Verma: Viral Hepatitis

Question 1

Serious concern of hepatitis resulting from infections with (blank) infecting the liver.

Answer 1

viruses

Question 2

Most common liver infection in the US

Answer 2

viral hepatitis

**can be A, B, C, D, or E

Question 3

These strains of viral hepatitis cause fecal-borne hepatitis

Answer 3

Hepatitis A & E

Question 4

These strains of viral hepatitis cause blood-borne hepatitis

Answer 4

Hepatitis B, C, & D

Question 5

What differentiates acute vs chronic hepatitis?

Answer 5

acute: less than 6 months - causes short-term infection
chronic: lasts for more than 6 months

Question 6

Which forms of hepatitis virus cause chronic or life-long infections?

Answer 6

Hep B, C & D

Question 7

What test would you order if you suspect infection with Hep A or E, the fecal borne viral strains?

Answer 7

IgM for HAV and HEV

Question 8

How is hepatitis A transmitted?

Answer 8

feco-oral route - hygiene is poor, common in childhood
close personal contact - household, child day-care centers
contaminated food/water - infected food handlers, international travelers, immigrants
blood exposure (rare)

Question 9

What types of laboratory tests can help diagnose HAV infection

Answer 9

HAV in stool
elevated ALT
IgM to HAV

Question 10

Hep A infection accounts for 44% of all cases of (blank)

Answer 10

acute viral hepatitis

Question 11

Who is at risk of developing hep A infection?

Answer 11

Persons living in crowded areas
Children/people who work in day-care
Homosexual men
Residents and travelers in underdeveloped countries

Question 12

What should be given to individuals exposed to Hep A?

What should be given to individuals at risk?

Answer 12

HAV immune globin is recommended for post-exposure
HAV vaccine (inactivated) for individuals at risk

Question 13

Are there specific treatments/vaccines for Hep E? What should be done to avoid its transmission?

Answer 13

No specific treatment or Vaccine for HEV.

Improved sanitary conditions lowers transmission.

Question 14

What lab values can you look at to diagnose Hep E infection?

Answer 14

virus in stool
elevated ALT
Increased IgM anti-HEV
IgG anti-HEV will be elevated shortly after

Question 15

Who is at risk for getting a Hep E infection?

Answer 15

people who have traveled to developing countries,

persons living in developing nations, refugee camps, overcrowded housing

Question 16

A 56-year-old Southeast Asian immigrant is diagnosed with chronic hepatitis B virus infection. Considering the epidemiology of this infection in endemic countries, what is the most likely way that this man became infected?

Answer 16

perinatally

Question 17

A 23-year-old woman presented with an insidious onset of fever, fatigue, joint pain, nausea, anorexia, and abdominal pain. Physical exam revealed hepatomegaly. Serologic tests indicated acute infection with hepatitis B virus. Considering the epidemiology of this disease in the United States, what would the history of the above patient most likely include?

Answer 17

unprotected sex with multiple partners

Question 18

What are the parameters used in characterizing HBV infection?

Answer 18

HBV antigens & host antibodies

HBV DNA

Question 19

What are the antigens on Hep B virus?

Answer 19

surface antigen - HBsAg
core antigen - HBcAg
Hbe Ag

Question 20

What does it mean if a patient is HBs Ag positive?

Answer 20

the patient has overt HBV infection, but not necessarily liver disease

Question 21

What will the following values be like (+ or -) if an individual has an acute Hep B infection?

HBs Ag
anti IgM HBc
Anti HBc
Anti HBs

Answer 21

+
+
+
-

Question 22

What will the following values be like (+ or -) if an individual has a chronic Hep B infection?

HBs Ag
anti IgM HBc
Anti HBc
Anti HBs

Answer 22

+
-

Question 23

What will the following values be like (+ or -) if an individual is immune to Hep B infection due to vaccination?

HBs Ag
anti IgM HBc
Anti HBc
Anti HBs

Answer 23

-
+

Question 24

What will the following values be like (+ or -) if an individual is immune to Hep B infection due to natural infection?

HBs Ag
anti IgM HBc
Anti HBc
Anti HBs

Answer 24

+
+

Question 25

When is Hep A vaccine recommended?

Answer 25

for sexually active men who have sex with men!

Question 26

Are men who have sex with men at a greater risk for Hep C infection?

Answer 26

NO!

Question 27

T/F: An HBsAg positive test result is a reportable condition in most states.

Answer 27

True!

Question 28

RNA virus 9.4 kb 55 nm diameter One serotype

Answer 28

Hep C virus

Question 29

What can happen after initial exposure with the Hep C virus?

Answer 29

the infection can resolve or become chronic if chronic, 20% of these cases progress to liver cirrhosis can then progress to end-stage liver disease or hepatic cell carcinoma leading to need for transplant or death **20yr progression rate is accelerated with HIV, Hep B infection, & alcohol

Question 30

What do the following values mean in regards to Hep C infection? Anti HCV + HVC RNA +

Answer 30

acute or chronic HCV

Question 31

What do the following values mean in regards to Hep C infection? Anti HCV + HVC RNA -

Answer 31

resolved HCV infection

Question 32

What do the following values mean in regards to Hep C infection? Anti HCV - HVC RNA +

Answer 32

early acute HCV or chronic HCV & immunosuppressed host

Question 33

How do ALT levels differ in patients with acute vs chronic hepatitis C?

Answer 33

acute: ALT levels are usu at least 7x the upper limit of normal chronic: ALT levels are elevated, but usu lower than pts with recently acquired infection

Question 34

Defined as the period of time during which HCV is present in the blood but antiviral antibodies are not detectable

Answer 34

window period