Hepatitis- Jenkins Flashcards
(35 cards)
What can cause an elevated alkaline phosphatase?
biliary disease
***What are the differentials in AST/ALT elevation? (6) What labs should be ordered to rule these differentials in or out?
- Hepatitis C: Viral count
- Hepatitis B: Viral count
- Hepatitis A: Serology (antibodies)
- NAFLD/NASH
- Autoimmune Hepatitis: ANA
- Hemochromatosis: Ferritin
***What are the primary causes of chronic liver disease?
- Hepatitis C (26%)
- Alcohol (24%)
How did a lot of people contract Hepatits C?
Blood transfusions before 1990 (were not regulated)
***What is the leading cause of liver transplantation?
Hepatitis C
***What is Hepatitis C? How many genotypes are there? What are the most common? Is it curable?
- Small , enveloped, icosahedral positive-sense RNA virus.
- 6 genotypes
- most common: 1a, 1b, 2a and 2b
*NOW curable!
***What are the most common HCV genotypes in the US?
1-3
Who is at risk for HCV?
- persons in contact with non sterile needles (IVDA, tattoos before 1990, piercings, accupunctures, needlesticks)
- persons who snort cocaine and share snorting straws
- exposure to HCV
What do many pts with HCV present with?
- most with chronic HCV are asymptomatic or have mild, nonspecific symptoms
- only 20-30% of acute illnesses have symptoms (fever, fatigue, dark urine, clay-colored stool, abd pain, loss of appetite, n/v, joint pain, jaundice)
***What is the screening test for HCV? What is the confirmatory test? What is the timeline that will produce a + result?
- screen: anti-HCV antibody –> detected within 4-10 weeks after exposure
- Confirmatory: HCV RNA PCR (viral count) –> in blood as early as 2-3 weeks after infection
***How many people with HCV will develop a chronic infection? How many will develop cirrhosis?
- 80% will develop a chronic infection
* 5-20% will develop cirrhosis over 20-30 years (why it’s hard to get insurance to pay for tx)
***What is the curative treatment for Hepatitis C (Genotype 1)? How much does this cost?
1 pill for 90 days (each pill=$1100) ==> about $100, 000
What are some characteristics of HBV?
- Member of Hepadnavirus family
- Partially double stranded circular DNA virus with reverse transcriptase replication
- Virion consist of outer lipid envelope and icosahedral nucleocapsid core composed of protein.
- Four known genes encoded by the genome:
- Gene C codes for core protein (HBcAg)
- Gene P codes for DNA polymerase
- Gene S codes for the surface antigen (HsAg)
***What percentage of adults with HBV will become chronically infected? What about infants?
- 95% of adults will recover completely and NOT become chronically infected.
- 90% of infants will become chronically infected
How is HBV transmitted?
- 50-100X more infectious than HIV*
- through percutaneous or mucosal contact with infectious blood or body fluids (SEX, IVDA, birth to an infected mother, contact with open sores, sharing razors or toothbrushes)
What are the signs and symptoms of decompensated cirrhosis?
- Jaundice
- Splenomegaly
- Ascites
- peripheral edema
- encephalopathy
***What does the presence of HBsAg indicate? What should be done next?
acute or chronic active infection
–> do a viral count
***What does anti-HBs or HBsAb indicate?
recovery and immunity for HBV infection (either through recovery from infection or vaccine)
What does anti-HBc IgG indicate? How long will this persist?
previous infection with HBV
appears at recovery from acute Hep B and persists for life
What does IgM anti-HBc indicate?
recent acute infection with HBV (< 6 months)
***What does HBV DNA PCR indicate?
the viral load–> the higher the number, the more infectious the pt is
What do the following labs indicate?
- HBsAg
+anti-HBc
+ anti-HBs
Immune due to natural infection
What do the following labs indicate?
- HBsAg
- anti-HBc
+ anti-HBs
immune due to vaccination
What do the following labs indicate? \+ HBsAg \+ anti-HBc \+ IgM anti-HBc - anti-HBs
acutely infected
