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GI > Hepatitis: Pathophysiology > Flashcards

Hepatitis: Pathophysiology Flashcards

1
Q

Hepatitis A & E transmission

A

-contaminated

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2
Q

Acute Hepatitis

A

A & E, B too

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3
Q

Chronic Hepatitis

A

C, D & B

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4
Q

Clinical Picture of Acute Hepatitis

A
  • Hep A, B, E
  • fever, fatigue, abdominal pain
  • Enlarged, tender liver
  • Labs: high AST/ALT(1,000-5,000), bilirubin, Prothrombin time
  • HVC rarely acute
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5
Q

Clinical Outcome of Acute Hepatitis

A

most common: spontaneous resolution (no treatment needed), 95% hep B resolves
-progression to chronic infection
Hep C (80%), 5% of HBV, not Hep A or Hep E
-Fulminant liver failure, rare but most life-threatening complication, <1% HBV less common in HAC

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6
Q

Acute Hepatitis Diagnosis

A

-IgM antibody
hep A: IgM anti HAV ab
hep E: IgM anti HEV ab
Acute HBV: IgM anti HBcore ab

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7
Q

What does IgG antibody indicate?

A

-previous infection (resolved or active chronic infection)

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8
Q

What does viral RNA or DNA indicate?

A

-active infection (does not differentiate chronic vs acute)

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9
Q

Fulminant Hepatic Failure

A

-most serious complication of acute viral hepatitis
Presentation: altered mental status in patient with acute hepatitis (hepatic encephalopathy due to cerebral edema)
-90% mortality (brain herniation, infection)
-urgen liver transplant is the only cure

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10
Q

Chronic Viral Hepatitis

A
  • persistent infection >6 months
  • asymptomatic (most cases found incidentally)
  • mild elevations in AST & ALT (<5x normal)
  • some patient can have normal LFT
  • almost all cases caused by Hep C & Hep B
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11
Q

Accelerated Fibrosis

A

-progression to cirrhosis in 15-20 yrs
-obesity (fatty liver)
-HIV
-Post Liver Transplant
-Alcohol consumption
(normal to fibrosis to cirrhosis to HCC liver cancer)

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12
Q

Alcohol drinking in patients with chronic HCV?

A

2 beers/day
2 wind/day
30 cc rum/twice week
60cc whisky/week

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13
Q

When do you treat chronic HBV?

A
  1. when evidence of liver injury (high ALT)

2. liver biopsy showing advanced fibrosis

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14
Q

Goals of HBV Treatment

A

-chronic cannot be cured in most patients
(only 5-10%)
-decreased replication: lower DNA
minimize liver injury & prevent progression
-decrease risk of hepatocellular carcinoma

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15
Q

Hep B: Immunocompromised Host Reactivation of Latent (occult) Infection

A
  • all should be tested for HBV
  • natural history is likely to be worse and chance of spontaneous clearance is low
  • presents as acute inc. in LFT due to reactivation of “inactive infection”
  • pharmacologic prophylaxis is indicated in all patients with HBV surface antigen positivity
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16
Q

Hep B in HIV

A
  • all HIV patients should be tested
  • likely worse and chance of spon. clearance is low
  • many anti HIV drugs have anti HBV activity also
  • Tenofovir
17
Q

Hep Delta

A

-not complete virus
-needs Hep B surface antigen to infect
-seen only in paitents who have HBV
-parenterally transmitted
Super Infection: infect patient with chronic HBV
CO-Infection: along with HBV

18
Q

Hepatitis Delta: Implication in HBV & Diagnosis

A

-inc. severity of HBC
-large # of patients develop cirrhosis
-Disgnosis: by delta ab or RNA
all patients have HepB Surface Antigen (HBsAG)

19
Q

Hep. C

A

most common chronic viral hepatitis in US

20
Q

Screening for HCV

A

-anyone born b/w 1945-1965 irrespective of risk factors

21
Q

Hep C Clinical Presentation

A
  • incidental
  • screening risk population
  • testing for abnormal ALT/AST
  • asymptomatic
  • extra hepatic manifestations
22
Q

Hep C Treatment

A

-curable with treatment
-goal to eradicate
Duration: typically 6 months to 1 year

23
Q

Hep B & C: Hepatocellular Carcinoma

A
  • most common cancer worldwide
  • inc. in US
  • HCV causes HCC only with cirrhosis
  • HBV can cause HCC even without cirrhosis
24
Q

Liver Transplantation in Viral Hepatitis

A
  1. Cirrhosis with liver failure
  2. Hepatocellular carcinoma
  3. Fulminant hepatic failure
25
Q

CMV Hepatitis in Immunocompromised Patients

A
  • fever, diarrhea (GI tract involve)
  • acute increase in ALT & AST
  • Diagnosis: CMV DNA, CMV antigen
  • gold standard is tissue biopsy: liver of GI tract
  • Treatment: Ganciclovir, prophylaxis is recommended with valcyclovir

GI (19 decks)

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