clinical chem exam 1 hepatitis

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clinical chem exam 1 hepatitis
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2010-02-24 14:41:06
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clinical chem exam 1 hepatitis
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  1. hepatitis
    inflammation of the liver
  2. mechanisms that can cause hepatitis
    • a)
    • viruses

    • b)
    • bacteria

    • c)
    • drugs, chemical, toxins

    • d)
    • excess alcohol

    • e)
    • autoimmune mechanisms

    • f)
    • metabolic disorders
  3. general symptoms of hepatitis
    • a)
    • flulike

    • b)
    • fatigue

    • c)
    • joint & muscle pain

    • d)
    • loss of appetite

    • e)
    • nausea

    • f)
    • vomiting

    • g)
    • diarrhea

    • h)
    • fever

    • i)
    • enlarged and tender liver = jaundice
  4. Acute hepatitis
    • i)
    • Symptomatic individuals may present after
    • convalescent stage of 7-10 days, with total illness lasting 2-6 weeks

    • ii)
    • Wide range Symptoms: require no treatment to
    • hepatic failure and need for transplant

    • iii) Nonspecific
    • flulike symptoms: malaise, muscle and joint aches, fever, nausea, vomiting,
    • diarrhea, an headache

    • iv) Specific
    • symptoms: loss of appetite, aversion to smoking, jaundice, abdominal
    • discomfort, hepatomegaly, splenomegaly
  5. Chromic hepatitis
    • i)
    • Majority asymptomatic or mildly symptomatic

    • ii)
    • Abnormal blood test being only manifestation

    • iii) Many
    • experience return of acute symptoms

    • iv) Jaundice
    • can be late feature and indicator of damage

    • v)
    • Other: abdominal fullness from enlarged liver and
    • spleen, low grade fever, fluid retention (ascites), extensive damage and
    • scarring of liver (cirrhosis) leads to weight loss, easy bleeding and bruising
    • tendencies
  6. Hepatitis A route of transmission
    • a)
    • Via fecal-oral route

    • b)
    • Virus infects GI tract and is shed in feces.
    • Contaminated feces ingested by another

    • c)
    • Conditions of poor personal hygiene or
    • contaminated water
  7. Persons at increased risk of Hepatitis A
    • a)
    • Patients and staff at custodial institutions

    • b)
    • Person in close contact with an infected
    • individual

    • c)
    • Travelers and military in areas where disease is
    • widespread

    • d)
    • Children in child centers

    • e)
    • The immunocompromised
  8. Hepatitis A clinical course
    • a)
    • Abrupt onset

    • b)
    • Highest infectivity is during late incubation
    • period

    • c)
    • 20-40% no longer infectious when symptoms appear

    • d)
    • all considered to be infectious for up to 2
    • weeks

    • e)
    • disease resolves itself (low mortality)
  9. Hep A serological markers
    • a)
    • Anti-HAV, IgM

    • i)
    • First Ab to appear

    • ii)
    • Rises rapidly, last 3-6 mo

    • iii) Used
    • to diagnose an acute Hep A infection

    • b)
    • Anti-HAV, IgG

    • i)
    • Appears in about 6 mo

    • ii)
    • Replaces IgM

    • iii) Used
    • to indicate past infection or immunity to HAV
  10. Dane particle
    • a)
    • Hepatitis B DNA virus
  11. Route of transmission Hep. B
    • a)
    • Parenteral route

    • b)
    • When contact with infected blood or fluids

    • c)
    • At birth, through sex contact, contaminated
    • needles, open wound, cntact eith mucous memb, or blood tranfusion
  12. Persons at increased risk of hep B
    • a)
    • Multi sex partners

    • b)
    • Intravenous drug users

    • c)
    • Person born in endemic area

    • d)
    • Babies born to infected moms

    • e)
    • Household contact and sex partners of infected

    • f)
    • Medical and dental workers
  13. Clinical course Hep B
    • a)
    • 50% acute w/symptoms for up to 4 weeks

    • b)
    • up to six months before feel “normal”

    • c)
    • most serious consequence are from chronic
    • infection (40% hepatic cancer or cirrhosis)

    • d)
    • 6-10% rate of chronicity (infection doesn’t
    • resolve)
  14. HBV serological markers
    • a)
    • HBsAg

    • i)
    • First to appear

    • ii)
    • Detectable 30-60 days after infected

    • iii) Eventually
    • disappears

    • iv) If
    • present consider infectious

    • v)
    • If marker persists loger than 6 mo then
    • considered chronic

    • b)
    • Anti-Hbs

    • i)
    • Appears after HBsAg disappears

    • ii)
    • Time between loss of surface Ag and gain of
    • surface Ab = convalescent window

    • iii) This
    • is the major protective Ab that gives immunity

    • iv) Detect
    • for life

    • v)
    • Develop with vaccine

    • vi) Indicative
    • of previous infection or exposure (vaccination)

    • c)
    • Anti-HBc IgM

    • i)
    • 2 wks-3 mo after patient becomes symptomatic

    • ii)
    • remains for up to 6 mo

    • iii) used
    • to diagnose acute case of HBV

    • iv) does
    • not give immunity

    • d)
    • Anti-HBc IgG

    • i)
    • Appears in about 6 mo to replace IgM

    • ii)
    • Used to indicate previous exposure or infection

    • iii) Detect
    • for life

    • iv) Does
    • not give immunity
  15. Hep C transmission route
    • a)
    • Parenteral route: contact w/ infected blood or
    • body fluids

    • b)
    • Birth, sex contact, contaminated needles, open
    • wound, contact w/mucousal memb, or blood transfusion
  16. Persons at increased risk of HCV
    • a)
    • Multi blood transfusion recipients

    • b)
    • Intravenous drug users

    • c)
    • Health care workers
  17. Clinical course HCV
    • a)
    • Incubation from 2wks to 1 yr

    • b)
    • Hepatitis symptoms

    • c)
    • Can be asymptomatic

    • d)
    • Most common symptom is chronic asymptomatic
    • increase in ALT & AST

    • Leading reason liver
    • transplant
  18. HCV serological markers
    • a)
    • Hard to do due to high frequency of mutation

    • b)
    • Anti-HCV

    • i)
    • Detect presence of Ab to virus

    • ii)
    • Indicates exposure

    • iii) Cannot
    • tell you if active infection (tests for IgG Ab)

    • c)
    • HCV RIBA test

    • i)
    • Confirms presence of Ab

    • ii)
    • Cannot tell you if you are currently infected,
    • chronically, or resolves

    • iii) Only
    • tells you about exposure

    • d)
    • HCV-RNA test

    • i)
    • Identifies whether virus is in your blood

    • ii)
    • Indicates active infection

    • iii) Molecular
    • diagnostic technique: nucleic acid test
  19. HBV and HDV
    • a)
    • Hep D relies on Hep B to replicate

    • b)
    • Co-infection with HBV
  20. HEV
    • a)
    • In pregnant women

    • b)
    • Course similar to HAV

    • c)
    • Rare in US
  21. Hepatitis treatments
    • a)
    • Prophylaxis (pre-exposure)

    • b)
    • Immunoglobulin for passive, short term
    • prevention 80-90% effective for up to 3mo

    • c)
    • Mainly treat symptoms (mild to severe)

    • d)
    • Longterm treatments: alpha-interferon,
    • corticosteroids

    • e)
    • Most likely to resolve with low viral load

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