Flashcards in L75 (Hep B & D) Deck (27)
What does elevated AST/ALT indicate vs elevated bilirubin?
AST/ALT: liver injury
Bilirubin: liver dysfxn
DNA or DNA?
DNA - partially ds
Important Hep B antigen proteins
Role of e antigen
May buffer virus from immune response
USED as marker of viral replication
How is Hep B transmitted?
Blood = high [ ]
- Also wound exudates
Sexual = moderate [ ]
Once Hep B gets to the liver via blood, how does it enter hepatocytes?
You don't know this
Where does Hep B replicate in hepatocytes?
partially dsDNA -> RNA -> totally dsDNA = cccDNA
Because Hep B is so small, how does it manipulate its genome to create the various proteins it needs?
Overlapping reading frames
What enzyme does Hep B carry?
Duh! B/c it's a DNA virus!!
What is a common theme throughout hepatitis?
Immune response to the virus = 1ary liver damage
- T cells
What Ab shows acute Hep B infection? Chronic?
Acute = IgM
Chronic = IgG
DUH! Immunology 101!!!
What will you see on serology for acute Hep B?
Viral load - antigens & DNA only
Not enough time to create Ab response
Serology for resolved Hep B + other signs?
Surface antigen Ab
cccDNA !!! not in serum but permanently in cells!
Serology for chronic Hep B
Surface antigen present for 6mo
+/- e antigen
IgG core Abs
NO surface Ab!!! Weird
Progression of undiagnosed/treated Hep B
Fibrosis -> cirrhosis -> liver failure
Will most Hep B infected kids progress to chronic infection or not?
Will most normal pts infected with Hep B progress to chronic infection or not?
Less than 5%
Resolved: no additional surveillance
What is the difference between chronic hepatitis with or without e antigen?
+ e antigen = MUCH higher viral load
Who/why do you treat chronic Hep B?
- High viral load
- Active liver disease
Why: prevent progression
Treat Hep B
- Entecavir OR tenofovir
2 ways to prevent Hep B
1. Passive immunity = Hep B IG
- Babies of infected moms
- Within 24hrs, ineffective 7 days later
Hep D requires...
Hep B for infection!!1
Hep D transmission
2 types of Hep D infection
1. Coninfection w/ B
Hep D structure
ssRNA --> codes for delta antigen
Hep B membrane!!!
Diagnose presence of Hep D
Ab in serum
RNA by PCR