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CMT-dos > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

Viral Hepatitis

general

A

Common condition characterized by diffuse liver inflammation caused by specific hepatotropic viruses
Etiology:
Hepatitis A (HAV)
Hepatitis B (HBV)
Hepatitis C (HCV)
Hepatitis D (HDV)
Hepatitis E (HEV)
Other viruses can also cause an acute presentation of hepatitis (Epstein-Barr virus, Cytomegalovirus)

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2
Q

HEP

Patho

A

Pathophysiology:
Cytotoxic killing of the hepatocytes by CD8 T-cells which leads to cell apoptosis and liver damage

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3
Q
A
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4
Q

HEP A

Genral

A

Most common cause of acute viral hepatitis

Enterically transmitted RNA virus(fecal-oral route)

Produces typical S/S of hepatitis: anorexia, malaise, jaundice, fever, RUQ abdominal pain, hepatomegaly

Fulminant hepatitis and death are rare; increased risk in patients with chronic hepatitis C infection

Chronic hepatitis does not occur

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5
Q

HEP

typical S/Sx

A

Produces typical S/S of hepatitis: anorexia, malaise, jaundice, fever, RUQ abdominal pain, hepatomegaly

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6
Q

HEP A

Dx

A

Diagnosis is by antibody testing

IgM anti-HAV: detectable from 1–2 weeks after infection; remain for up to 6 months

IgG anti-HAV: evidence of past infection or vaccination

IGM is acute, IGG is either from past infection or immunization

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7
Q

HEP A

Tx and prevention

A

Treatment is supportive
Vaccination and previous infection are protective

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8
Q

Hepatitis B

general

A

Parenterally transmitted DNA virus
Coinfection with hepatitis D may occur

Produces typical S/S of hepatitis: anorexia, malaise, jaundice, fever, RUQ abdominal pain, hepatomegaly

Fulminant hepatitis and death may occur

Chronic infection can occur → cirrhosis and/or hepatocellular carcinoma

parentally : Sex, mother to baby, IVDU

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9
Q

Hep B

Dx

A

Diagnosis is by serologic testing: antigens and antibodies (surface, core, envelop)

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10
Q

HEP B

Tx

A

Treatment is supportive; antivirals for severe disease

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11
Q

Hep B

Prevention/protection

A

Vaccination is protective

Postexposure use of hepatitis Bimmune globulin (HBIG) may prevent or attenuate clinical disease
HBIGcontains antibodiestohepatitis B
Gives rapid, but short lived protection

Who should receive HBIG?
A baby born to a mother with hepatitis B; needle stick injury

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12
Q

Hepatitis B infection
serology

A

HBsAg positive- (surface antigen)
1st evidence of infection
Elevation >6 months → chronic infection

IgM Anti-HBc positive (acute infection)

Anti-HBs negative

IgG Anti-HBc positive (chronic infection)

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13
Q

HBV-vaccination
serology

A

HBsAg negative

IgM Anti-HBc negative

IgG Anti-HBc negative

Anti-HBs positive

c=core protein, should alsways be negative for vaccinated

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14
Q

Hep B

vaccination series

A

HBVvaccine:
Active immunity; leads to long-term immunity

For infants:
3-dose series, administered at 0, 1, and 6 months

For adults:
2-dose series (1 month apart)

Hepatitis A+ B combinationvaccine is also available as 3-dose series

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15
Q

Hepatitis B Screening

A

CDC issued new guidelinesrecommending expansion of hepatitis B screening to everyone

Under the new guideline,all adults 18 and older should be screened for hepatitis B at least once in their lifetime

Screening should be done using a triple panel test which includes HBsAg, anti-HBs, and anti-HBc

If the test is negative and no new risk factors are identified, people don’t need to be screened again

People considered at increased risk for HBV should still get periodic repeat testing

All pregnant people should be tested for HBsAg during each pregnancy regardless of vaccination status or history of testing

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16
Q

Hep B

The CDCidentifies these groupsto be at increased risk:

A

Currently or formerly incarcerated persons
Persons with current or past STIs or multiple sex partners
Persons with current or past hepatitis C virus infection
Persons born in regions with an HBV prevalence 2% or greater
US-born persons whose parents were born in regions of high HBV prevalence (>8%) and who were not vaccinated as infants
Persons with HIV infection
Persons with current or past injection drug use
Men who have sex with men
Infants born to people who are HBsAg-positive
Household contacts of persons with HBV infection
Needle-sharing or sexual contacts of persons with known HBV infection
Patients on dialysis
Persons with elevated ALT or AST levels of unclear etiology
Persons who request HBV testing (may be due to reluctance to disclose risk factors)

dont memeorize

17
Q

HCV

General

A

Parenterally transmitted RNA virus
< 50% due to IV drug use

Sometimes causes typical S/S of hepatitis: anorexia, malaise, and jaundice, but may be asymptomatic

Fulminant hepatitis and death rarely occur

Chronic hepatitis develops in ~80% of patients → cirrhosis and rarely hepatocellular carcinoma

18
Q

HCV

Dx

A

Diagnosis is by serologic testing:
Anti-HCV → HCV RNA (confirmatory testing)

19
Q

HCV

Tx

A

Treatment is based on the genotype and presence of cirrhosis → combination of direct-acting antivirals

20
Q

HCV

prevention/protection

A

No vaccine is available

Previous infection is not protective to later infection with the same or different genotypes of the virus

21
Q

Hepatitis D

general

A

Defective RNA virus (delta agent) that can replicate only in the presence of hepatitis B virus

Parenterally transmitted

Produces typical S/S of hepatitis: anorexia, malaise, jaundice, fever, RUQ abdominal pain, hepatomegaly

Occurs as a coinfection with acute hepatitis B or as a superinfection in chronic hepatitis B
HDV–HBV coinfection/superinfection is the most severe form of chronic viral hepatitis → rapid progression toward hepatocellular carcinoma (HCC) and liver-related death

22
Q

HDV

Dx

A

Diagnosis is by serologic testing:
HBsAg
Anti-HDV IgM (early) or IgG (late)
HDV RNA

23
Q

HDV

Tx and prevention

A

Treatment is supportive

VaccinationagainstHBV is the most effective way to prevent HDV

24
Q

Hepatitis E

general

A

Enterically transmitted RNA virus(fecal-oral route)

Produces typical S/S of hepatitis: anorexia, malaise, jaundice, fever, RUQ abdominal pain, hepatomegaly

Fulminant hepatitis and death are rare, except during pregnancy

25
Q

HEV

Dx

A

Diagnosis is by serologic testing:
Anti-HEV IgM (acute infection)
Anti-HEV IgG (previous infection)
HEV RNA

26
Q

HEV

Tx and prevention

A

Treatment is supportive

A vaccine for hepatitis Eis available in China, but is not available in the United States

27
Q

Hepatitis

phases of infection (4)

A
  1. incubation
  2. prodromal (pre-icteric)
  3. icteric
  4. recovery
28
Q

hepatitis

Prodromal (pre-icteric) phase:
Hep B?

A
  • Nonspecific symptoms
  • Profound symptoms: anorexia, malaise, nausea and vomiting, fever, RUQ abdominal pain
  • Urticaria and arthralgias occur occasional and are most associated with HBV infection
29
Q

Icteric phase:

A
  • Occurs ~3-10 days after the prodromal phase
  • Urine darkens, followed by jaundice
  • Systemic symptoms often regress, and patients feel better despite worsening jaundice; jaundice peaks ~1-2 weeks
  • Liver is usually enlarged (hepatomegaly) and tender

check spleen too

30
Q

Recovery phase:

A

During this 2- to 4-week period, jaundice fades

31
Q

hepatitis

Liver lab tests

A

Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) elevated (> 1000 IU/L)
ALT > AST
ALT is the slowest to return to baseline (recovery phase)
ALT and AST will be elevated out of proportion to alkaline phosphatase

Hyperbilirubinemia (conjugated and unconjugated)
Fractionation of bilirubin is of no clinical value
Urinary bilirubin usually precedes jaundice

32
Q

hepatitis

Prothrombin/international normalized ratio (PT/INR)

A

measurement to access liver function

can be elevated

33
Q
A
34
Q

hepatitis

Tx

A

Supportive care
Avoid alcohol and hepatotoxic drugs
Treatment of acute hepatitis C – prevent transmission

Cases of viral hepatitis should be reported to the local and states health department

35
Q

hepatitis

prevention

universal precautions/ Immunoprophylaxis

A

Good personal hygiene

Universal precautions:
Barrier protection when handling blood and other body fluids from patients with acute HBV and HCV; stool from patients with acute HAV

Immunoprophylaxis:
Antibody-containing preparations to provide a susceptible individual with immunologic protection against a specific disease
Vaccines for hepatitis A and hepatitis B are available in the United States

CMT-dos (95 decks)

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