uw revision Autoimmune hepatitis, viral (A, B)

Question 1

Autoimmune hepatitis. CP?

Answer 1

Asymptomatic
Symptomatic (anorexia, nausea, abdominal pain, jaundice)

Question 2

Autoimmune hepatitis. Lab. liver?

Answer 2

Hepatocellular pattern (incr. AST and ALT, +/- mildly elevated ALP and total bilirubin)

Question 3

Autoimmune hepatitis. Labs immunoglobulins?
formula?

Answer 3

Hypergammaglobulinemia with elevated gamma gap

gap: total protein - albumin –> >4g/dl.

Question 4

Autoimmune hepatitis. Antibodies?

Answer 4

Elevated anti-smooth muscle autoantibodies - more specific

also in case was antinuclear antibody - most common antibody

Question 5

Autoimmune hepatitis. histology?

Answer 5

Portal and periportal lymphoplasmacytic infiltration

Question 6

Autoimmune hepatitis. Age?

Answer 6

Chronic liver disease that occur in middle-aged women with comorbid autoimmune disease (eg autoimmune thyroiditis)

Question 7

Autoimmune hepatitis. Tx?

Answer 7

Immunosupression with GK (PREDNISONE) +/- azathioprine

Question 8

KEPENU TX in autoimmune?

Answer 8

in acute liver failure or decompensated cirrhosis.

Can be considered in autoimmune, but first step - immunosupression.

Question 9

Hepatitis A table. Transmission/risk? 3

Answer 9

Fecal-oral transmission
Poor sanitation/hygiene, travel to endemic areas
Contaminated food and water

Question 10

Hepatitis A table. CP?

Answer 10

Fever, nausea, RUQ pain, jaundice, hepatomegaly

Question 11

Hepatitis A table. Diagnostic testing?

Answer 11

Elevated tranaminases (>1000)
Anti-hepatitis A serology

Question 12

Hepatitis A table. Mx?

Answer 12

Supportive/expectant
Spontaneous recovery in most patients

Question 13

Hepatitis A. Spread food?

Answer 13

Unsanitary foods, eg shellfish and water supplies.

Question 14

Hepatitis A. venues?

Answer 14

Poor sanitation - homeless shelters and day care centers (children often do not have jaundice and may go undiagnosed)

Question 15

Hepatitis A. Who is at risk?

Answer 15

unvaccinated persons, international travels, MENS HAVING SEX WITH MEN

Question 16

Hepatitis A. Dx serology?

Answer 16

Anti-HAV IgM serology

Question 17

Hepatitis A. how long takes to resolve?

Answer 17

2-3 months.

Question 18

HBV table. HBsAg? 3

Answer 18

Acute HBV (early)
Chronic active HBV
Inactive HBV carrier state

Question 19

HBV table. HBeAg - proteins that circulates in blood when virus replicates

Answer 19

Early phase

Might be +/- in chronic active HBV infection

Question 20

negative HBeAg - shows low infectivity and viral load.

HBeAg and anti-HBeAg are positive only in a subset of patients and correlate with active viral replication [early infection, chronic infection with viral replication)

anti-HBeAg - typically evident in recovery phase of acute infection.

Answer 20

.

Question 21

HBV table. IgM anti-HBc. 2

Answer 21

Acute HBV early phase and WINDOW PERIOD

Question 22

HBV table. IgG anti-HBc. 3

Answer 22

Acute HBV recovery
chronic active HBV infection
immune due to natural HBV infection

Question 23

HBV table. Anti-HBs 3

Answer 23

Acute HBV recovery
Vaccinated for HBV
Immune due to natural HBV infection

Question 24

HBV table. Anti-HBe 3

Answer 24

Acute HBV recovery
+/- chronic active HBV infection
Inactive HBV carrier state

Question 25

HBV table. HBV DNA?5

Answer 25

Acute HBV: Early phase: +++ Window: + Recovery: likely + Chronic active HBV infection: ++ Inactive HBV carrier state: normal/mildly +

Question 26

HBV table. Acute HBV - early phase. 4

Answer 26

HBsAg, HBeAg, IgM anti-HBc HBV DNA +++

Question 27

HBV table. Acute HBV - window phase. 2

Answer 27

IgM anti-HBc HBV DNA +

Question 28

HBV table. Acute HBV - recovery phase. 4

Answer 28

IgG anti-HBc, Anti-HBs, Anti-HBe HBV DNA likely +

Question 29

HBV table. Chronic active HBV infection. 5

Answer 29

HBsAg +/- HBeAg IgG anti-HBc +/- Anti-HBe HBV DNA ++

Question 30

HBV table. Inactive HBV carrier state?3

Answer 30

HBsAg Anti-HBe HBV DNA normal/mildly +

Question 31

HBV table. vaccinated? 1

Answer 31

Anti-HBs

Question 32

HBV table. Immune due to natural HBV infection. 2

Answer 32

IgG anti-HBc Anti-HBs

Question 33

Anti-HBc - only in response to viral infection, not present in vaccination.

Answer 33

.

Question 34

only diagnostic for early infection during window?

Answer 34

IgM anti-HBc

Question 35

what correlate with active replication? 2

Answer 35

HBeAg and anti-HBeAg

Question 36

negative HBsAg?

Answer 36

cleared infection

Question 37

from answer: chronic infection (active or inactive), positive and negative?

Answer 37

positive HBsAg and negative anti-HBs

Question 38

HBeAg - SHOWS INFECTIVITY, but poor test for acute HBV infection.

Answer 38

.

Question 39

despite HBV DNA can be present prior others, but this test is generally not performed to diagnose acute infection.

Answer 39

.

Question 40

yra dvi schemos - acute and chronic - ju nepatariau niekur