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Flashcards in Viral hepatitis Deck (27):
1

chronic persistent hepatitis

- lymphocytic infiltration maintained within the portal triad

2

chronic active hepatitis

- lymphocytic infiltration which spreads into the lobule

3

treatment of HAV

- HAV vaccine + globulin within 2 weeks of exposure

- prophylaxis: HAV vaccine + globulin

4

diagnosis of HAV

- HAV IgM

- HAV IgG: infection has cleared, confers immunity

5

HBV DNA

- denotes viremia
- >10,000 denotes active disease

6

treatment of chronic stable HBV

- entecavir is a new protease inhibitor with good results and little to no resistance

- pegylated interferon used for 4 months as a weekly injection has the highest percentage of seroconversion

7

SE of adefovir

- occasionally can cause nephrotoxicity

8

if pregnant woman is HBsAg positive

- child needs immune globulin and vaccine at birth
- C-section is not helpful

9

goals of treatment

- conversion of HBeAg to HBeAb positivity
- loss of HBV DNA in blood
- long term conversion of HBsAg to HBsAb
- slow progression to cirrhosis or HCC

10

surveillance program for HBV

- sonogram and a-fetoprotein q 6 months

11

NIH definition of chronic HBV

- HBsAg positive for more than 6 months
- HBV DNA >105
- persistent or intermittent ALT/AST elevation
- liver biopsy showing chronic hepatitis

12

NIH definition of inactive HBsAg carrier

- HBsAg positive for more than 6 months
- HBeAg negative, HBeAb positive
- persistently normal ALT/AST
- liver biopsy showing no inflammation

13

NIH definition of resolved

- previously known history of hep B
- HBcAb positive or HBsAb positive
- undetectable HBV DNA
- normal ALT

14

treatment of acute HDV

- supportive

15

treatment of fulminant HDV

- liver transplant

16

treatment of chronic HDV

- interferon

17

hepatitis E

- 20% fatality in pregnancy

18

associations with hep C

- porphyria cutanea tarda
- cirrhosis is necessary for HCC unlike with HBV

19

testing for HCV

- ELISA II - sensitive but not specific
- RIBA II - confirmatory tests

20

criteria for HCV treatment

- positive HCV RNA
- positive liver biopsy for chronic infection
- no significant psychiatric disease, blood dyscrasias, ongoing alcohol or drug abuse

21

treatment of HCV

- IFN, ribavirin, protease inhibitors

- pegylated IFN with ribavarin: 61% cure

22

interferon

- interaction with cell surface receptors
- WORSENS PSYCH - dont use with depression and other psych disorders
- increased cytotoxic activity of NK cells

23

ribavirin

- may cause hemolysis
- teratogenic: use 2 kinds of BC while on this

24

protease inhibitors

- telaprevir and boceprivir increase rate of clearance when used with PEG interferon and ribavirin

25

type 1 HCV

- treat for 12 months

26

CMV hepatitis

- owls eye inclusions
- TX: gancyclovir

27

herpes hepatitis

- giant cell granulomas
- cause fulminant hepatic failure
- usually occurs in 3rd trimester of pregnancy in those with genital herpes
- Tx: acyclovir