Liver Flashcards
(36 cards)
The next test after elevated ALP
abdominal Ultrasound
the best marker for previous exposure to HBV.
anti-HBc IgG
It correlates with the quantity of intact virus and, therefore, with infectivity and liver inflammation
HBeAg
the first marker detectable in the serum in hepatitis B
the antigen HBsAg
What is the”window”period for Hepatitis B infection?
HBsAg becomes undetectable, there is a period of Weeks to months before the anti-HBs antibody becomes delectable. This is called the “window,” and you must perform an unti-HBc IgM during this period to confirm acute hepatitis
Polyarteritis nodosa is associated with which hepatitis virus?
Hepatitis B is strongly associated with polyarteritis nodosa
Can pregnnt patients use HBV vaccine?
yes it is safe for pregnant patients
The likelihood of developing chronic HBV
is inversely related to age
a woman with breast cancer who also has an inactive carrier state with hepatitis B is to be started on chemotherapy. What other drug is given?
Lamivudine is given with her chemotherapy to blunt viral replication
a newborn of a mother with hepatitis B
Give a newborn of a mother with hepatitis B HBIG and hepatitis B vaccination. There is a 5-10% transplacental transmission of HBV.
If an asymptomatic patient has HBsAg in the serum, what does it mean?and what should we do?
either the patient is a carrier or the patient has early hepatitis B -so initial action is only to follow closely (once the patient is infected; neither vaccine nor HBIG helps).
Close contacts to a patient with acute HBV infection should be given
should be given hepatitis B immune globulin (HBIG) followed by a complete course of HBV vaccinations. Pregnant women are treated the same.
Treatment of hepatitis B:
Pegylated interferon alpha (IFN-a) weekly injections x 4 months.
Oral lamivudine x 12 months
How to use HAV vaccine?
It is for use in patients 2 years or older, and given as 2 doses, 6 months apart.
Indications for use of HAV vaccine:
- high-risk behavior
- children > 2 years old in communities with high rates
- chronic liver disease pa
- travel in high-risk countries
- HAV vaccine is also given to all patients with hepatitis C; if these patients get hepatitis A. it can be fulminant.
With which hepatitis infection mixed cryoglobulinemia strongly associated? How does it present?
Hepatitis C
Mixed cryoglobulinemia presents as a small vessel (leukocytoclastic) vasculitis with a rash consisting of “palpable purpura” or “crops of purple papules.”
Treatment of hepatitis C:
pegylated INF-a and
• oral ribavirin.
diagnosis of of hepatitis C:
- Within 2-4 months after an episode of hepatitis C, recheck for loss of HCV-RNA
- In a person positive for anti-HCV, check for active virus with HCV-RNA
How Meaure response to treatment in Hepatitis C?
Measure response to treatment by following HCV-RNA: if no response at 12 weeks, discontinue therapy. For those who respond, if the HCV is genotype 1, treat for 1year; if it is genotype 2 or 3, treat for 6 months.
With acute hepatitis in a traveler and negative standard serology (Hep A. B), think of
Hepatitis E
Hepatitis E is associated with which risk factor?
Unlike hepatitis A. hepatitis E carries a very high risk for fulminant hepatitis in the 3rd trimester of pregnancy
Autoantibodies in Autoimmune Chronic Hepatitis
affected patients often have a positive ANA, anti-dsDNA. smooth muscle antibody (SMA), ANCA, and anti-actin.The SMA test is
the most specific of the autoantibody tests for type 1
Diagnosis of Autoimmune Chronic Hepatitis
Other forms of hepatitis must be excluded. and the following autoantibody tests are done: ANA, SMA, ANCA. You can also do antimitochondrial antibody
Treatment of Autoimmune Chronic Hepatitis
prednisone +/- azathioprine
