Hepatitis

Question 0

What are risk factors for hepatitis A?

Answer 0

(1) contact with infected person
(2) daycare
(3) IV drug use
(4) recent travel
(5) contaminated food or water

Question 1

What is the most common viral hepatitis worldwide?

Answer 1

Hepatitis A.

Question 2

How is hepatitis A usually spread?

Answer 2

Fecal-to-oral. It is absorbed in the intestine, travels the portal vein, and enters and replicates within hepatocytes.

Question 3

What is an indication that a hepatitis A patient is no longer contagious?

Answer 3

Jaundice has resolved.

Question 4

Can hepatitis A lead to a chronic infection?

Answer 4

No.

Question 5

How is hepatitis A diagnosed?

Answer 5

Presence of HAV IgM antibodies.

Question 6

When might you worry about a fulminant hepatitis A infection?

Answer 6

(1) >40 years
(2) chronic liver disease

Fulminant infections are rare.

Question 7

How is hepatitis B usually spread?

Answer 7

(1) perinatally
(2) blood products
(3) sexually
(4) IV drug use

Question 8

Which are more likely to develop a chronic hepatitis B infection: adults or children?

Answer 8

Children (90% vs 5%).

Question 9

What is the serology profile for acute HBV infection?

Answer 9

+: HBsAg, HBcAb (IgM or IgG), HBV DNA

-: HBsAb

Question 10

What is the serology profile for chronic HBV infection?

Answer 10

+: HBsAg, HBcAb, HBV DNA

-: all else

Question 11

What is the serology profile for a person vaccinated to HBV?

Answer 11

+: HBsAb

-: all else

Question 12

What is the serology profile of a person with a cleared HBV infection?

Answer 12

+: HBsAb, HBcAb

-: all else

Question 13

How is hepatitis B treated?

Answer 13

(1) tenofovir

(2) entecavir

Question 14

What is done for infants born to mothers that are HBsAg positive?

Answer 14

(1) vaccine at birth

(2) HBIG

Question 15

How is hepatitis D spread?

Answer 15

Percutaneous exposure.

Question 16

Which virus requires HBV for infection?

Answer 16

Hepatitis D.

Question 17

Why is HBV infection necessary for HDV?

Answer 17

The HDV virions are coated using HBV products, allowing cell-to-cell spread.

Question 18

What increases the risk of fulminant hepatitis from acute HBV infection?

Answer 18

Co-infection with HDV (34% vs 4%).

Question 19

Is hepatitis C a DNA or RNA virus?

Answer 19

RNA.

Question 20

How is hepatitis C spread?

Answer 20

(1) IV drug use
(2) sexually
(3) blood products

Question 21

What is the probability of developing a chronic HCV infection once infected?

Answer 21

80%.

Question 22

Which hepatitis infection has the strongest association with hepatocellular carcinoma?

Answer 22

HCV.

Question 23

How is HCV treated?

Answer 23

(1) interferon
(2) ribavirin
(3) telaprevir
(4) boceprevir

Question 24

Is hepatitis E a DNA or RNA virus?

Answer 24

RNA.

Question 25

How is hepatitis E spread?

Answer 25

Fecal-orally.

Question 26

Which group has the greatest risk of fulminant hepatitis in an HEV infection?

Answer 26

Pregnant women.

Question 27

How is hepatitis E treated?

Answer 27

Ribavirin.

Question 28

Is hepatitis A a DNA or RNA virus?

Answer 28

RNA.

Question 29

Is hepatitis B a DNA or RNA virus?

Answer 29

DNA.

Question 30

What is the main difference between Type 1 and 2 autoimmune hepatitis?

Answer 30

(1) autoantibodies to ANA or SMA | (2) autoantibodies to LKM1

Question 31

Which type of autoimmune hepatitis is more likely to have extrahepatic manifestations?

Answer 31

Type 2.

Question 32

How is autoimmune hepatitis treated?

Answer 32

(1) prednisone | (2) prednisone & azathioprine

Question 33

What is primary biliary cirrhosis?

Answer 33

An ongoing, auto-immune inflammatory destruction of the interlobular and septal bile ducts, leading to chronic cholestasis and biliary cirrhosis. (Not really cirrhosis.)

Question 34

What is the trigger for primary biliary cirrhosis?

Answer 34

An immune-mediated response to a foreign or self antigen. Presence of AMA antibodies inevitably leads to PBC.

Question 35

What is the LFT profile of primary biliary cirrhosis?

Answer 35

Elevated ALK.

Question 36

What are the histological features of primary biliary cirrhosis?

Answer 36

(1) damage to epithelial cells of small bile ducts (2) ductopenia (3) non-caseating granulomas

Question 37

How is primary biliary cirrhosis treated?

Answer 37

Ursodiol. Prednisone does not work.

Question 38

What is primary sclerosing cholangitis?

Answer 38

A chronic cholestatic liver disease of unknown etiology characterized by inflammation and fibrosis of the biliary tree.

Question 39

What is the primary worry with primary sclerosing cholangitis?

Answer 39

Development of cholangiocarcinoma.

Question 40

What are the histological features of primary sclerosing cholangitis?

Answer 40

Onion skin fibrosis around bile ducts.

Question 41

What other disorder is usually seen in patients with primary sclerosing cholangitis?

Answer 41

IBD (80%).

Question 42

What is the primary cause of acute liver failure in the US?

Answer 42

Drug-induced liver disease (acetaminophen).

Question 43

What profile is at increased risk of drug-induced liver disease?

Answer 43

An aging, obese, alcoholic female that has malnutrition and multiple prescriptions.

Question 44

What are 2 drugs causing intrinsic DILI?

Answer 44

(1) acetaminophen | (2) methotrexate

Question 45

What are characteristics of hepatocellular DILI?

Answer 45

(1) elevated AST/ALT (2) acute liver failure (3) 10% mortality

Question 46

What are characteristics of cholestatic DILI?

Answer 46

(1) elevated ALK (2) jaundice (3) pruritus

Question 47

What is the reason for acetaminophen toxicity?

Answer 47

A buildup of the toxic metabolite, NAPQI, due to an exhaustion of glutathione stores.

Question 48

How is acetaminophen-induced liver disease treated?

Answer 48

N-acetylcysteine, which is metabolized to glutathione in the body.

Question 49

What drug class is implicated in the most cases of DILI?

Answer 49

Antimicrobials.