Viral Hepatitis

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giddyupp
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78152
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Viral Hepatitis
Updated:
2011-04-07 18:34:49
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Viral Hepatitis PHPR524 Test6
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Viral Hepatitis
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  1. Which Hepatitis viruses can be transmitted enterally?
    A and E
  2. Which Hepatitis viruses can be transmitted parenterally?
    B, C, and D
  3. Which Hepatitis viruses exist in a chronic carrier state?
    B, C, and D
  4. Which Hepatitis viruses do not exist in a chronic carrier state?
    A and E
  5. What modes of transmission are possible for HAV?
    • Orofecal
    • Sexual
    • Rarely by blood
  6. What modes of transmission are possible for HBV?
    • Possibly Orofecal
    • Sexual
    • Blood
  7. What modes of transmission are possible for HCV?
    • Rarely sexual
    • Blood
  8. What modes of transmission are possible for HDV?
    • Sexual
    • Blood
  9. What modes of transmission are possible for HEV?
    Orofecal
  10. Which Hepatitis viruses cause cirrhosis and hepatocellular carcinoma?
    • B
    • C
    • D (with HBV co-infection)
  11. Which type of Hepatitis virus is DNA based?
    HBV
  12. What are the risk factors for contracting HAV?
    • Travel to regions at risk
    • Infected sexual partners
    • Household members or caregivers of infected persons
    • Homosexuals
    • Users of certain illegal drugs (non-injection included)
    • Clotting factor disorders
  13. What are the risk factors for contracting HBV?
    • Travel to regions at risk
    • Infected sexual partners
    • Multiple sex partners
    • Household members and caregivers of infected persons
    • Homosexuals
    • Injection drug users
    • Hemodialysis patients
    • Persons with STDs
    • Infants born to infected mothers
  14. What are the risk factors for contracting HCV?
    • Current or former injection drug users
    • Recipients of clotting factor concentrates before 1987
    • Recipients of donated organs or blood transfusions before July 1992
    • Long-term dialysis patients
    • Persons with known exposure to HCV (needlesticks, blood or organ recipients)
    • HIV infected persons
    • Infants born to infected mothers
  15. What are the types of acute Hepatitis?
    • Asymptomatic
    • Symptomatic
    • Fulminant
  16. What is the characteristic associated with asymptomatic hepatitis?
    • marked only by a rise in liver function tests and detection of serological markers
    • 10-30 times more likely than symptomatic infection
  17. What are the phases and characteristics of symptomatic hepatitis?
    • Incubation period: no symptoms
    • Pericteric phase: nonspecific, influenza-like sx for 2-3wks (malaise, conjugated bilirubin increases, may see dark urine)
    • Icteric phase: Jaundice in the sclera, pale stools, pruritis for 7-30d
    • Convalescent phase: fatigue and weakness for up to 6 months
  18. What are the characteristics of fulminant hepatitis?
    • Severe liver failure that develops within 8wks of sx onset
    • Characterized by liver cell destruction leading to coagulopathy and hepatic encephalopathy
    • Rare
  19. What are the characteristics of chronic hepatitis?
    • Protracted hepatocellular necrosis and inflamation
    • Fibrosis often present
    • Lasts longer than 6mo
    • Cirrhosis, portal HTN, and/or hepatocellular carcinoma possible
    • Result of cytolytic T-cell response to infected hepatocytes rather than direct viral injury to cells
  20. What plays a key role in the transmission of HAV?
    asymptomatic children
  21. How is HAV primarily transmittted?
    contaminated food and water
  22. Why is HAV so easily transmitted?
    Viremia and fecal shedding occur before the sx begin
  23. What is the supportive care for HAV?
    • Bed rest until sx resolve
    • Anti-nausea meds (not chlorpromazine)
    • Correct fluid imbalances
    • Pain control (use APAP, not narcotics or hypnotics)
    • Manage pruritis (cholestyramine)
  24. What are the pharmacological therapies for HAV?
    • Pre-exposure: HAV immunoglobulin
    • Post-exposure: HAV immunoglobulin (also to contacts)
    • Steroids (prednisone) in the iteric phase may decrease bilirubin, alleviate itching, and minimize fatigue
  25. Which racial groups are at higher rick for HBV?
    • Black
    • Hispanic
  26. How is diagnosis made for HBV?
    based on serologic markers of infection in a clinical setting consistent with acute infection
  27. What is the presence of HBc indicative of?
    Replicating HBV
  28. If serologic testing is positive for anti-HBc and anti-HBs, how was immunity acquired?
    immunity due to natural infection
  29. If serologic testing is positive for anti-HBs only, how was immunity acquired?
    through vaccination
  30. If serologic testing is positive for HBsAg, anti-HBc and IGM anti-HBc, what type of infection is present?
    Acute HBV infection
  31. If serologic testing is positive for HBsAg and anti-HBc, what type of infection is present?
    Chronic HBV infection
  32. What are the phases of chronic HBV infection?
    • Immune tolerant: active replication in the liver, but little or no evidence of disease
    • Immune active: symptomatic w/ flares of hepatitis and ALT. cirrhosis and carcinoma
    • Inactive carrier: anti-HBe present, HBV DNA present but undetectable
  33. What is the treatment for chronic HBV?
    • Interferon-α2b 30-35 million IU TIW SC(only for compensated disease)
    • Peginterferon-α2a 180μg/wk SC x 48wks (only for compensated disease)
    • Lamivudine 100mg/d PO
    • Adefovir 10mg/d PO
    • Entecavir 0.5mg/d PO
    • Tenofovir 300mg/d PO
    • Telbivudine 600mg/d PO
  34. What is the most common blood borne pathogen?
    HCV
  35. What is decompenstated liver disease?
    • ascites
    • hepatic encephalopathy
    • hemorrage d/t portal HTN
  36. What is the treatment for acute HCV?
    • Interferon-α2b 3million IU TIW SC
    • Peginterferon-α2a 180μg/wk SC x 48wks
    • Peginterferon-α2b 1.0μg/kg/wk x 52wks
    • Any of the above + Ribavirin 800mg/d PO for genotypes 2and 3
    • Any of the above + Ribavirin 1000-1200mg/d PO for genotypes 1 and 4
  37. What are the SE of PEGinterferon?
    • Depression
    • Insomnia
    • Irritability
    • Anxiety
    • Flu-like sx
    • Neutropenia
    • Alopecia
  38. What are the SE of interferon-α2b?
    • Bone marrow suppression
    • Depression
    • Flu-like sx
  39. What are the SE of Lamivudine?
    • Lacitc acidosis
    • Severe hepatomegaly w/steatosis
    • Malaise
    • Fatigue
    • GI upset
  40. What are the SE of Adefovir?
    • Lactic acidosis
    • Severe hepatomegaly w/steatosis
    • Hepatitis
    • Nephrotoxicity
    • HA
    • GI upset
  41. What are the SE of Entecavir?
    • Lactic acidosis
    • Severe hepatomegaly w/steatosis
    • HA
    • Fatigue
    • Dizziness
    • Nausea
  42. What are the SE of Tenofovir?
    • Lactic acidosis
    • Severe hepatomegaly w/steatosis
    • Nepthrotoxicity
    • Nausea
    • Decrease in bone mineral density
  43. What are the SE of Telbivudine?
    • Lactic acidosis
    • Severe hepatomegaly w/steatosis
    • Myopathy
    • Peripheral neuropathy
    • Fatigue
    • HA
    • Flu-like sx
    • GI upset
  44. What are the SE of ribavirin?
    Hemolytic anemia

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