Hepatitis

Question 1

Acute Hepatitis

Answer 1

A, E

Question 2

Chronic Hepatitis

Answer 2

B, C, D

Question 3

Fecal derived hepatitis

Answer 3

A, E

Question 4

Blood derived hepatitis

Answer 4

B, C, D

Question 5

Hepatitis immunization

Answer 5

A, B/D

Question 6

“Infectious hepatitis”

Answer 6

A

Question 7

“Serum hepatitis”

Answer 7

B

Question 8

“Transfusion-associated hepatitis”

Answer 8

C

Question 9

“Virus parasite”

Answer 9

D

Question 10

Hepatitis most associated with liver cancer

Answer 10

B

Question 11

Possible course of viral hepatitis

Answer 11

1. Subclinical and anicteric
2. Typical acute icteric hepatitis
3. Fulminant hepatitis
4. Chronic hepatitis

Question 12

1. Subclinical and anicteric

Answer 12

Recognized by seroconversion

Question 13

2. Typical acute icteric hepatitis

Answer 13

Incubation period varies depending on type:

• A: 2-6 weeks
• B: 2-6 months
• C: 2-24 weeks (most 6-7)
• D: 1-6 months
• E: 3-9 weeks
• Prodrome (pre-icteric): Fatigue, malaise, anorexia
• Icteric phase: Yellow skin, elevated liver enzymes
• Convalescent phase: Disappearance of jaundice and symptoms

Question 14

3. Fulminant hepatitis

Answer 14

Disease outside the liver

HIGH FATALITY RATE

Question 15

4. Chronic hepatitis

Answer 15

Very infectious (lots of virus in blood)
Only for B, C, and D

Question 16

Hepatitis A

Answer 16

Infectious hepatitis
Does NOT become chronic
Excreted in feces
Food and water borne transmission
Closed populations with poor hygiene
Disease is typically mild

Question 17

Hep A transmission

Answer 17

Entry through intestine after ingestion

Fecal-oral route

Question 18

Hep A Diagnosis

Answer 18

IgM antibody by ELISA

Question 19

Hep A prevention

Answer 19

Handwashing
Avoid contaminated food (uncooked shellfish)
Post-exposure prophylaxis with immunoglobulin
Killed virus vaccine available
EDUCATION (break chain of transmission)

Question 20

Most common cause of chronic hepatitis

Answer 20

Hep B

Question 21

Most likely results of Hep B infection in adults

Answer 21

Resolution

Question 22

Most likely results of Hep B infection in kids

Answer 22

Chronicity

Question 23

Hep B Antigens

Answer 23

HBsAg - Surface antigen
HBcAg - Core antigen
HBeAg - Surface antigen (always have c too)

Question 24

Double-walled Dane particle

Answer 24

Infectious form of Hep B

Question 25

Hep B transmission

Answer 25

Present in serum, blood, semen Spread by needle: - Acupuncture - Piercings - Tattooing

Question 26

Major reservoir for Hep B

Answer 26

Chronic hepatitis patients

Question 27

Risk factors for perinatal-congenital infection of Hep B

Answer 27

- Chronic infection in mother - HBeAg positive mother * *90% of infected infants will become chronically infected

Question 28

Populations at risk for Hep B

Answer 28

``` Healthcare IV drugs users Homosexuals Promiscuous heterosexuals Institutionalized persons Family contacts of infected individuals ```

Question 29

Where does Hep B replicate

Answer 29

Liver

Question 30

Hep B clinical manifestations

Answer 30

Incubation period of 50-180 days Insidious onset Prodrome: Fever, rash (urticarial), arthralgias (symmetrical) Self-limited in most adults Subclinical infection possible - Recognized by presence of anti-HBsAg

Question 31

Complications of Hep B infection

Answer 31

Cirrhosis Liver failure Hepatocellular carcinoma

Question 32

Hep B Diagnosis

Answer 32

Clinical symptoms Liver enzymes Serum antibodies

Question 33

Antigens secreted into blood stream during infection

Answer 33

HBsAg | HBeAg

Question 34

IgM anti-HBc WITH HBsAg

Answer 34

Hallmark of initial ongoing HBV infection

Question 35

IgG anti-HBc WITHOUT HBsAg

Answer 35

Indicates past HBV infection

Question 36

IgG anti-HBc WITH HBsAg

Answer 36

Indicates chronic HBV infection

Question 37

Best indication of the presence of infectious Hep B virus

Answer 37

HBeAg

Question 38

Continued detection of HBeAg and HBsAg or both without antibody to these antigens

Answer 38

Probable chronic HBV state

Question 39

How long does it take to determine resolution vs chronicity of Hep B

Answer 39

At least 6 months

Question 40

Rapid Hepatitis Virus Test detects

Answer 40

HBV surface antigen

Question 41

Hep B treatment/prevention

Answer 41

NO CURE EXISTS Can treat to prevent liver damage and progression Vaccine available! Immunoglobulin for prophylaxis (w/in 1 week of exposure) -Give to newborns with HBsAg positive mothers

Question 42

The delta agent

Answer 42

Hep D

Question 43

Hep D

Answer 43

- A viral parasite of another virus - Replication requires the presence of HBV for helper functions - Increases severity of HBV

Question 44

Hep D disease requirements

Answer 44

- Coinfection with HBV | - Superinfection in pts with chronic HBV

Question 45

Fulminant hepatitis most likely with

Answer 45

Hep D

Question 46

Hep D transmission

Answer 46

Same routes as Hep B

Question 47

Hep D diagnosis

Answer 47

ELISA for delta antigen or antibodies

Question 48

Hep D prevention

Answer 48

HBV vaccine

Question 49

Post-transfusion Hepatitis

Answer 49

Hep C

Question 50

Hallmark of HCV infection

Answer 50

``` CHRONIC infection (70-85%) Often progresses to cirrhosis and liver failure ```

Question 51

Hep C transmission

Answer 51

Not well understood

Question 52

Hep C risk factors

Answer 52

``` IV drug use Hemodialysis Blood transfusions Organ transplants Contact with health care providers Tattoos? ```

Question 53

Factors that promote HCV infection

Answer 53

``` Alcohol Infection at age >40 Male sex Hep B co-infection HIV co-infection ```

Question 54

Hep C diagnosis

Answer 54

EIA Seroconversion at 24 weeks ***Chronic state and acute phase viremic patients often escape detection!!! - Direct assays helpful and recommended for confirmation

Question 55

HCV Presentation

Answer 55

ASYMPTOMATIC (often) - Goes undiagnosed

Question 56

HCV Treatment

Answer 56

Direct-acting antiviral agents (DAAs) - Possible cure

Question 57

HCV prevention

Answer 57

Blood screening | Identify compensated, unrecognized infections