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Flashcards in Hepatitis/Alcoholic Liver Disease Deck (70)
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1

Pathological features of hepatitis

-inflammation of the liver
-Hepatocellular necrosis (focal or extensive)
-Inflammatory cell infiltration of the liver (Portal areas vs parenchyma)

2

Acute hepatitis

-condition lasting less than 6 months
1. Complete resolution of liver damage with return to normal function and structure
OR
2. Rapid progression of the acute injury toward extensive necrosis and a fatal outcome

3

Chronic hepatitis

-sustained inflammatory process lasting longer than 6 months

-Difficult to differentiate from acute hepatitis on clinical or histologic criteria alone

4

Common causes of acute hepatitis

-Viral hepatitis (A through E)
-Drugs (prescription, OTC and illicit)
-Alcohol
-Toxins
-Autoimmune
-Wilson Disease

5

Wilson Disease

-Autosomal recessive disorder
-Results in accumulation of copper in various tissues (liver, brain, and corneas)

-Neuropsychiatric s/s along with liver disease is present

6

How to diagnose Wilson Disease

Low serum ceruloplasmin with high urinary and hepatic copper levels

7

Treatment for Wilson Disease

-Indefinite
-Copper chelation
-Zinc supplementation

8

Acute hepatitis can be caused by direct toxin induced necrosis via

Acetaminophen or Amanita phalloides toxin (fungus/mushroom)

9

Acute hepatitis can be caused my host immune-mediated damage

-viral
(Hep A, B, C, D, E viruses)

10

Most common cause of acute hepatitis in the US?

Hep A virus

-Hep B is 2nd most common
(Most extensively characterized)

11

Most prevalent hepatitis virus world wide?

Hep C

-But is an infrequent cause of symptomatic acute hepatitis
-Accounts for most cases of acute hepatitis previously designated as non-A, non-B

12

Hep B antigens

HBsAg (surface)
HBeAg (Be Ag)
HBcAg (core)

13

Hep Be Ag is found....

Hepatitis Be antigen (HBeAg) is found in the EARLY phase of hepatitis B infection, then a bit later the hepatitis Bs antigen becomes detectable

-Serum levels of both antigens rise rapidly during the period of viral replication.

14

In HBV carriers and patients with chronic hepatitis B, positive HBeAg results usually indicate

presence of ACTIVE HBV replication and high infectivity

15

In HBV carriers and pts with chronic hep B, a negative HBeAg result indicates

very minimal or lack of HBV replication

16

What type of virus is Hep D?

-Hepatitis D is an incomplete RNA virus
***Requires HBV (HBsAg) for transmission****
-Thus only causes hepatitis in people with HBV

17

Hepatitis E is typically found in endemic areas and is most commonly associated with __________

poor sanitation

-Shares many similarities with hepatitis A

18

SEE SCREEN SHOT OF COMPARISON CHART

of all hepatitis viruses

19

Acute viral hepatitis usually starts with

-a prodromal phase (several days)
-Typically constitutional and GI symptoms
-Jaundice with bilirubinuria and acholic stools follow (pts usually feel better by now)
-Hepatomegaly is present
-Splenomegaly is present in 20% of patients

**Many patients are asymptomatic or have symptoms without jaundice and thus do not seek medical attention**

20

5-10% of hepatitis-B and C cases will have _________

-arthritis and urticaria
-Resembling serum sickness (due to immune complex deposition)

21

Labs with acute hepatitis

-Aminotransferases (ALT and AST) are often greater than 20-fold normal and as high as 100-fold normal
-Elevation in bilirubin (>2.5 to 3 mg/dL) results in jaundice and defines icteric hepatitis
-Alkaline Phosphatase is usually 3xs normal
(except in cholestatic hepatitis)
-CBC usually shows mild leukopenia (w/ atypical lymphocytes)

22

+ HepBcAb IgG means

+HepBsAb means

pt had been infected with HBV

pt has mounted an immune response to the virus and is now immune

23

Serology for acute hepatitis B infection

+ HBsAg
- HBsAb
+ HBcAb IgM

24

Serology for chronic carriers of hep B

+ HBcAb IgG
- HBcAb IgM
+ HBsAg (+ HBeAg)
-HBsAb

Chronic active: HBeAg
Chronic passive: HBeAb

25

Serology of people vaccinated against hep B

+ HBsAb only

(Vaccine ONLY contains HBsAg)
-no core Abs and no Ags present (the only way to get these is to be exposed to the actual virus)

26

Serology for window period of Hep B infection

-Window period is the time when HBsAg has disappeared, but HBsAb isn't detectable yet

+ for HBcAb ONLY

27

Cholestatic hepatitis

-Self-limited with marked conjugated hyperbilirubinemia, alkaline phosphatase and pruritus
-Usually associated with hepatitis A
-Usually associated with hepatitis-A

28

Fulminant hepatitis

-Due to massive hepatic necrosis
-Occurs in

29

Chronic hepatitis is typically seen in (which types)

hepatitis B, C and D

-1-10% in HBV (90% in neonates)
-85% in HCV
-Common in HDV

30

Rare complications
with HBV and HCV

-Cryoglobulinemia (HBV and HCV)
-Glomerulonephritis (HBV and HCV)
-Polyarteritis nodosa (HBV)