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Session 3 CM- GI-5

CM- GI-5- Viral Hepatitis

What are the five recognized hepatitis viruses A, B, C D, E&G
Does acute hepatitis only occur because of hepatitis virus infections no, CMV, EBV, HSV, Yellow Fever virus, Rubella all can cause acute hepatitis
What s/sx can help you differentiate cause of acute viral hepatitis between hepatitis viruses and other viral causes actually they present clinically in similar ways and the only way to differentiate them is Lab results
What clinicla features will patient with hepatitis present with anorexia, nausea, vomiting, right upper quadrant pain, elevated liver enzymes AST and ALT, headache, malaise, fever, Jaundice, dark urine, pale stool
What two hepatitis viruses are from fecal source A and E
what is the source of the majority of hep viruses Blood or body fluids
What hep viruses cause chronic infection those that are of blood or body fluid source B, C, and D
What are the best ways to avoid hep infection immunization and avoiding high risk behaviours
What will you likely see on lab eval of pt w/ viral hep WBC normal to low, Lymphocytes (large atypical), Mild protienuria, bilirubinuria (precedes jaundice), elecated AST/ALT early, then ALT/AST, acholic stool
What is the hallmark s/sx of viral hep Jaundice, usually develops late in infection
Hep called infectious hepatitis, incubation period 2-5 weeks, milder disease than hep B, asymptomatic infections are common especially in kids Hep A
What groupd is more likely to develop severe infectious hepatits from Hep A Adults especially pregnant women,
Is there a chronic form of Hep A no
What is the pathogenesis of HEP A viruses eneter via gut (fecal oral transmission), replicates in alimentary tract then spreads to infect liver hepatocytes, viremia is transient, virus is excreted in stools for 2 weeks preceding onset of s/sx
How do you dx Hep A culture of virus from in vitro material or HAV IgM in patients blood
How can you prevent Hep A infections passive immunization or active immunization(not in general use)
This hepatits has incubation period of 30-40 days acute self limiting hepatits no chronic carrier state and predominantly found in young adults 15-40yrs of age. (not hep A) Hep E
What is a major complication associated w/ Hep E Fulminant Hep in preganat women w/ high mortality rate up to 40%
What is the pathogenesis of Hep E replicates in gut then invades liver shed in stool prior to s/sx viremia is transient requires large inoculum to establish infection (very similar to Hep A)
How can you dx Hep E Specific IgM in serum though no routine lab tests are available
This Hepatitis has a incubation period of 1-6 months, insidious onset of s/sx, tend to cause more severe disease than Hep A asymptomatic infections occur frequently Hep B
How is Hep B transmitted sexually, parenterally, mucus membrane exposure,
What hep is associated with polyarteriitis nodosa (PAN) Hep B and C
Patient has an Ab against the surface (coat) protein of Hep B what antigen does it target HBsAG- produced as small spheres and tubules
What are HBcAg and HBeAg antigens of Hep B inner core protein (HBcAg) and secreted protein (HBeAg)
What is the first marker present in a pt w/ viral Hep B HBsAg
Will you find Hep B antigen HBcAg in the pts serum no it does not circulate
What is the HBV window period period during which HBsAg is not detectable and Anti HBs is not present but Anti HBc appears. Can last several weeks during this time a pt is likely to test negative but still be able to infect others
What is the pathogenesis of HBV infection from blood or body fluid exposure, virus replicates in liver, virus is shed into blood viremia is prolonged, blood is highly infectious of conatminated individual
What is the likely course of a HBV infection 90% self limited, 1-2% fulminant and 5-7% chronic carriers
What group is most likely to become a chronic carrier of HBV infants that get infected, immunocompromised pt, male>female
Can HBV be transmitted across the placenta yes 5-10% transmission rate
pt has failed to eliminate HBV and have a chronic infection what two ways could this chronic infection go Chronic Persistent- minimal liver damage or Chronic Active- aggressive destruction of liver tissue and rapid progression to cirrhosis or liver failure
What are chronic HBV patients at increased risk of developing Hepatocellular Carcinoma (HCC), 80% of pt w/ HCC are HBV carriers, have virus DNA in HCC cells
the following are high risk activities for what disease blood transfussions, serum product transfussion, sharing needles, razors, tattooing, acupuncture, renal dialysis, organ donation HBV, Hep C, HIV
What 2 hep antigens when found in the blood or serum indicate viral replication is taking place in the liver HBsAg and HGeAg
What ab indicates immunity following a hep infection it is detectable for life and is not found in chronic carriers Anti-HBs
When does the anti-HBe antibody become detectable when viral replication falls
What indicates pt has been exposed to HBV core IgM and core IgG antibodies against core protein
How can you prevent HBV infection active immunization with 3 doses of either serum derived or recombinant HBsAg vaccines both are eqully safe and effective
What liver condition can chronic viral hepatits B lead to macronodular cirrhosis
Your pt was working at a laundry and has never been vaccinated for HBV they got stuck by a needle left in someones clothes what should you order for them as a precaution (assume HIV isn't a problem) Hep B immune Globulin + vaccine if HBsAg negative. Newborns of Hep B mothers should get HBIG as well
Your patient is a chronic carrier of Hep B and just gave birth to a baby what should be done for the baby Give baby Hep B immune Globulin
This viral hep has an incubation period of 4-8 weeks cases are milder but more people infected develop chronic infection (50%) Hep C
What are major complications of Hep C Chronic liver disease and hepatocellular carcinoma
How is Hep C transmitted exposure to blood or body fluids of infected individual especially blood transfusion/products, organ donation, IV drug use, sex
How can you dx Hep C serology- HCV specific IgG indicates exposure not infectivity, PCR detects viral genome in pt serum, HCV RNA
What is chronic viral hepatitis >6months infection with either B,C, or D
What tx can you give for chronic HBV carrier interferon alpha 30% long term remission, or Lamivudine reduces HBV-DNA reduces ALT levels and 15-20% seroconvert
What tx can you give for chronic HCV Interferon alfa, 15% remit, Interferon/Ribavirin
If pt has inflammation extending beyond the portal areas into surrounding hepatic structures w/ extensive necrosis and fibrosis what are they suffering from chronic active hepatitis CAH
If pt has chronic inflammatory infiltration of portal areas with little or no fibrosis what are they suffering from chronic persistent hepatitis CPH
This hep virus requires comorbid infection with HBV Hep D uses the Hep B capsule so Hep D has HBsAg
What are the consequences of Hep D infection in pt increased severity of liver disease in hep B carriers.
pt is infected w/ a flavivirus, they present w/ glomerulonephritis, cryoglobulins, porphyria cutanea tarda (PCT), thrombocytopenia, neuropathy, thyroiditis sjorgren's syndrome or inflammatory arthritis name cause Hep G
What are the non viral causes of acute hepatitis Drugs, Alcohol, toxins, metabolic and autoimmune
What is the leading cuase of Acute Liver Failure in the US drug related hepatotoxicity
Pt has liver disease and is taking cascara, chaparral, comfrey, kava and ma-huang (they really like herbal meds) why could this be a problem compound liver disease
What drug is most common implication in alcoholic liver acetaminophen it has a syngergistic effect w/ alcohol
What are s/sx of alcoholic liver w/ acetaminophen nausea, vomiting, diarrhea abdominal pain and shock alt/ast
exposure to this drug can cause a Type I mild hepatitis which is typically benign or self limiting 20-30%, or can causea type II rxn w/ fever, jaundice and increased transaminases mortality of 50% Halothane and the fluranes
What effect can INH (isoniazid) have on the liver This drug causes a mild hepatitis toxicity in 20% of patients more men then female more in adults and cannot be distinguished clinically from viral heptatitis
This drug accumulate in hepatocytes and rarely causes clinical iver disease liver injury once done may continue for months you will see a transaminase elevation Amiodarone
Why do you see liver damage in HIV patients Anti-retroviral therapy has liver toxicity especially in HAART- highly active retroviral therapy
what is steatosis fatty liver
what is cirrhosis scarring and fibrosis of liver tissue
pt test positive for smooth mucle antibody they also have clinical signs of hepatitis what is the likely cause of their hepatitis autoimmune hepatitis AIH
What is Gilbert's sndrome glucoronyl transferase deficiency which is a benign chronic disorder w/ asymptomatic hereditary jaundice.
Created by: smaxsmith