

25

What is HAV infection associated with?

Traveling is considered classic
- South America
- Africa
- SE Asia
- Greenland*

*****HOWEVER, in the US, DAYCARE is the most common*****

26

How is HAV transmitted? What are the unusual modes of transmission?

Fecal-oral
- Homosexual activity
- IVDA

27

What lab test is associated with symptomatic HAV infection?

ALT elevation is associated with symptomatic HAV

28

What are the worrisome variants of HAV infection?

1) Cholestatic hepatitis
2) Relapsing hepatitis
3) Fulminant hepatitis

29

What type of virus is HBV?

Hepadnaviridae--dsDNA

30

Is HBV enveloped?

Yes

31

How is HBV transmitted?

Parenterally:
- IVDA
- Transfusion
- Sex

*Most of the transmission world-wide happen via the mucosa at birth*

32

What population in the US has the most HBV?

Immigrants from Asia
- Africa is 2nd
- Both together= 80%

*Note this data comes from Olmsted Count, MN (Mayo Clinic)

33

How is the transmission of HBV from mother to child described?

"Vertical transmission"

34

What is the risk of HBV infection becoming chronic? How is the risk different between infants and adults?

Infants= 90% likelihood

Adults= 5% likelihood

35

What is the most likely outcome of HBV infection in adults? What are the treatment implications?

- Self-limited recovery occurs 95% of the time
- Don't treat

36

When is HBV infection "chronic"?

Six months

37

When is HBV infection treated?

Once it is chronic

38

What are the complications of chronic HBV infection?

1) Cirrhosis
2) HCC

39

What does HBsAg indicate?

Current infection

40

What does HBsAB IgG ALONE indicate?

Confirms vaccination

41

What is the integral component of the HBV vaccination?

HBsAg

42

What is HBV immune tolerance?

The baby's reaction to HBV
- Tons of HBV DNA present
- No immune system reaction

43

What antibody markers the carrier/ infective state of HBV infection?

HBe

44

In Taiwan, what was the impact of HBV vaccination on HCC?

Vaccination lowered the incidence of HCC

45

What is the only treatment for HBV that is definitive in its elimination?

Interferon--but it has major adverse side effects

46

What are the oral medications for HBV that has little adverse effects?

1) Lamivudine
- Nucleoside analog
- Prevents viral replication by incorporating in replicating DNA strand
2) Adefovir
- Used to treat Lamivudine mutants

47

What is the only medication that is safe for HBV infection in pregnancy?

Lamivudine

48

What does HDV require for infection?

HBV

49

When is HDV infection seen in the U.S?

IDVA

50

What is worse, coinfection or superinfection of HDV?

Superinfection
- HBV infection with HDV added ontop

51

When can HEV cause fulminant hepatitis?

Pregnant women

52

What is the reservoir for HEV in the US?

Swine i.e. pigs in the midwest