Viral, Toxin, and Immune Mediated Liver Diseases
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41 Terms
How are Hep A and E spread?
fecal–oral transmission
What is the clinical presentation of acute HAV?
Self‑limited hepatitis
What serology diagnoses acute HAV?
Anti‑HAV IgM positive.
What serology indicates immunity to HAV?
Anti‑HAV IgG positive.
How is Hep B mostly spread?
Sexual transmission
What is the clinical presentation of acute HBV?
Flu‑like prodrome
What are long‑term complications of chronic HBV?
Cirrhosis and hepatocellular carcinoma.
What serology pattern defines acute HBV?
HBsAg +
What serology pattern defines HBV vaccination?
HBsAb +
Does HBV therapy cure infection?
No — suppresses but does not cure.
What is the major risk factor for HCV?
IV drug use.
What is the typical clinical presentation of acute HCV?
Usually subclinical.
What is the earliest diagnostic test for acute HCV?
HCV RNA (~day 12).
What is the recommended therapy for HCV? Cure or not?
DAA therapy: sofosbuvir‑velpatasvir or glecaprevir‑pibrentasvir (~95% cure).
What is required for HDV infection?
HBV coinfection (needs HBsAg).
What are the two clinical presentations of HDV?
Coinfection and superinfection.
How is HDV diagnosed?
HDV RNA PCR (only if HBsAg+).
What population has high mortality from Hepatitis E virus?
Pregnant women (15–25%).
How is HEV diagnosed?
HEV RNA or HEV IgM.
What is the most common cause of acute liver failure in the US?
Drug Induced Liver Disease (DILI)==>Acetaminophen toxicity.
What is the classic histology of acetaminophen toxicity?
Centrilobular (zone 3) necrosis.
What is the toxic metabolite in acetaminophen overdose?
NAPQI.
What protects against NAPQI toxicity?
Glutathione (GSH).
What increases risk of acetaminophen toxicity at lower doses?
Chronic alcoholism, malnutrition/fasting
What does NOT increase acetaminophen toxicity risk?
Acute alcohol ingestion
What is the treatment for acetaminophen overdose?
Activated charcoal (<4 hrs) + NAC(N-Acetylcysteine).
What is the mechanism of NAC?
Replenishes glutathione to detoxify NAPQI.
What is Reye syndrome associated with?
Aspirin use in children with viral illness.
What is the pathology of Reye syndrome?
Microvesicular steatosis
What LFT pattern suggests acute viral or toxic hepatitis?
ALT > AST and levels >1000
What defines acute liver failure?
Encephalopathy + INR >1.5 + no prior liver disease.
What are the most common causes of acute liver failure?
Acetaminophen, Drug Induced Liver Injury (DILI), Acute viral hepatitis
What is the typical patient with autoimmune hepatitis?
Young/middle‑aged woman with autoimmune disease with elevated LFTs and jaundice
What are the diagnostic criteria for autoimmune hepatitis?
↑ALT/AST; ANA or ASMA, IgG
What is the treatment for autoimmune hepatitis?
Prednisone + azathioprine.
What is the typical presentation of Primary Biliary Cholangitis?
Middle‑aged woman with pruritus + fatigue.
What LFT abnormality defines Primary Biliary Cholangitis?
ALP elevation (cholestatic). AMA ≥1:80. Bile duct destruction
What is the treatment for Primary Biliary Cholangitis?
Ursodeoxycholic acid (UDCA).
What is the typical presentation of Primary Sclerosing Cholangitis? Diagnose? Complications
Cholestatic LFTs in a patient with IBD. Diagnose with MRCP. Complications: Cholangiocarcinoma (10–20%)
What is the key biopsy finding in PBC?
Bile duct destruction ± granulomas.
What is the key biopsy finding in autoimmune hepatitis?
Portal lymphocytes + plasma cells
