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GIHEP > L3: Acute and Chronic Hepatitis > Flashcards

L3: Acute and Chronic Hepatitis Flashcards

1
Q

What are some diseases that will only cause chronic hepatitis?

A
  1. Autoimmune Hepatitis (AIH)

2. Wilson’s Disease

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2
Q

What is the inflammatory cell type of hepatitis?

A

Lymphocyte

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3
Q

What causes chronic liver damage but is not considered “chronic hepatitis”

A

alcohol-related liver disease
non-alcoholic fatty liver disease
chronic inflammatory biliary tract diseases (PBC, PSC)
hereditary haemocrhomatosis (HFE)

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4
Q

What are some causes of acute hepatitis?

A
  1. Viruses

2. Drugs

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5
Q

What are some viruses that may cause hepatitis?

A

HAV, HBV, HCV, HEV, EBV, CMV, Rubella, Yellow Fever Virus

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6
Q

What are some causes of chronic hepatitis?

A
  1. Viruses
  2. Drugs
  3. Auto-immune
  4. Wilson’s Disease
  5. Alpha-1-Antitrypsin Deficiency
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7
Q

What are some consequences of chronic hepatitis?

A

fibrosis - cirrhosis

risk of HCC

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8
Q

What does the core of a hepatitis B virus contain?

A
  • hepatitis B core antigen
  • e antigen
  • HBV DNA
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9
Q

What is the main role/function of the e antigen in the HBV?

A

important for viral replication

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10
Q

What is the function of interferon on the immune response?

A

augments immune response

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11
Q

What is a good marker(s) for active replication and infectivity of hepatitis B?

A

HBV DNA* or HBeAg

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12
Q

What are the phases of a chronic HBV infection?

A
  1. Immune Tolerance
  2. Immune Clearance
  3. Inactive HBV Carrier
  4. Immune Escape = Reactivation of Chronic HBV Hepatitic
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13
Q

What may be some causes of reactivation of a hepatitis B infection?

A
  • mutant strains develop

- immune suppression

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14
Q

Which hepatitis virus is most common in IVDUs?

A

Hepatitis D

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15
Q

Which genotype of hepatitis C is most common in the US?

A

Type 1a

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16
Q

Which genotype of hepatitis C is most common in Europe?

A

Type Ib

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17
Q

What does a polymorphism in the IFNL3/IL28B gene indicate?

A

predicts the response in type 1 hepatitis C

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18
Q

How long does acute hepatitis last for?

A

< 6 months

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19
Q

How long does chronic hepatitis last for?

A

> 6 months

20
Q

List some of the symptoms and signs of ACUTE hepatitis

A

< 6 months

  • often silent (more common in children)
  • vague symptoms (nausea, anorexia, malaise)
  • enlarged tender liver
  • ± jaundice
21
Q

What would be the blood test findings for someone with ACUTE hepatitis?

A
  • high AST/ALT
  • elevated bilirubin
  • lengthened PT (a/w coagulation factors)
  • NORMAL albumin
22
Q

What is the characteristic histological finding of chronic hepatitis?

A

interface inflammation with piecemeal necrosis

aka interface necrosis

23
Q

Viral hepatitis may also cause superinfections. List some possible combinations/pairings for a viral hepatitis superinfection

A
  1. Hep B + Hep D

2. Hep B ± Hep C ± HIV

24
Q

What is the significance of the IgG Anti-HAV (antibody)?

A

gives lifelong immunity to Hepatitis A

25
Q

What is the significance of the IgM Anti-HAV (antibody)?

A

indicates acute (recent) infection

26
Q

If HBsAg is present, what would this indicate?

A

HBV infected - current infection

27
Q

Can HBcAg be detected in blood?

A

No.

28
Q

If anti-HBs (antibody) is present, what would this indicate?

A
  • recovery from HBV infection

- or response to vaccination

29
Q

If anti-HBc (antibody) is present, what would this indicate?

A

the person has been exposed to HBV at some point in their life

30
Q

If IgM anti-HBc is present, what would this indicate?

A

recent/acute infection to HBV

31
Q

If there is HBeAg present in the blood, what would this indicate?

A
  • active viral (HBV) replication

- marker of infectivity

32
Q

If there is anti-HBe (antibody) present in the blood, what would this indicate?

A

individual is now an inactive carrier of HBV

33
Q

An ACUTE HBV infection mainly occurs in which age group?

A

Adults

34
Q

A CHRONIC HBV infection mainly occurs in which age group?

A

Neonates/Children

35
Q

What occurs in the 1st phase of an HBV chronic infection, the Immune Tolerance phase? What would the blood serology show?

A
  • no immune response
  • – therefore, unresponsive to treatments (no immune response to augment)
  • reservoir of infection; highly infective

HBsAg +
HBeAg+
High Level Viral DNA

36
Q

What occurs in the 2nd phase of an HBV chronic infection, the Immune Clearance phase? What would the blood serology show?

A
  • occurs in HBV adult infection or if immune tolerance wanes
  • viral replication occurs, but also have immune response and damage

HBsAg+
HBeAg+
elevated ALT
high viral DNA

also considered HBeAg+ Chronic HBV Hepatitis

37
Q

Which phase of a chronic HBV infection may be considered “HBeAg+ Chronic HBV Hepatitis”?

A

2nd Phase - Replicative, Immune Clearance

38
Q

What occurs in the 3rd phase of an HBV chronic infection, the Inactive HBV Carrier phase? What would the blood serology show?

A
  • no/minimal viral replication
  • inactive carrier state
  • can be reactivated

HBsAg+
HBeAg-
anti-HBe+

39
Q

What occurs in the 4th phase of an HBV chronic infection, the Reactivation phase? What would the blood serology show?

A

reactivation either due to:

a) Mutant Strains Develop
b) Immune Suppression

  • viral replication resumes

HBsAg+
HBeAg- (most often)
variable viral DNA and ALT

also considered: HBeAg- Chronic HBV Hepatitis

40
Q

Which phase of a chronic HBV infection may be considered “HBeAg- Chronic HBV Hepatitis”?

A

4th Phase - Reactivation

41
Q

Those with cirrhosis, who are pregnant or have a chronic HBV infection may be given treatment for their HBV infection.

List 2 drugs that may be given to treat this condition.

A
  1. Pegylated Interferon-Alpha

2. Anti-Virals

42
Q

How does a Hepatitis C acute or chronic infection present?

A
  • silent

- or with vague symptoms (fatigue, arthralgia…)

43
Q

If there is HCV RNA present, what would this represent?

A

current infection

44
Q

If there is anti-HCV (antibody) present, what would this indicate?

A
  • indicates exposure to HCV
  • most with this have an ACTIVE CHRONIC infectin

it is NOT protective

45
Q

What is the main treatment for a hepatitis C infection?

A

Direct-Acting Anti-Viral Agents (DAAs)

± Interferon

GIHEP (24 decks)

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