L3: Acute and Chronic Hepatitis

Question 1

What are some diseases that will only cause chronic hepatitis?

Answer 1

1. Autoimmune Hepatitis (AIH)

2. Wilson’s Disease

Question 2

What is the inflammatory cell type of hepatitis?

Answer 2

Lymphocyte

Question 3

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

Answer 3

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

Question 4

What are some causes of acute hepatitis?

Answer 4

1. Viruses

2. Drugs

Question 5

What are some viruses that may cause hepatitis?

Answer 5

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

Question 6

What are some causes of chronic hepatitis?

Answer 6

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

Question 7

What are some consequences of chronic hepatitis?

Answer 7

fibrosis - cirrhosis

risk of HCC

Question 8

What does the core of a hepatitis B virus contain?

Answer 8

• hepatitis B core antigen
• e antigen
• HBV DNA

Question 9

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

Answer 9

important for viral replication

Question 10

What is the function of interferon on the immune response?

Answer 10

augments immune response

Question 11

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

Answer 11

HBV DNA* or HBeAg

Question 12

What are the phases of a chronic HBV infection?

Answer 12

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

Question 13

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

Answer 13

• mutant strains develop

- immune suppression

Question 14

Which hepatitis virus is most common in IVDUs?

Answer 14

Hepatitis D

Question 15

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

Answer 15

Type 1a

Question 16

Which genotype of hepatitis C is most common in Europe?

Answer 16

Type Ib

Question 17

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

Answer 17

predicts the response in type 1 hepatitis C

Question 18

How long does acute hepatitis last for?

Answer 18

< 6 months

Question 19

How long does chronic hepatitis last for?

Answer 19

> 6 months

Question 20

List some of the symptoms and signs of ACUTE hepatitis

Answer 20

< 6 months

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

Question 21

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

Answer 21

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

Question 22

What is the characteristic histological finding of chronic hepatitis?

Answer 22

interface inflammation with piecemeal necrosis

aka interface necrosis

Question 23

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

Answer 23

1. Hep B + Hep D

2. Hep B ± Hep C ± HIV

Question 24

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

Answer 24

gives lifelong immunity to Hepatitis A

Question 25

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

Answer 25

indicates acute (recent) infection

Question 26

If HBsAg is present, what would this indicate?

Answer 26

HBV infected - current infection

Question 27

Can HBcAg be detected in blood?

Answer 27

No.

Question 28

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

Answer 28

- recovery from HBV infection | - or response to vaccination

Question 29

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

Answer 29

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

Question 30

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

Answer 30

recent/acute infection to HBV

Question 31

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

Answer 31

- active viral (HBV) replication | - marker of infectivity

Question 32

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

Answer 32

individual is now an inactive carrier of HBV

Question 33

An ACUTE HBV infection mainly occurs in which age group?

Answer 33

Adults

Question 34

A CHRONIC HBV infection mainly occurs in which age group?

Answer 34

Neonates/Children

Question 35

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

Answer 35

- no immune response - -- therefore, unresponsive to treatments (no immune response to augment) - reservoir of infection; highly infective HBsAg + HBeAg+ High Level Viral DNA

Question 36

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

Answer 36

- 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

Question 37

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

Answer 37

2nd Phase - Replicative, Immune Clearance

Question 38

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

Answer 38

- no/minimal viral replication - inactive carrier state - can be reactivated HBsAg+ HBeAg- anti-HBe+

Question 39

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

Answer 39

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

Question 40

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

Answer 40

4th Phase - Reactivation

Question 41

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.

Answer 41

1. Pegylated Interferon-Alpha | 2. Anti-Virals

Question 42

How does a Hepatitis C acute or chronic infection present?

Answer 42

- silent | - or with vague symptoms (fatigue, arthralgia...)

Question 43

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

Answer 43

current infection

Question 44

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

Answer 44

- indicates exposure to HCV - most with this have an ACTIVE CHRONIC infectin it is NOT protective

Question 45

What is the main treatment for a hepatitis C infection?

Answer 45

Direct-Acting Anti-Viral Agents (DAAs) | ± Interferon