Digestive Pathophysiology > Hepatitis > Flashcards

Hepatitis Flashcards

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1
Q

In how many categories does the acute hepatitis has been categorized; and which ones are they:

A

4
-Incubation/
preclinical
-Prodromal
-Icteric
-Convalescent/ resolution

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2
Q

What does laboratory findings tend to reveal at acute hepatitis?

A

serum aminotransferase >500 units/L (~1000 units/L)

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3
Q

How is used to be the aminotransferase balance at acute hepatitis?

A

AST tend to be higher than ALT; elevation of both tend to begin at prodromal phase

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4
Q

Mild and diffuse elevation of gamma globulin is particularly increased in which infection?

A

Acute hepatitis A infection

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5
Q

Imaging tests might be helpful on the setting of which disorder?

A

Cholestasis, as might happen in Hepatitis A and E

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6
Q

At chronic hepatitis, the serum aminotransferase balance how tends to be?

A

ALT is higher than AST (unless the px has cirrhosis, when AST tends to be higher)

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7
Q

Abdominal ultrasound, CT & MRI are helpful in which case?

A

For looking for portal hypertension signs such as varices, ascites or splenomegaly

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8
Q

How is the Hepatitis A infection acquired?

A

Via fecal-oral route; causing a self-limited infection that solves spontaneously

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9
Q

Which serologic marker is needed to assess Hep. A infection dx?

A

IgM anti-HAV

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10
Q

How long is the incubation period for Hep. A infection?

A

2-6 weeks

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11
Q

Which is another serum key feature related to Hep.A infection?

A

marked elevation of total bilirubin (>10 mg/dL) and alkaline phosphatase

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12
Q

True or False. Cholestasis at Hep. A infection needs tx

A

False. it might solve spontaneously

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13
Q

Which is the mechanism of liver cell damage at Hep. A infection?

A

Immune cell mediated cytotoxicity

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14
Q

How must de Hep. A vaccine must be administered?

A

2 doses at least 6 months apart

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15
Q

True or False. Hep. B virus is a RNA virus

A

False. its the only hepatitis virus that is DNA

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16
Q

How is the Hep. B infection acquired.

A

-Perinatal (vertical transmission)
-Contaminated needles
-Sexually

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17
Q

On which serum marker does the Hep. B infection dx relies on?

A

HBsAg on the serum

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18
Q

What does presence in the serum of anti-HBc indicates?

A

Recent infection (<6 months) or chronic infection reactivation

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19
Q

What does HBeAg presence on the serum indicates?

A

Active viral replication; might also indicate active liver injury

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20
Q

What does replacement of HBeAg for Anti-HBe is associated with?

A

Suppression of viral replication & reduced liver injury; might also mean immune clearance

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21
Q

What does presence of isolated anti-HBs mean?

A

Vaccine induced immunity

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22
Q

True or false. HBV has a similar way of replication that HIV

A

True. It might add his genetic material to the host genome (key step on oncogenesis)

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23
Q

True or False. Hep.B infection might not recur after liver transplant

A

False. Since there are viral sequences in extrahepatic tissue (eg. lymph nodes), it might recur

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24
Q

To which type of cancer is chronic Hep. B infection related to?

A

Hepatocellular carcinoma: for the liver cell turnover linked to inflammation

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25
How long is the incubation period for Hep. B infection
1 to 6 months (~75 to 90 days)
26
Which is the biochemical hallmark of Hep. B infection?
Aminotransferase elevations
27
In a small % of HBV px, what syndrome might develop?
Serum-sickness like syndrome -Arthralgias -Rash -Angioedema Happening at prodromal phase
28
Which clinical features might herald progression from acute to chronic hepatitis B?
-Persistent anorexia -Weight loss -Fatigue (Although most px with chronic hep. are asymptomatic)
29
Which clinical features might appear on the physical exam, supportive for Hep. B chronic infection?
Hepatomegaly & Splenomegaly
30
Which features might be seen on laboratory tests, supportive for chronic Hep. B infection?
-Persistent HBsAg -Positive HBeAg -Elevated aminotransferase, bilirubin & globulin
31
True or False. Px's with high levels of viremia might develop immune complex depositions
True. This might manifest as: -arthritis -generalized vasculitis -pancreatitis glomerulonephritis
32
Which histologic features might be present, supportive for Hep. B infection
-Fibrosis (according on duration & severity of the disease) -Ground glass hepatocytes (Indicative of robust production of HBsAg)
33
At chronic Hep. B infection, in which situation IgM anti-HBV might be seen again? (For commonly are IgG at chronic infection)
Viral reactivation
34
Which is a quite recent vaccine, more effective than others for preventing Hep. B infection?
HepB-CpG vaccine
35
How is the Hep. C infection acquired?
-Percutaneous exposure (contaminated needles) -Perinatal -Sexual
36
Incubation period for HCV
2 weeks to 6 months
37
Which test is used for dx Hep. C infection
Enzyme immunoassay: might indicate ongoing exposure or prior exposure (it might give false-positives also)
38
Which serologic marker is supportive for Hep. C infection
HCV RNA: indicative of an ongoing infection and might be detectable ~7-14 days after exposure
39
True or False. Its uncommon that Hep. C infection progress to chronic infection
False. Its common that infection might progress to chronic
40
Which histologic features might be seen at Chronic Hep. C infection
-Lymphocytic portal inflammatory infiltrate -Hepatocellular steatosis
41
True or False. Hep. C infection is symptomatic & the px tends to recognize it quickly
False. Hep. C infection is usually asymptomatic & tends to be unrecognized by px's
42
Which is a characteristic pattern with ALT values on Hep. C infection
They used to fluctuate in a "saw-tooth" pattern
43
Which drugs might be used for treating Hep. C infection?
Direct Acting Antivirals (DAA)
44
How is eradication of Hep. C infection defined.
sustained virologic response (no HCV RNA on serum) 12 weeks following completion of antiviral therapy
45
True or False. Achieving a SVR is linked to a decreased risk of cirrhosis?
True. it might also improve histologic findings & fibrosis stage
46
How does Hep. D infection is acquired?
Infection occurs only in presence of HBV & is detected by finding anti-HDV on serum
47
True or False. HDV RNA isn´t helpful to assess the dx, just the anti-HDV is useful
False. HDV RNA is helpful too.
48
Why is helpful testing for IgM & IgG
to differentiate: -Acute simultaneous infection (IgM anti-HBc +) -Acute HDV superinfection in px's with chronic HBV (IgG anti-HBc+)
49
Which HBV protein does HDV uses as its envelope protein?
HBsAg
50
True or False. HDV supress HBV replication
True
51
Which are histologic findings on acute hep. D infection?
-micro-vesicular steatosis -Granular eosinophilic necrosis Chronic infection tends to manifest as nonspecific necrotic activity
52
True or False. Chronic Hep. D infection isn´t considered too severe.
False. It is considered one of the most severe forms of chronic hepatitis; it has a higher risk of hepatic decompensation & a faster progression to cirrhosis
53
Incubation period of HDV
-At acute coinfection: 1-6 months -At acute superinfection: 2-8 weeks
54
How does Acute coinfection of hep. D might present?
-liver inflammation that might progress to acute liver failure
55
How does Hep. E infection is acquired.
Via fecal-oral route
56
In which px's Hep. E infection might become chronic
In immunocompromised px's
57
How does the Hep. E diagnosis might be established.
By the presence of IgM anti-HEV or HEV RNA by PCR (in stool or serum samples)
58
When is more commonly observed Hep. E infection?
On travelers returning from endemic regions
59
On which px´s Hep. E infection is specifically dangerous
Pregnant women, especially on the third trimester
60
Incubation period of Hep. E infection
2 to 10 weeks
61
True or False. Hep. E infection tends to be milder than Hep. A infection
False. Tends to be more severe
62
Which clinical features might be present at the prodromal phase of Hep. E infection?
-Acholic stools -Dark urine -Fever -Nausea & vomiting -Transient macular skin rash
63
Which clinical features might be present at the icteric phase of hep. E infection
-Jaundice -Elevated aminotransferase -Elevated bilirubin
64
Examples of immunocompromised px´s, in which chronic Hep. E infection is easier to happen
-organ-transplant recipients -Those receiving Chemotherapy -those with HIV
Digestive Pathophysiology
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