Hepatitis Pathophys

Question 1

What is the sequence of events in viral hepatitis?

Answer 1

1) Acute Hepatitis
2) Acute Liver Failure
3) Chronic Hepatitis

Question 2

Once you get chronic hepatitis what happens

Answer 2

you get cirrhosis, liver failure, and/or hepatocellular carcinoma

Question 3

Hepatitis A and E mostly cause what

Answer 3

Acute hepatitis

Question 4

HBV mostly causes what

Answer 4

Acute hepatitis like A and E. The difference is that there is a greater chance that B can lead to fulminant liver failure.

A small percentage of HBV causes chronic hepatitis. This is mostly in the presence of Hep D

Question 5

HCV causes what

Answer 5

chronic hep

Question 6

hepatits pts will, of course, have an acute rise in liver enzymes (AST and ALT)

Answer 6

ok

Question 7

Constitutional symptoms of acute hepatitis?

Answer 7

fever, fatigue, abdominal pain

Question 8

High AST/ALT is what levels?

Answer 8

1,000 - 5,000….usually doesnt exceed 5,000

Question 9

Most serious complication of acute viral hepatitis

Answer 9

Fulminant liver failure

Question 10

Presentation of fulminant liver failure

Answer 10

altered mental status in pt with acute hepatitis.
The altered mental status is due to the hepatic encephalopathy

Fulminant liver failure mortality rate is close to 90%

Question 11

Key test for Hepatitis A diagnosis?

Answer 11

IgM anti-HAV antibody

Question 12

Key test for HEV

Answer 12

IgM anti-HEV antibody

Question 13

Chronic HBV represents a vital public health problem for which part of the american population

Answer 13

Asian Americans…HBV is endemic to many parts of Asia

Question 14

Positive HBsAg means what?

Answer 14

Active infection

Question 15

Positive HBsAg antibody means what?

Answer 15

resolved infection or prior vaccination

Question 16

Positive HBc antibody means what?

Answer 16

Definitely have been infected in the past…this does not show up with a vaccination

Question 17

Positive HBe antigen means what?

Answer 17

Active replication and highly infectious

Question 18

In patients with chronic HBV, what serological (plasma or serum) markers are detectable for life?

Answer 18

HBsAG and IgG for HBc

Question 19

When is it appropriate to start treating chronic HBV?

Answer 19

When there is evidence of liver injury….meaning high ALT

Question 20

What are the treatment goals of chronic HBV tx?

Answer 20

Decrease replication and minimize liver injury.
Reduce the risk of Hepatocellular carcinoma

Unfortunately, chronic HBV can only be cured in approximately 5-10% of pts.

Question 21

All HIV fts should be tested for HBV. There chance of natural clearance is lower

Answer 21

ok….the good news is that some anti-HIV drugs, like Tenofovir, are also anti-HBV.

Question 22

HBD is transmitted parenterally or enterically>

Answer 22

Parenterally…Needs the HBsAG to infect

Question 23

Super-infection

Answer 23

When a person with CHRONIC HBV becomes infected with HDV

Question 24

Co-infection

Answer 24

Just acute HBV and HDV infection occuring simultaneously

Question 25

New CDC recommendation for HCV screening?

Answer 25

Anyone born between 1945 and 1965

Question 26

Regarding HCV serotypes, the most prevalent in the US is

Answer 26

HCV 1

Question 27

HCV 2 where

Answer 27

Developed countries (US included)

Question 28

HCV 3

Answer 28

IV drug users

Question 29

HCV 4

Answer 29

Middle East and North Africa

Question 30

HCV 5

Answer 30

South Africa

Question 31

HCV 6

Answer 31

Asia

Question 32

Goal of HCV tx

Answer 32

Eradicate teh HCV...it is curable with treatment

Question 33

Hepatocellular carcinoma is actually the most common cancer worldwide.

Answer 33

ok

Question 34

What are the major risk factors for Hepatocellular carcinoma?

Answer 34

Chronic Hepatitis (either B or C)

Question 35

Hepatitis C viruse causes cancer only in the setting of

Answer 35

Cirrhosis

Question 36

Which of the hep viruses can cause HCC without even entering into a stage of cirrhossis?

Answer 36

HBV

Question 37

Proteinuria of unknown cause calls for

Answer 37

Screen for HCV

Question 38

CMV hepatitis in mmunocompromised pts. Become suspicious when you see what symptoms

Answer 38

Fever, diarrhea, increase in liver enzymes

Question 39

Gold standard test for CMV?

Answer 39

Tissue Biopsy

Question 40

Gold standard treatment for CMV hep

Answer 40

Ganciclovir

Question 41

Hepatitis E causes what type of infection and is more severe in who?

Answer 41

AcutE, More severe in pregnant women and the elderly...KNOW

Question 42

Hep A and B vaccines should be given to who

Answer 42

anyone with any type of liver disease

Question 43

Which genotype of HCV has the lowest cure rate?

Answer 43

1

Question 44

All HBV pts should be screeened for HCC, whereas HCV pts should only be screened if...

Answer 44

They have Cirrhosis