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Nelson - The Digestive System > Viral hepatitis > Flashcards

Flashcards in Viral hepatitis Deck (79):
1

Acute response of liver to hepatotropic viruses: Direct cytopathic vs immune-mediated

Both

2

Necrosis in viral hepatitis is most marked in what area

Centrilobular areas

3

Inflammatory infiltrates are settles in what area in cases of chronic hep

Inflammatory infiltrates

4

Neonates often respond to hepatic injury by forming

Giant cells

5

Viral hepatitis T/F Rapidly falling aminotransferase levels reflect poor outcome

T

6

Most important marker of liver injury

Altered synthetic function

7

Most prevalent of the hepatotropic viruses

Hepatitis A

8

Hepa viruses: Responsible for most forms of acute and benign hepatitis

A

9

Hepa viruses: RNA

A, C, E

10

Hepa viruses: Picornavirus

A

11

Hepa A transmission

Person-to-person through fecal-oral route

12

T/F Hepa A is responsible for ACUTE hepatitis only

T

13

Hepa A infection is diagnosed by

Anti-HAV IgM

14

2 distinct complications of Hepa A infection

1) Acute liver failure, usually in adolescents and adults 2) Prolonged cholestatic syndrome

15

Hepa A treatment

None specific

16

Patients infected with HAV are contagious when

2 weeks before and 7 days after onset of jaundice (should be excluded from school, child care, or work)

17

Indications for IM administration of Ig and vaccine (pre- and post-exposure)

1) Ig for susceptible travelers to countries where HAV is endemic 2) Vaccine for healthy persons prior to travel 3) Ig for <1 y/o, patients allergic to vaccine component, or those who elect not to receive vaccine 4) Ig postexposure EXCLUSIVELY for <12 months, immunocompromised, chronic liver disease, or if vaccine is contraindicated

18

Hepa viruses: DNA

B

19

Hepa viruses: Hepadnaviridae

B

20

Hepa B: Serves as a marker of active viral replication

HBeAg

21

Correlates with HBV DNA levels

HBeAg

22

Hepa B transmission

Blood transfusion and sexual contact

23

Most important risk factor for acquisition of HBV in children

Perinatal exposure to an HBsAg positive mother

24

T/F Breastfeeding of nonimmunized infants by infected motgers confers a greater risk of hepatitis than formula feeding

F

25

Chronic HBV infection is defined as

Positive HBsAg for >6 months

26

T/F Risk of developing chronic HBV infection is inversely related to age of acquisition

T

27

Most prevalent cancer-related death in young adults in Asia where HBV is endemic

Hep B hepatocellular carcinoma

28

Hepa B: Direct cytopathic vs immune-mediated

Immune-mediated

29

First biochemical evidence of HBV infection

Elevation of ALT (begins to rise just before development of fatigue, anorexia, and malaise)

30

First serologic marker of infection to appear in HBV infection

HBsAg

31

HBV infection: During recovery from acute infection, ___ might be the only marker of acute infection

HBc IgM (since HBsAg levels fall before symptoms wane)

32

HBV infection: Valuable serologic marker of acute HBV infection as it rises early after the infection and remains positive for many months

Anti-HBc

33

HBV infection: Marks serologic recovery and protection

Anti-HBs

34

HBV infection: Only this serologic marker is present in persons immunized with Hep B vaccine

Anti-HBs

35

HBV infection: Marker of infectivity

HBeAg

36

T/F: HBeAg is present in active acute and chronic infection

T

37

HBV infection: Development of ___ marks improvement and is goal of therapy in chronically infected patients

Anti-HBe

38

Hepa viruses: Acute liver failure occurs more commonly with ___ than with other hepatotropic viruses

Hepa B

39

T/F Treatment of acute HBV infection is largely supportive

T

40

Goal of treatment in chronic HBV infection

Reduce viral replication

41

Reduction of viral replication in HBV infection is defined by

1) Undetectable HBV DNA in the serum 2) Development of anti-HBe

42

Hepa B: Treatment is only indicated for

Patients in immune-active form with evidence of ongoing inflammation and fibrosis, putting the child at higher risk for cirrhosis during childhood

43

Hepa B treatment: Immunomodulator with antiviral effects

IF-α-2b

44

Hepa B treatment: Oral synthetic nucleoside analog that inhibits viral enzyme reverse transcriptase

Lamivudine

45

Hepa C: Most prevalent mode of transmission

Perinatal

46

Hepa C: Direct cytopathic vs immune-mediated

Cytopathic

47

Most likely hepatotropic virus to cause chronic infection

Hepa C

48

Hepa viruses: Infection is associated with small vessel vasculitis

Hepa C

49

Hepa viruses: Infection is associated with essential mixed cryoglobulinemia

Hepa C

50

Hepa C: Most widely used serologic test

3rd generation EIA to detect anti-HCV

51

Hepa C: Most widely used virologic assay

PCR assay that detects HCV RNA

52

Hepa C: Most effective treatment in adults

Peg interferon combined with oral Ribavirin

53

Hepa C: Goal of treatment

Sustained viral response

54

Hepa C: Sustained viral response is defined as

Absence of viremia 6 months after stopping medications

55

T/F There is no vaccine available to prevent Hepa C

T

56

Annual tests done for patients in whom HCV infection is identified

1) Liver ultrasound 2) Serum AFP for HCC

57

Smallest known animal virus which is considered to be defective

Hepa D

58

Why is Hepa D considered to be defective

Cannot produce infection without concurrent HBV infection

59

T/F Concurrent infection of Hepa D with Hepa B takes 2 forms - co-infection (at the same time) or superinfection (infect a person already infected with Hepa B

T

60

Hepa D: Direct cytopathic vs immune-mediated

Cytopathic

61

HDV-HBV co-infection vs superinfection: Acute hepatitis > chronic hepatitis

Co-infection

62

HDV-HBV co-infection vs superinfection: Chronic hepatitis > acute hepatitis

Superinfection

63

HDV-HBV co-infection vs superinfection: Risk for ALF is highest

Superinfection

64

T/F HDV must be considered in all cases of acute liver failure

T

65

Diagnosis of HDV infection is made by detecting

HDV IgM

66

T/F There are no specific HDV-targeted treatments

T

67

Hepa viruses: Similar in structure to caliciviruses

HEV

68

Hepa viruses: Epidemic form was formerly called non-A, non-B hepatitis

HEV

69

HEV: Transmission

Fecal-oral

70

HEV: Direct cytopathic vs immune-mediated

Cytopathic

71

T/F Chronic illness does not occur in HEV infection

T

72

Hepa viruses: Major pathogen in pregnant women in whom it causes ALF with a high fatality incidence

HEV

73

Hepa viruses: Flavivirus

HCV, HEV, HGV

74

HAV incubation period

15-30 days

75

HBV incubation period

60-180 days

76

HCV incubation period

30-69 days

77

HEV incubation period

35-60 days

78

Hepa viruses: Causes chronic infection in 90% of patients when acquired perinatally

HBV

79

Hepa viruses: Increased risk of hepatocellular carcinoma

HBV and HCV