Hepatitis

Question 1

Hepatitis

Answer 1

-inflm of the liver

Question 2

Hepatitis etiology

Answer 2

• microbes -especially viruses
• hepatotoxic durgs
• autoimmunity (some types are d/t autoimmunity)

Question 3

Viral hepatitis are the hepatitis________

Answer 3

-hep A, B, C, D, E (virus and infection have same
name)
-differences between these are: -virus & transmission
-incubation period
-severity
-mnfts are similar

Question 4

Hep A

Answer 4

• mild and acute
• self-limiting (cannot ignore pt, but heals by self)
• oral-fecal transmission
• HAV, antiboides hep A virus antibodies Abs measured used to make a diagnosis)
• no chronic or carrier stage

Question 5

with Hep A person will have what kind of antibodies and they will be measured for?

Answer 5

Hep A virus antibodies and they will be measured to make a diagnosis

Question 6

Hep B

Answer 6

• more severe than Hep A
• acute or chronic (10-15%)
• carrier state (harbours virus, doesnt mnfts, can pass it on)
• cirrhosis: end stage liver disease, not very common with hep B may develop
• 3 Abs: anti-HBS (antigen that forms against this sits on the surface of the virus) anti-HBC (antigen that sits at core of virus) anti-HBe(referring to antigen in core & around core)

Question 7

how is Hep A transmitted

Answer 7

-oral-fecal transmission

Question 8

how is Hep B transmitted

Answer 8

-blood, most body fluids, oral, sexual

Question 9

what are the three antibodies with Hep B

Answer 9

anti-HBs (antigen that forms against this sits on the surface of virus)
anti-HBc (antigen that sits at the core of the virus)
anti-HBe (referring to antigen in core and around core)

Question 10

Hep C

Answer 10

• chronic (80%)- cirrhosis & hepatocellular cancer
• from infected blood
• infected drug use (most common)
• high risk sex practices (2nd)
• Ab & viral tests for diagnosis (antibodies don’t serve as protective only serve for diagnostics)

Question 11

patho of hepatitis

Answer 11

(similar in all types except auto immune)

• 2 mechanisms in all types:
• Viral injury causing necrosis
• IR (normal immune response mediated injury) causing Inflm & necrosis
• these lead to inflammatory damage and hepatocyte necrosis causing decreased liver function
• liver is richly vascularized undergoing inflm damage d/t Immune res

Question 12

Mnfts

Answer 12

3 phases 
Prodromal:
-lethargy, myalgia
-anorexia, nausea & vomiting 
-fever, abdm pain (liver has capsule that it is in, inflm causes swelling which stretches capsule which causes pain)

Clinical: (5-10 days later)

• mnfts worsen
• enlarged & tender liver
• jaundice (bilirubin, cells that breakdown heme into bilirubin being damaged)
• pruitits (d/t bile salts, accumulate & deposit in skin cause irritation)

Recovery:

• acute mnfts subside (aprox 3 wks)
• full recovery in approx 16 wk

Question 13

what are the 3 phases for the manifestations of hepatitis

Answer 13

• prodromal
• clinical
• recovery

Question 14

Diagnosing hepatitis

Answer 14

• history, physical exam

- measure liver enzymes (ALT & AST)-damaged release enzymes

Question 15

why will hepatitis cause abdominal pain

Answer 15

-liver in a capsule, inflammation of liver causes swelling which stretches the capsule and causes pain

Question 16

Treatment of hepatitis

Answer 16

(facilitate self-limitness)

• bed rest (decrease energy requirement of the body)
• smaller meals, increased calories and low fat (hepatic workload decreases)
• no alcohol or hepatoxic drugs
• symptomatic management
• vaccines for Hep A & B (prevent) dont want to give vaccines to infected person
• new direct acting antivirals (DAA) for Hep C only!: target specific stages in life cycel of virus-up to 95% cure rate
• interferon can be used was used in the past: problems with side effects

Question 17

what are the 2 mechanisms that happen in hepatitis that would happen in any viral infection

Answer 17

• Viral injury-causing necrosis: an aspect of viral infection is always cell damage by virus invading host cell & causing lysis (direct hepatocyte injury by virus)
• IR (normal immune response mediated injury) causing Inflm & necrosis

Question 18

the liver has enormous _______ so that means

Answer 18

functional reserve that means alot has to happen before it shows it is failing

Question 19

autoimmune hepatitis is a ________ form

Answer 19

severe, chronic form (no recovery)

Question 20

Etiology of autoimmune hepatitis

Answer 20

• complex trait: -genetic component + environmental component (usually triggered by bacteria or viral infection)
• Idiopathic (because unclear of viral trigger or chemical trigger and what it will produce
• HLA gene on chr 6 (proteins on cells that allow to differentiate self from foreign)
• viral and chemical triggers

Question 21

what do the HLA genes on Chr 6 do?

Answer 21

proteins on cells that allow to differentiate self from foreign

Question 22

Type 1 autoimmune hepatitis

Answer 22

• more common
• 80% in females (about 1/3 are under 40-1/3 of that 1/3 have an autoimmune disorder already)
• ANAs (antinuclear antibodies) & anti-smooth muscle abs

Question 23

in autoimmunity it is generally

Answer 23

antibodies and t cells damaging self

Question 24

what are the two antibodies with Type 1 autoimmune hepatitis

Answer 24

-ANAs (antinuclear antibodies) & anti-smooth muscle abs