Liver Path IV

Question 1

Hep D

Answer 1

needs Hep B

Question 2

yellow fever

Answer 2

like ebola

Question 3

chronic liver disease

Answer 3

Hep C

Question 4

Hep C route of transmission

Answer 4

one third have unknown risk factors

Question 5

path viral hepatitis

Answer 5

not caused by virus but immune response to infected hepatocyte

Question 6

extrinsic pathway

Answer 6

death receptor

Question 7

intrinsic pathway

Answer 7

mitochondria

Question 8

cytotoxic T cell apoptosis

Answer 8

type IV hypersensitivity

Question 9

mito pathway

Answer 9

intrinsic

• CTL recognize foreign viral expression of MHC-1
• perforin creates channels for granzymes
• caspase activation - hepatocyte apoptosis
• IFN-delta from CTL activates macros to phagocytose

caspase - cytochrome c

Question 10

acute hepatitis clinical

Answer 10

jaundice, flu-like, RUQ pain, acholic stool, choluria, pruritis, eruptive xanthomas, encephalopathy

Question 11

best panel to dx acute hepatitis

Answer 11

anti-HAV
HBs-Ag
IgM anti-HBc
anti-HCV

Question 12

hepatitis A

Answer 12

fecal oral
1 month incubation

shellfish, daycare, food

does not cause chronic or carrier state

childhood - asymptomatic - long term immunity
adult - acute hepatitis pattern

vaccine very effective

Question 13

HAV vaccine

Answer 13

active - all children >1yr, travelers, drug use, liver disease
Hep A Ig - lasts 3 months
prevaccination testing - age >40, geography, drug use

Question 14

hep A path

Answer 14

ingestion - replication in liver
-shed in bile - to intestines - to feces

brief viremia

Question 15

IgM HAV

Answer 15

diagnostic

Question 16

anti-HAV antibody

Answer 16

vaccination

Question 17

hep B

Answer 17

lots have chronic infection

mode of transmission and pattern of disease different between high, intermediate, and prevalence populations

Question 18

dane particle

Answer 18

hepatitis B

-dsDNA circular and incomplete

Question 19

low prevalence hep B

Answer 19

sexual contact, IV drug use
1-6 month incubation

70% asymptomatic
95% recover - 5% to chronic hepatitis

may lead to hepatocellular carcinoma

Question 20

hep B with recovery

Answer 20

HBsAg - appear then disappear

Question 21

window period

Answer 21

in Hep B
-IgM anti-HBc

from drop in HBsAg until IgG anti-HBs

Question 22

acute hep B symptoms

Answer 22

with onset of anti-HBc

first IgM then IgG - IgM goes away within 6 months - IgG for life

Question 23

chronic hepatitis B definition

Answer 23

HBsAg for more than 6 months

Question 24

HBeAg

Answer 24

denotes high infectivity with high HBV DNA with elevated ALT

denotes low infective with low HBV and low ALT

Question 25

risk of Hep B

Answer 25

active hepatitis cirrhosis hepatocellular carcinoma

Question 26

younger age at time of hep B infection

Answer 26

higher probability of chronicity

Question 27

incubation period

Answer 27

Hep B exposure until HBsAg appears

Question 28

anti-HBs

Answer 28

denotes recovery and lifelong immunity

Question 29

chronic Hep B infection

Answer 29

persistance of HBVsAg

Question 30

vertical transmission

Answer 30

of Hep B -HBV mother gives to baby develop immune tolerant chronic Hep B infection normal ALT, positive for ABeAg, HBV DNA >100,000 poor response to tx immune active phase - 20-40yo immune active phase - high HBV DNA inactive chronic carrier - low HBV DNA

Question 31

ground glass

Answer 31

seen Hepatitis B HBsAg in ER

Question 32

chronic active Hep B

Answer 32

apoptosis of hepatocytes

Question 33

number 1 cause of cirrhosis

Answer 33

Hep C

Question 34

hep C

Answer 34

ssRNA - unstable genome - difficulty vaccine production genotype 1 most common - more resistant - require triple therapy leading infectious cause of chronic liver disease IV drug use, idiopathic, sex 75% asymptomatic

Question 35

all baby boomers

Answer 35

should be tested for Hep C

Question 36

hep C genome

Answer 36

unstable - cannot make vaccine

Question 37

most common hep C

Answer 37

stable chronic hepatitis 20% to cirrhosis may lead to hepatocellular carcinoma

Question 38

metabolic syndrome

Answer 38

with HCV genotype 3

Question 39

marker for hep C

Answer 39

HCV-RNA - to confirm diagnosis goes away with recovery chronic - persists

Question 40

chronic hep C

Answer 40

see bridging fibrosis

Question 41

ss-RNA virus that is replication defective

Answer 41

Hep D dependent on HBV for multiplication - coinfection - superinfection - latent infection - liver tranpsplant

Question 42

superinfection of Hep D

Answer 42

chronic HBsAg carrier - severe acute hepatitis or exacerbation of chronic

Question 43

Hep E

Answer 43

hep A of india ss-RNA - with multiple animal reservoirs in underdeveloped world - major cause of epidemics acute with chronic carrier state

Question 44

dangerous in pregnant women

Answer 44

Hep E infection - fatality

Question 45

grading of chronic liver disease

Answer 45

look at inflammation - number of lymphos and location | and look at fibrosis - level of bridging

Question 46

acute asymptomatic hepatitis

Answer 46

Hep A, B, C, E

Question 47

acute symptomatic hepatitis

Answer 47

Hep A, B, C, D/B, E

Question 48

chronic hepatitis

Answer 48

Hep B,C includes carrier state

Question 49

fulminant hepatitis

Answer 49

Hep B or Hep D/B

Question 50

helminth infection of liver

Answer 50

liver fluke - clonorchis sinensis??