Conditions
A 38-year-old female has just returned from a 2-week trip to Mexico. She complains of nausea, vomiting, loss of appetite, and right upper quadrant abdominal pain. She has been sick for the past 3 days. She complains of passing dark-colored urine for the past 2 days. She has had no exposure to blood products, has no history of intravenous drug use, and has no significant risk factors for sexually transmitted disease. On examination, she looks acutely ill. Her pulse is 100 beats/minute, blood pressure 110/70 mm Hg, respirations 18, and temperature 101°F. Her sclerae are icteric, and her liver edge is tender.
Acute hep A
MSM and drug users
Hep B
MCC of Hep C?
Injection drug use
A 31-year-old man with recent needlestick injury develops fatigue, jaundice, and right upper quadrant pain. Labs show:
HBsAg positive
Anti-HBc IgM positive
Anti-HBs negative
Which types of hepatitis have a vaccine?
A and B
A 37-year-old male presents to the occupational health clinic after a needlestick exposure in a patient with cirrhosis. In addition to a standard bloodborne pathogen laboratory panel sent for all needlestick exposures at his hospital, additional hepatitis panels are ordered. The patient’s results are shown below:
HIV 4th generation Ag/Ab: Negative/Negative
Hepatitis B surface antigen (HBsAg): Negative
Hepatitis C antibody: Negative
Anti-hepatitis B surface antibody (HBsAb): Positive
Anti-hepatitis B core IgM antibody (HBc IgM): Negative
Anti-hepatitis B core IgG antibody (HBc IgG): Positive
Acute hep B
Waxing/waning aminotransferase levels and high rate of chronic hepatitis
acute Hep C
MCC of acute viral hepatitis worldwide?
Hep E
A 29-year-old man with chronic Hepatitis B suddenly develops worsening jaundice, ascites, and hepatic decompensation. Labs:
HBsAg positive
Anti-HBc IgG positive
Anti-HDV positive
Hep D superinfection
loss of HBsAg + and seroconversion to anti-HBs
A 55-year-old rock musician comes to the office because he has been feeling increasingly tired for 6 months. He has a history of intravenous drug use and alcohol abuse. He states that he feels quite tired but otherwise has no complaints. The examination is non-contributory. His laboratory investigations are normal, aside from elevated liver enzymes.
Acute Hep C
Fecal-oral AND zoonotically/undercooked organ meat/infected cow's milk
Hep E
MC associated with epidemics and sporadic cases, especially in areas of crowding and poor sanitation?
Hep A
A 45-year-old man with a history of IV drug use is evaluated. Labs:
HBsAg: positive (6 months)
Anti-HBc IgG: positive
HBeAg: positive
Anti-HBs: negative
Chronic Hep B - highly infectious
What is the tx for a symptomatic pt with autoimmune hepatitis? What is the definitive tx?
Prednisone +/- azathioprine (start 2 weeks after pred)
Definitive = liver transplant
A 52-year-old man presents for routine evaluation. He reports intermittent fatigue and mild right upper quadrant discomfort over the past few months. He denies alcohol use. His past medical history is notable for multiple tattoos obtained in his 20s and a remote history of IV drug use. He has no known family history of liver disease.
On exam, he appears well, with mild hepatomegaly but no stigmata of chronic liver disease.
Laboratory studies reveal:
AST: 88 U/L, ALT: 94 U/L (waxing/waning pattern over the last year)
Normal INR, bilirubin, and albumin
Anti-HCV antibody: positive
HCV RNA PCR: positive
Ultrasound shows mild hepatic steatosis without cirrhosis.
Chronic Hep C
Defective RNA virus
Hep D
MC symptom of Hep C?
A 37-year-old woman presents for routine screening. She has no symptoms. Labs:
HBsAg: negative
Anti-HBc IgG: positive
Anti-HBs: positive
Resolved Hep B from natural infection
What phases of chronic Hep B should be treated? What medications are used?
Immune active, reactivation, cirrhosis
Entecavir, tenofovir
A 34-year-old male anesthesiology resident presents for occupational health evaluation after sustaining a needlestick injury while placing an IV line in a patient with known chronic Hepatitis B. He denies risk factors such as transfusions or IV drug use.
Physical exam is normal. He denies jaundice, abdominal pain, or fatigue.
Laboratory testing:
HBsAg: negative
Anti-HBc IgM: negative
Anti-HBc IgG: negative
Anti-HBs: positive
Vaccination against Hep B, no prior natural infection
Type II Autoimmune Hepatitis
3 MC complications associated with chronic Hep B?
HCC, cirrhosis, liver failure
A 27-year-old health care worker is evaluated after a needlestick exposure. He has no history of hepatitis. Labs:
HBsAg: negative
Anti-HBc (IgM/IgG): negative
Anti-HBs: positive
Hep B Vaccine Immunity
What drugs are approved for chronic Hep C?
Gosh Please Stop Virus
1. Glecaprevir plus pibrentsavir x 8 weeks → genotypes 1-6
2. Sofosbuvir plus velpatasvir x 12 weeks → 1-6