Hepatitides and alcoholic liver disease Flashcards
(86 cards)
1
Q
What family does the hepatitis A virus belong to?
A
Picornaviridae
2
Q
What is the structure of the hepatitis A virus?
A
Small, non-enveloped with ss + sense RNA
3
Q
What is the route of hepatitis A transmission?
A
Fecal-oral
4
Q
What is the course of hepatitis A infection?
A
- Incubation (2-6w)
- Prodrome (1-2w)
- Icteric phase (2w)
- Resolution of symptoms
5
Q
What are the clinical features of the prodromal phase of hepatitis A infection?
A
RUQ pain Hepatomegaly Fever Malaise Anorexia N+V
6
Q
What are the clinical features of the icteric phase of hepatitis A infection?
A
Jaundice
Dark urine
Pale stools
Pruritis
7
Q
How do you diagnose hepatitis A infection?
A
Bloods - transaminases - bilirubin - HAV RNA - antiHAV IgM - antiHAV IgG Liver biopsy
8
Q
What will you see on liver biopsy in a hepatitis A infection?
A
Periportal inflammation Hepatocyte swelling Ballooning degeneration Bridging necrosis Councilman bodies
9
Q
Which hepatitis viruses are fecal-oral?
A
HAV
HEV
Vowels = bowels
10
Q
What family does the hepatitis E virus belong to?
A
Hepeviridae
11
Q
What is the structure of the hepatitis E virus?
A
Non-enveloped with ss + sense RNA
12
Q
What is the route of hepatitis E transmission?
A
Fecal-oral transmission
13
Q
In which region is hepatitis A commonly found?
A
Tropical
Subtropical
14
Q
In which region is hepatitis E commonly found?
A
Equatorial
Developing countries
15
Q
What is the course of hepatitis E infection?
A
- Incubation (2-8w)
- Prodrome (1-2w)
- Icteric phase (2w)
- Resolution of symptoms
16
Q
What are the clinical features of the prodromal phase of hepatitis E infection?
A
RUQ pain Hepatomegaly Fever Malaise Anorexia N+V
17
Q
What are the clinical features of the icteric phase of hepatitis E infection?
A
Jaundice
Dark urine
Pale stools
Pruritis
18
Q
How do you diagnose hepatitis E infection?
A
Bloods - transaminases - bilirubin - HEV RNA - antiHEV IgM - antiHEV IgG Liver biopsy
19
Q
What will you see on liver biopsy in a hepatitis E infection?
A
Patchy necrosis
20
Q
Which group is most at risk for fulminant hepatitis in hepatitis E infection?
A
Pregnant women (incr mortality of both mother and fetus)
21
Q
Do affected hepatitis E patients become carriers?
A
No
22
Q
Which hepatitides can have chronic sequelae?
A
HBV
HCV
HDV
Consonants = chronic
23
Q
Discuss the treatment of hepatitis E infection
A
Self-limiting
Supportive care
24
Q
Which hepatitides have vaccinations available?
A
HAV
HBV
25
What family does the hepatitis B virus belong to?
Hepadnaviridae
26
What is the structure of the hepatitis B virus?
Enveloped, circular, partially ds DNA
27
What is the route of hepatitis B transmission?
Parenteral
Sexual
MTC
28
Which groups are at risk of parenteral hepatitis B transmission?
```
IVDUs
HCWs
Hemodialysis patients
Blood transfusion recipient
Organ transplant recipient
```
29
What is the replication cycle of HBV?
1. After entering the host cell's nucleus, reverse transcriptase completes the positive strand of the virus's partially double-stranded relaxed circular DNA (rcDNA).
2. The rcDNA is converted to covalently closed circular DNA
3. The cccDNA is then transcribed into viral mRNA by host RNA polymerase.
4. The viral mRNA leaves the nucleus and is translated into HBV core proteins and new reverse transcriptase in the cytoplasm.
5. Viral mRNA and reverse transcriptase are packaged into a capsid, where viral mRNA is then reverse-transcribed into viral rcDNA.
6. New viral DNA genomes are enveloped and leave the cell as progeny virions.
30
What is the pathophysiology of hepatocyte destruction in acute HBV infection?
HBV-derived peptides on HBV infected hepatocytes are detected by lymphocytes which activate CD8+ T cells that attack the hepatocytes
31
What is the pathophysiology of hepatocellular carcinoma in chronic HBV infection?
Persistent inflammation
| HBV DNA integration into the host genome
32
What is the course of hepatitis B infection?
1. Incubation (1-6m)
2. Clinical course varies significantly
- serum sickness-like syndrome
- subclinical hepatitis
- symptomatic hepatitis
- fulminant hepatitis
33
When can serum sickness-like syndrome in acute HBV infection develop?
1-2w post infection
34
What are the clinical features of serum sickness-like syndrome in acute HBV infection?
Rash
Myalgia
Arthalgia
Fever
35
What are the clinical features of symptomatic hepatitis in acute HBV infection?
```
Fever
Myalgia
Arthalgia
Skin rash
Fatigue
Anorexia
Nausea
RUQ pain
Jaundice
```
36
When does hepatitis B infection become chronic?
If the infection persists for more than 6 months with the detection of HBsAg
37
Which HBV antigen is the first evidence of infection?
HBsAg
38
Which HBV antigen indicates carrier state?
Continued HBsAg after 6mo
39
Which HBV antigen indicates active viral replicatoin?
HBeAg
40
Which HBV antibody indicates resolved infection or immunity?
Anti-HBsAg (with no HBsAg present)
41
Which HBV antibody indicates recent HBV infection
Anti-HBcAg IgM
42
Which HBV antibody indicates chronic HBV infection?
Anti-HBcAg IgG
43
Which HBV antibody indicates long-term clearance of HBV?
Anti-HBeAg
44
How do you screen for HBV infection and how do you confirm HBV infection?
Screen - HBsAg, anti-HBcAg IgM
| Confirm - HBV DNA, HBeAg
45
What additional laboratory studies should you perform in a patient with confirmed HBV infection?
```
Transaminases
Ferritin
Bilirubin
Albumin
INR
Cholinesterase
```
46
What will you see on liver biopsy in an acute hepatitis B infection?
Councilman bodies
| Bridging necrosis
47
What will you see on liver biopsy in a chronic hepatitis B infection?
Periportal infiltrates
Piecemeal necrosis
Ground glass hepatocytes
48
Which histology finding is pathognomic for chronic HBV?
Ground glass hepatocytes
49
What are extrahepatic manifestations of hepatitis B infection?
Polyarteritis nodosa
Glomerulonephritis
Aplastic anemia
50
Discuss your management of hepatitis B infection
```
Lifestyle changes (weight, alcohol, medications)
Acute
- supportive care
Chronic
- nucleoside/nucleotide analogues (tenofovir)
- pegylated interferon alpha
End-stage liver disease
- transplant
```
51
Name contraindications for tenofovir
```
Kidney disease (AKI, CKD)
Bone disease (osteomalacia, osteoporosis)
Fanconi syndrome
```
52
Name contraindications for pegylated interferon alpha
Decompensated cirrhosis
Psychiatric conditions
Pregnancy
53
What is the structure of hepatitis D virus?
Defective ss RNA
54
What does the hepatitis D virus require to enter host cells?
HBsAg coat of HBV
55
What is the incubation period of HDV coinfection?
1-6mo
56
What is the incubation period of HDV super infection?
2-8w
57
Define acute liver failure
Rapidly worsening liver function resulting in coagulopathy and hepatic encephalopathy in individual without preexisting liver disease or cirrhosis
58
Name causes of acute liver failure
Viral hepatitis
Substances (acetominophen, halothane)
Toxins (aflatoxin)
59
What investigations should you perform in acute liver failure?
```
Transaminases
Bilirubin
Coagulopathy studies
FBC (platelets)
Viral serology
Toxicology screening
```
60
Discuss your management of acute liver failure
Address underlying cause
| Early transfer to a transplant center
61
Name complications of HBV infection
```
Short-term
- HDV infection
- acute liver failure
Long-term
- liver cirrhosis
- hepatocellular carcinoma
- extrahepatic manifestations
- post-hepatitis syndrome
```
62
Which glomerulonephritis is more common as a extrahepatic manifestation of HBV infection?
Membranous glomerulonephritis
| Membranoproliferative type I is less common
63
Define acute hepatitis C infection
HCV infection that develops during the first 6 months following the exposure
64
Define chronic hepatitis C infection
HCV infection that persists beyond the first 6 months following the exposure
65
Do the majority of HCV infections resolve or progress?
85% become chronic - majority of acute infections are asymptomatic
66
What family does the hepatitis C virus belong to?
Flaviviridae
67
What is the structure of the hepatitis C virus?
Enveloped,+ sense ss RNA
68
What is the route of hepatitis C transmission?
Parenteral
Sexual
Perinatal
69
What is the incubation period for hepatitis C infection?
2w-6mo
70
What is the clinical presentation of acute hepatitis C infection?
Asymptomatic
Symptomatic
- same as other acute viral hepatitis
71
What is the clinical presentation of chronic hepatitis C infection?
Liver cirrhosis
72
What are the extrahepatic manifestations of chronic hepatitis C infection?
1. Hematological
- mixed cryoglobulinemia
- B cell non-Hodgkin lymphoma
- ITP
- autoimmune hemolytic anemia
2. Renal
- membranoproliferative glomerulonephritis
- membranous glomerulonephritis
3. Dermatological
- porphyria cutanea tarda
- lichen planus
4. Endocrine
- DM
- autoimmune thyroiditis
5. Vascular
- leukocytoclastic vasculitis
73
How do you diagnose HCV infection?
ELISA (antibodies) and confirm with PCR (HCV RNA)
74
Discuss the management of HCV infection
2 x DAA (ledipasvir + sofosbuvir)
| Interferon + ribavirin
75
What are the adverse effects of interferon and ribavirin combination?
```
Arthalgia
Thrombocytopenia
Leukopenia
Anemia
Depression
Teratogenic
```
76
Can pregnant women with HBV/HCV deliver vaginally and/or breastfeed?
Yes
77
Which sex does autoimmune hepatitis affect predominantly?
Females
78
Name the clinical features of autoimmune hepatitis
Fatigue
Abdominal pain
Weight loss
Jaundice (if acute liver failure)
79
How do you diagnose autoimmune hepatitis?
ANA
ASMA
Liver biopsy
80
Give a differential diagnosis for autoimmune hepatitis
Viral hepatitis
Primary sclerosing cholangitis
Primary biliary cirrhosis
Alcohol-related hepatotoxicity
81
Discuss the management of autoimmune hepatitis
Azathioprine
| Prednisone
82
What are the 3 stages of alcoholic liver disease?
Alcoholic fatty liver
Alcoholic hepatitis
Alcohol-related cirrhosis
83
What are the laboratory findings in alcoholic fatty liver disease?
AST>ALT
Incr GGT
Incr CDT
Macrocytic anemia
84
What are the laboratory findings in alcoholic hepatitis?
```
AST:ALT>2
Macrocytic anemia
Thrombocytosis
Incr GGT
Incr ALP
```
85
Which histological finding is associated with alcoholic liver disease?
Mallory bodies
86
What is the etiology of NAFLD and NASH?
DM II
| Obesity
