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CCFP 3 > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

Hep A transmission, RF + sx

A

Transmission: fecal oral, close contact, contaminated food, sexual contact
RF: travelers, MSM, IVDU, homelessness, incarceration
Sx: fever, faundice, malaise, N/V, abdo pain then icteric phase of high bili, jaundice, dark urine, pale stool

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2
Q

Hep A ix + results, management + complications

A

Ix:
↑↑AST, ↑↑AST, ↑ALP, ↑↑bili
Hep A IgG indicates immunity
Hep A IgM suggests recent/ acute infection
Management:
Close contact precautions + post-exposure prophylaxis (IG)
Fulminant illness = liver transplant
Complications:
Wt loss
Malabsorption

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3
Q

Hep B + C transmission + RF

A

Transmission:
Blood + body fluids (semen, saliva)
RF:
Household contact
Healthcare worker
IVDU
MSM

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4
Q

Hep B + C complications

A

Complications:
Cirrhosis
Hepatocellular carcinoma
Immunisations

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5
Q

Hep A + B immunisation schedule + name

A

Hep B: 3 dose series (Engerix-B, Twinrix)
Hepatitis A + B vaccine schedule timing:
0, 1, 6 months
1st Vaccine: given immediately
2nd Vaccine: given one month later
3rd Vaccine: given six months later
Rapid Schedule: 0, 7, 21 days + 1 year (4 doses)

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6
Q

Sx hepatitis

A

Nausea
Anorexia
Fatigue
Fever
RUQ pain
Jaundice
Myalgias

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7
Q

Ix for hepatitis + meaning of each

A

HbsAg: active infection
Anti-HBc: previous infection
IgM: infection in past 6 months
IgG: distant HBV infection

Anti-HBs: immunity from vaccine or prev infection
HBeAg: how active the virus is
HBV DNA = viral laod

Anti-HCV ab - detected 5-10w after exposure
If positive: HCV ENA PCR + genotype + viral load
HCV RNA negative: prev infection that has cleared
Positive: positive
Other tests: AST, ALT, ALP, bili, albumin, CBC, PTT, INR

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8
Q

Screening

A

Screen for Hep C once for all adults >18 + anyone w/ RF

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9
Q

Management of chronic HBV

A

Chronic HBV: TIE
Tenofovir
Interferon alfa 2b
Entecavir
Lifestyle: stop alcohol, stop smoking, maintain healthy wt, immunise against A + B
Reduce transmission: never donate blood, never share drug paraphernalia, disclose to sexual partners

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10
Q

management of positive hep C

A

Positive Hep C: refer to experienced provider, treatment depends on genotype
Lifestyle: stop alcohol, stop smoking, maintain healthy wt, immunise against A + B
Reduce transmission: never donate blood, never share drug paraphernalia, disclose to sexual partners

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11
Q

Labs for pre, post and intra-hepatic dz

A

Pre-hepatic - high unconjugated bilirubin, normal liver enzymes, high LDH
Hepatic - high conjugated + unconjugated bilirubin, AST + ALT ++
Post-hepatic - high conjugated bilirubin, ALP ++

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12
Q

What is the difference between NASH + NAFLD, and how do you dx NAFLD?

A

NAFL = fatty liver, reversible
NASH = severe, inflammation, scarring - can lead to fibrosis, cirrhosis

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13
Q

Ix for autoimmune hepatitis

A

anti smooth muscle antibody

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14
Q

Hepatocellular carcinoma IX

A

alpha fetal protein

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15
Q

Signs associated with liver cirrhosis

A

Encephalopathy
Xanthelasma
Scleral Icterus
Jaundice
Fetor Hepaticus
Gynecomastia
Esophageal Varices
Splenomegaly
Spider Angioma
Caput Medusa
Umbilical Hernia
Ascites
Muscle Wasting
Weakness
Easy Bruising
Pruritus
Hemorrhoids
Testicular Atrophy
Edema
Palmar Erythema
Dupuytren’s Contracture
Asterixis
Leuconychia
Clubbing
Encephalopathy

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16
Q

Causes of liver cirrhosis

A

Alcoholic Liver Disease
Fatty Liver Disease (NASH)
Chronic Viral Hepatitis (B, B+D, C)
Autoimmune Hepatitis
Primary Biliary Cirrhosis
Primary Sclerosing Cholangitis
Chronic Hepatic Congestion (cardiac, hepatic vein thrombosis)
Hemochromatosis
Wilson’s Disease
Alpha-1 Antitrypsin Deficiency
Granulomatous Disease (Sarcoidosis)
Drug Induced Liver Disease
Idiopathic

17
Q

Types of hepatitis

A

infectious, medication, alcohol, iron overload, autoimmune

18
Q

NAFL + hepatitis (raised AST + ALT) = what?

A

NASH

19
Q

Rx for NASH

A

exercise, diet, lose weight, stop alcohol

20
Q

Hepatitis B bloods

A

anti-HBs, HBsAg, anti-HBc (IgM, total)

21
Q

Markers for infectiousness in hep B

A

serum HBV DNA, serum HBeAg, Anti-Hbe

22
Q

Hep C bloods

A

serum ant-HCV, HCV RNA, genotype and subtype

23
Q

What % of hep c pts clear spontaneously?

A

20% hep C spontaneously clear (Anti-HCV positive but HCV RNA negative)

24
Q

Hep A management

A

supportive, report

25
Q

Hep B management

A

refer to hepatology, treat if severe (cirrhosis, fibrosis) w/ tenofovir, entecavir, monitor

26
Q

Hep C management

A

refer, quit risks, Epclusa (direct antiviral agent)

27
Q

Monitoring for hep B + C

A

liver US q6-12months, monitor for varices w/ scope q3yrs, monitor alcohol use

CCFP 3 (67 decks)

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