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Clin Med 2 > Hepatitis > Flashcards

Flashcards in Hepatitis Deck (49):
1

What is acute hepatitis

inflammation of the liver

2

What is the cause of acute hepatitis

infectious
- Hep B and C
non-infectious
- alcohol
- drugs
-autoimmune

3

Clinical acute hepatitis

- fatigue/maliase
- anorexia
- N/V
- fever
- enlarged tender liver
- jaundice
- normal/low WBC
- elevated aminotransferase (>1000U/L)
- hyperbilirubinemia
- increase PT/INR (>1.5)
- encephalopathy
- viral has viral sickness included

4

Transmission of hep a

fecal-oral route due to crowding and poor sanitation

5

Is there a vaccine for hep A

yes

6

Dx hep A

anti-HAV appears early (IgM= active, IgG= previous exposure)

7

Tx hep A

symptomatic
recovery in 3 mo and no chronic liver dz

8

Transmission Hep B

infected blood products, sexual contact, delivery by HBV+ mother

9

Do adults or infants develop acute hepatitis infection from HBV

infants

10

Is there a vaccine for Hep B

yes

11

If mother is HBV+ and delivers baby, what do we give baby? What could we give mother in 3rd trimester?

- vaginal delivery give baby HBIG and HBV vaccine within 12 hrs of birth
- give mother antiviral therapy in 3rd trimester is high viral load

12

HbSAg

-first evidence of infection
- persistent for more than 6 months--> chronic infection

13

HBV DNA

active viral replication; viral core

14

Anti-HBc

IgM indicating acute hepatitis infection and IgG indicated chronic or recovered infection

15

Anti-HBs

after successful vaccination or recovery from HBV infection

16

Transmission of Hep C

IVDA
body piercing
tattooing
hemodialysis
pre-1992 blood transfusion

17

Do people usually develop chronic HCV

yes

18

Dx HCV

anti-HCV ELISA
HCV RNA PCR serology for confirmation (do if ELISA positive)

19

Tx HCV

8-12 weeks Ledipasvir/sofosbuvir (Harvoni)
Recover in 3-6mo

20

Hep D is only associated with what and only present when?

Associated with HBV and HBsAg has to be present

21

Transmission Hep D

blood- percutaneous exposure

22

Dx Hep D

anti-HDV

23

Transmission Hep E

fecal oral- waterborne
consuming undercooked pig meat or if pet a pig

24

Who gets autoimmune hepatitis

young to middle aged women

25

When is autoimmune hepatitis common

following viral illness or drug exposure

26

Labs autoimmune hepatitis

aminotransferace>1000
positive ANA and/or smooth muscle Ab most common
IgG increase

27

Dx autoimmune hepatitis

liver biopsy

28

Tx autoimmune hepatitis

corticosteriods
azathioprine

29

How much alcohol consumed to produce cirrhosis

over 50g alcohol/day for 10 yrs

30

What preceded alcoholic hepatitis

recent period of heavy drinking

31

Sign of alcoholic hepatitis

fatty liver

32

Lab alcoholic hepatitis

macrocytic anemia
thrombocytopenia
AST/ALT ratio 2:1 and mildly elevated
PT/INR elevated

33

Imaging alcoholic hepatitis

CT/MRI: mod-severe steatosis

34

Tx alcoholic hepatitis

Emergent
- steroids: methylpredisone if MELD over 18
- pentoxiphylline if steriods C/I
General
- stop alcohol
- correct folate, thiamine, and zinc def
- abstinence
- liver transplant if abstinent for 6mo

35

Drugs that cause direct hepatotoxicity and are dose related

APAP
ALcohol
niacin
tetracycline
valproic acid
vitamin a

36

Drugs that cause direct hepatotoxicity and are not dose related and an allergy at times

amiodarone
aspirin
diclofenac
fluoroquinolones
phenytoin
methyldopa

37

Non-inflammatory drug induced cholestasis

azathioprine
estrogen
anabolic steriod
diclofenac

38

Inflammatory drug induced cholestasis

augmentin
azithromycin
erythromycin
macrobid- nitrofurytoin
cephalosporin
azathriprine

39

How much of world infected with HBV

1/3

40

What is the dominant cause of cirrhosis and HCC

chronic HBV

41

What is a predictor of cirrhosis and HCC

High HBV DNA

42

chronic HBV labs

HbSAg and anti-HBc IgG

43

Imaging chronic HBV

US/CT/MRI- coarse nodular echogenic appearance

44

TX HBV

entecavir and tenofovir

45

Clinical active chronic HBV

elevated transaminase more than 3-6mo
HBV DNA elevated
cirrhosis (ugly liver F2-F4)
acute liver failure

46

Most cases chronic HCV

Africa, C. America, E. Asia

47

Who has an increased risk of developing cirrhosis with chronic HCV

chronic alcohol ingestion
male
hcv>40yo
co-infection with HIV/HBV

48

Prevent Chronic HCV

needle exchange for IVDA
tx substance abuse
blood donor screening
universal precautions

49

Tx Chronic HCV

12 wks w/o cirrhosis and 24wks w/ cirrhosis
Ledipasvir/sofosbuvir (harvoni)