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Clin Med - GI > Hepatitis > Flashcards

Hepatitis Flashcards

(45 cards)

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1
Q

What are the reportable Hepatitis

A

Hep A, B, C

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2
Q

What is Hepatitis A and how is it spread

A

RNA virus
spread via fecal-oral route

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3
Q

what are the risk factors for hepatitis A

A

MSM (men sex with men - questionable)
drug use
homelessness
occupational exposures

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4
Q

What is the incubation period of Hep A

A

2 weeks - 6 months (avg 30 days)
acute illness

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5
Q

what are common symptoms of Hepatitis A

A

abrupt or insidious onset
Malaise
myalgia and arthralgia
fatigue
URI symptoms
aversion to smoking
anorexia
N/v
diarrhea/constipation
RUQ or epigastric pain

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6
Q

what is seen on PE with hep A

A

Low grade fever
hepatomegaly
splenomegaly
lymphadenopathy
+/- Jaundice

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7
Q

what are the lab results of Hep A

A

Increased AST and ALT
WBC usually normal
+ Hep A serology: IgM (acute), IgG (long term immunity)

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8
Q

what is post-exposure prophylaxis

A

single dose of HAV vaccine
immunoglobulin
-the sooner the better

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9
Q

What is the treatment of Hep A

A

self limited: improvement in 2-3 weeks
frequent hand washing to prevent spread
symptomatic treatment: rest, hydration, caloric intake, avoid exertion

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10
Q

What is Hep E
where is is common
what is the transmission

A

RNA virus
similar to HAV
primarily in India, Asia, Africa, Middle East and Central americas
fecal-oral transmission (contaminated water)

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11
Q

what is the incubation period of Hep E

A

14-60 days (avg 5-6 weeks)

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12
Q

what are the at risk populations of Hep E

A

Pregnant women
underlying liver disease
HIV
cancer on chemo
Organ transplant recipient

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13
Q

What are the symptoms of Hep E

A

most asymptomatic
immune compromise -> symptoms
malaise, myalgia and arthralgias, fatigue, anorexia, N/v, abd pain, jaundice, dark urine, clay colored stool

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14
Q

What are the extra-hepatic manifestations of Hep E

A

arthritis
pancreatitis
thrombocytopenia
Guillain-Barre
peripheral neuropathy

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15
Q

What are the labs with Hep E

A

+ AntiHEV igM and - IgG = acute infection
- AntiHEV Igm and + igG = prior infection
may see liver function test derangements similar to HAV

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16
Q

what is the prevention of Hep E

A

no vaccine
sanitation
purified water or boiling/chlorinating

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17
Q

what is the treatment of Hep E

A

self limited
symptomatic treatment: rest, adequate fluid and caloric intake, avoid ETOH and other hepatotoxins

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18
Q

What is Hep B

A

Ds-DNA Virus
inner core and outer surface coats
8 different genotypes

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19
Q

how is Hep B transmitted and what is the incubation

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A

blood born
remains infectious on fomites for up to 7 days
incubation: 6 weeks to 6 months, avg 12-14 weeks

20
Q

what are symptoms of acute hep B

Study These Flashcards
A

often asymptomatic
if symptoms - similar to Hep A and E infections: +/- serum sickness (hypersensitivity reaction) in early infection

21
Q

What are the lab tests for acute hep B

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A

liver function derangements similar to Hep A: higher AST and ALT elevations
+ antigen and antibody testing
HBC DNA (‘viral load’)

22
Q

what is the surface antigen on Hep B used for

Study These Flashcards
A

HBV vaccine (recombinant HBsAg)

23
Q

what antigens indicate viral infection in Hep B

Study These Flashcards
A

+ HBsAg and HBeAg

24
Q

what is the natural progression of hep B

Study These Flashcards
A

acute illness lasts roughly 2-3 weeks
typcially clinical or lab recovery by 16 weeks
longer course in some (immunocomp and children)
may persist as chonic HBV infection

25
how is Hep B prevented
hand washing standard precautions safter sex post-exposure prophylaxis (immunoglobulin + HBV vaccine) tx of chronically infected persons vaccination
26
what is the treatment of Acute Hep B
usually self limited symptomatic treatment: rest, hydration, caloric intake, avoid hepatotoxins if signs of acute liver failure - transplant
27
what is chronic Hep B
infection persisting longer than 3-6 months heralded by 3-6+ months of AST/ALT elevations rates highest in infants and immunocompromised
28
What are the symptoms of chronic hep B
in absence of cirrhosis, mostly asymptomatic symptoms generally non-specific reactivation HBV more sever symptoms (fulminant)
29
what is the tx of chronic Hep B
active viral replication (+HBeAg and + HBV DNA) - antivirals nucleoside and nucleotide analogues usually preferred Goal is serovonverstion from HBeAg to Anti-HBe and HBV DNA suppression low rates of resistance with enecavir and tenofovir
30
what is Hep D transmission
RNA virus only occurs as co-infection with HBV - requires HBAg co-infection during actue HBV or superimposed on chronic HBV blood borne transmission - rare in US
31
what are the symptoms of Hepatitis D
when co-infection with Acute HB, same symtpoms when superimposed on chronic HBV: provokes fluminant hepatitis decompensation hastens progression to cirrhosis more liekly to get HCC
32
what are the labs wtih Hep D
+ anti-HDV + HDAg or + HDV RNA
33
what is the treatment of Hep D
spontaneous resolution in most with acute HBV treat underling chronic HBV if indicated
34
What is Hep C
single-strand RNA virus 7 Different genotypes - dictates choice of tx common co-infection with HIV
35
how is Hep C transmitted
blood borne IVDU, sexual contact, occupational exposures, early blood/blood products transfusion
36
what is the incubation of Hep C
Incubation period 2-12 weeks (avg 6-7 weeks)
37
what are the symptoms of Hep C
often asymptomatic otherwise, mild non-specific symptoms often diagnosed with routine screening
38
what is HCV screening
all US adults at least once pregnant females (each pregnancy) one time screening regardless of age: HIV+, Hx or active IVDU, dialysis pts, persistent ALT elevations, following needle sticks, recipients of tranfusions/transplants, children of HCV+ mothers, on request
39
when is perioidc HCV screening recommended
IVDU dialysis patients high-risk comorbidities (HIV+)
40
what is the screening lab for HEP C
ANti-HCV (antibody) CHV RNA for confirmation
41
what is the natural progression of Hep C
spontaneous resolution/clearance in up to 50% progression to chronic Hep C infection in 50-85%
42
what is Hep C prevention
decreased incidence of infection following routine screening for transfusion no vaccine available safer sex practices and standard precautions vaccination for HBV and HAV for chronic HCV patients to improve prognosis
43
What is the treatment for acute HCV
none consider PEG interferon +/- ribavirin if no spontaneous clearance by 3 months
44
what is the first line treatment of chronic HCV
first line = ledipasvir + sofosbuvir (harvoni) - genotype 1
45
what is the goal of treatment of chronic HCV
goal is 'sustained virologic response' response dependent on genotype

Clin Med - GI (11 decks)

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