Hepatitis Flashcards MD2 Block 3 — TBL Prep + CAS Study

These flashcards cover key concepts, transmission methods, clinical features, and treatment of various hepatitis viruses for MD2 Block 3 exam preparation.

What is hepatitis and what causes it?

Hepatitis is inflammation of the liver parenchyma, caused by viruses, alcohol, drugs or toxins, or autoimmune disease.

What are the two liver enzymes that rise in hepatitis, and why?

Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST) rise due to liver cell damage leaking these enzymes into the bloodstream.

In most viral or toxic hepatitis, which enzyme is higher — ALT or AST?

Alanine aminotransferase (ALT) is higher than Aspartate aminotransferase (AST) in most cases, except alcoholic hepatitis.

What causes dark urine and pale (light-colored) stool in hepatitis?

Dark urine results from conjugated bilirubin building up in the blood; pale stool results from bilirubin not reaching the gut.

What are the universal clinical symptoms of hepatitis?

Fever, anorexia, nausea, vomiting, jaundice, dark urine, pale stool, and elevated transaminase levels.

What are the general histologic findings in ALL types of hepatitis?

Ballooning degeneration, Councilman bodies, lobular disarray, lymphoid infiltration, and necrosis of liver cells.

What is the unique finding of Hepatitis B virus infection?

Ground-glass hepatocytes under the microscope due to accumulation of Hepatitis B surface antigen.

What are the findings of Hepatitis C virus infection?

Lymphoid aggregates in portal tracts and macrovesicular steatosis (fat accumulation in liver cells).

What are Mallory bodies and what condition are they associated with?

Clumps of damaged intermediate filaments in hepatocytes, hallmark of alcoholic hepatitis.

What role do Kupffer cells play in hepatitis?

Kupffer cells are macrophages in the liver that proliferate in response to liver damage in hepatitis.

What primarily causes liver cell damage in viral hepatitis?

The immune system, mainly the action of Cytotoxic T cells, not the virus directly.

What type of virus is Hepatitis A virus?

Hepatitis A virus is a nonenveloped, single-stranded positive-sense RNA virus from the Picornavirus family.

How is Hepatitis A virus transmitted?

Via the fecal-oral route, typically through contaminated food or water.

How does Hepatitis A virus cause liver damage?

It replicates in the GI tract, spreads to the liver, triggers immune response, resulting in liver cell necrosis.

What is the immune response to Hepatitis A virus infection?

IgM appears during acute infection, followed by IgG for lifelong immunity.

How is Hepatitis A virus infection diagnosed in the lab?

Based on clinical symptoms, common source identification, and serologic tests for antibodies.

What is the treatment and vaccine for Hepatitis A virus?

No antiviral treatment; vaccination is an inactivated virus given in two doses.

What is passive-active immunization for Hepatitis A?

Simultaneous administration of immune globulin for immediate protection and vaccination for long-term protection.

What type of virus is Hepatitis B virus?

Hepatitis B virus belongs to the Hepadnaviridae family and is an enveloped, partially double-stranded DNA virus.

What are the four genes of Hepatitis B virus?

S (surface antigen), C (core antigens), P (polymerase), and X (transcriptional activator).

What is the difference between HBcAg and HBeAg?

HBcAg is the core antigen not detectable in blood, while HBeAg is secreted and indicates active viral replication.

How does Hepatitis B virus replicate?

It enters liver cells, converts DNA to cccDNA, and uses host enzymes for transcription and replication.

What are the three types of particles in Hepatitis B virus infection?

Complete Dane particles, non-infectious 22 nm spheres, and 22 nm filaments, with a 1000:1 ratio.

What is the role of the HBx protein?

HBx activates viral and cellular genes, contributes to liver cancer by inactivating the p53 tumor suppressor.

What are the main modes of Hepatitis B virus transmission?

Blood, sexual contact, and perinatal transmission.

What are the extrahepatic manifestations of Hepatitis B virus infection?

Serum sickness-like symptoms, neuropathies, glomerulonephritis, and polyarteritis nodosa.

What are the outcomes of Hepatitis B virus infection in adults vs newborns?

Adults clear infection 90-99% of time; newborns have an 80-95% chance of becoming chronic carriers.

What drugs are used to treat chronic Hepatitis B virus infection?

Entecavir or Tenofovir as first-line drugs, both are nucleoside analogues.

What is the Hepatitis B virus vaccine?

A recombinant subunit vaccine given in three doses, contains only HBsAg.

What is Hepatitis B immune globulin (HBIG)?

A high concentration of antibodies providing immediate protection post-exposure.

What indicates successful Hepatitis B virus vaccination?

Anti-HBs titer greater than 100 IU/L indicates full protective immunity.

What are the 5 key Hepatitis B virus serology markers?

HBsAg (current infection), Anti-HBs (immunity), Anti-HBc IgM (acute infection), Anti-HBc IgG (past infection), HBeAg (high replication).

What does a positive HBsAg and negative Anti-HBs indicate in serology?

Current active Hepatitis B virus infection.

What does positive Anti-HBc IgM and HBsAg negative indicate?

The window period of Hepatitis B virus infection.

What signifies a resolved Hepatitis B virus infection?

HBsAg negative, Anti-HBs positive, and Anti-HBc positive indicates natural immunity.

What distinguishes vaccinated individuals from naturally recovered individuals?

Vaccinated: Anti-HBs positive + Anti-HBc negative; Recovered: Anti-HBs positive + Anti-HBc IgG positive.

What does HBeAg positive indicate?

High probability of active viral replication and high infectiousness.

What type of virus is Hepatitis C virus?

Hepatitis C virus is an enveloped, single-stranded positive-sense RNA virus from the Flavivirus family.

What are the key genes of Hepatitis C virus?

C (core), E1, E2 (envelope proteins), NS3/4A (protease), NS5A (phosphoprotein), NS5B (polymerase).

How is Hepatitis C virus primarily transmitted?

Primarily via blood, especially through sharing needles.

What is the chronicity rate of Hepatitis C virus infection?

Approximately 75 to 80% of those infected become chronically infected.

How is Hepatitis C virus diagnosed in the lab?

Through ELISA to detect antibodies and PCR for the presence of viral RNA.

What drugs are used to treat Hepatitis C virus infection?

Directly Acting Antivirals (DAAs) including protease, polymerase, and NS5A inhibitors.

Is there a vaccine for Hepatitis C virus?

No vaccine exists for Hepatitis C virus.

What type of virus is Hepatitis D virus?

Hepatitis D virus is a defective RNA virus that depends on Hepatitis B virus for its envelope.

Why can Hepatitis D virus only infect those with Hepatitis B virus?

It hijacks HBsAg from Hepatitis B virus to enter liver cells.

What is the difference between Hepatitis D co-infection and superinfection?

Co-infection occurs simultaneously, usually resolves; superinfection in chronic Hepatitis B leads to worse outcomes.

How is Hepatitis D virus diagnosed?

By detecting delta antigen or IgM antibodies against delta antigen.

What type of virus is Hepatitis E virus?

Hepatitis E virus is a nonenveloped, single-stranded RNA virus from the Hepevirus family.

What is unique about Hepatitis E virus in pregnant women?

Causes fulminant hepatic necrosis with high mortality rates, especially in the third trimester.

How is Hepatitis E virus diagnosed?

By detecting IgM antibodies or PCR for Hepatitis E virus RNA.

What is alcoholic hepatitis?

Liver inflammation due to heavy alcohol use characterized by a 2:1 AST to ALT ratio.

What is autoimmune hepatitis?

Liver inflammation caused by the immune system attacking liver cells, diagnosed by ASMA antibodies.

What is toxic hepatitis?

Liver inflammation from drugs or chemicals, with acetaminophen being a key example.

What is steatohepatitis?

It is liver inflammation with fat accumulation, mainly alcoholic (ASH) and non-alcoholic (NASH).

What is Hepatitis G virus (HGV)?

A Flavivirus that can cause chronic infection and may improve HIV outcomes when co-infected.

What are the transmission routes for all five main hepatitis viruses?

A: fecal-oral, B: blood and body fluids, C: blood, D: co-transmission with B, E: fecal-oral.

Which hepatitis viruses cause chronic infection?

B, C, and G can cause chronic infections; E can in immunocompromised, while A NEVER causes chronic infection.

Which hepatitis viruses are linked to hepatocellular carcinoma (HCC)?

B (directly), C (via cirrhosis), and D (chronic infection). A and E do not cause HCC.

Which hepatitis viruses have vaccines available?

A (inactivated) and B (recombinant); C, D, and E do not have vaccines.

Compare the incubation periods and chronicity of Hepatitis A, B, and C viruses.

A: 3-4 weeks, mild, never chronic; B: 10-12 weeks, severe, chronic (5-10% adults); C: 8 weeks, mild, chronic (75-80%).

What indicates a Hepatitis B chronic carrier state?

HBsAg positive, Anti-HBc positive, and Anti-HBs negative.

What does HBsAg positive, HBeAg positive indicate?

Highly contagious state of active Hepatitis B virus infection.

What are indicative serologic patterns for hepatitis recovery?

HBsAg negative, Anti-HBs positive, and Anti-HBc positive indicate recovery.

What is the clinical significance of cccDNA in Hepatitis B virus?

cccDNA is the master template that persists despite antiviral treatment, complicating eradication efforts.

What is the significance of reverse transcriptase activity in Hepatitis B virus?

It allows the replication of the virus and is exploited by antiviral drugs like tenofovir to inhibit viral replication.