Olive Oil
Fish
Legumes
Fruits
Nuts
100
What is a unique presentation of a patient that comes in with Hepatitis A?
Loses taste of cigarettes/loss of taste in smoking
100
What type of virus is Hepatitis B? How does it differ from A and C? (RNA/DNA, circular or linear)
All hepatitis have circular genetic material, A and C is RNA, but B is DNA
100
How are Hepatitis B and C transmitted?
B is primarily through sexual transmission, can also be through needles
C is primarily through blood transfusions, can be through needles and sexually also
100
What must be present for Hepatitis D to infect? And which one is worse co-infection or superimposed infection?
HBsAg and superimposed is worse
100
What antibody shows that HBV is improving in the patient? Which antibody is noticed first in HBV?
Anti-HBs IgG; Anti-HBc IgG
First: Anti-HBc IgM
200
How can interferon alpha be used to treat HBV?
IFN-α inhibits HBV replication by decreasing RNA transcription; Also leads to less acetylation which leads to less decreased gene expression
200
How does Hepatitis B DNA formation change upon infection?
Hepatitis B virus has both RNA and DNA dependent polymerases. Polymerase completes the partial dsDNA then host RNA polymerase is used to make mRNA from viral DNA. DNA polymerase then takes viral RNA to go back to DNA
200
What are a few ways to diagnose Hepatitis?
Ultrasound, liver biopsy, blood test, liver enzyme tests
200
What are some symptoms of Hepatitis B and C?
Dark Urine, Stomach pain, pale stool, yellowing eyes, low grade fever, loss of appetite, fatigue, "Stomach" pain
200
What HIV NRTI drug can be used for Hep B? What is a major major adverse affect of this drug?
Tenofovir; Fanconi Syndrome
300
How does invade and why is it called the "silent" virus?
300
Which is zone 3 of the liver more likely to get alcohol induced hepatitis?
Zone 3 of the liver has the most cytochrome 450, drinking a lot of alcohol leads to damage of this area of the liver and damage to hepatocytes making it easier for the virus to infect
300
What type of vaccine is Hepatitis A, and B? Why does C not have one?
A is inactivated/killed; B is subunit recombinant
C have constant change of the envelope protein
300
How would alcohol versus viral hepatitis be differentiated? Why would this be expected?
AST>ALT in alcohol; ALT > in viral; AST is aspartate transferase which is found in the mitochondria (aspartate malate shuttle)
300
What are ways that Hepatitis A can be avoided in developing countries?
Water purification, chlorination, boiling
400
How does Hepatitis lead to cirrhosis?
Hepatitis invades hepatocytes via the envelope viral proteins. It disrupts hepatocyte function and leads to cytokine release and inflammation leading to damage of the liver (cytokines induce apoptosis).
400
How does HCV constantly change their surface viral proteins?
Lack exonuclease 3' to 5' activity leads to no proofreading so there are more changes
400
How does a pregnant women with HBV pass is to her baby? How can this lead to chronic HBV in the baby?
Crosses via placenta (TORCHES), unique though since it is so big, baby can develop chronic hepatitis since the immune system is not as well developed
400
How does liver damage lead to jaundice?
Liver damage means that bile cannot be properly taken up by hepatocytes, which leads to a buildup that is leaked out in blood
400
Hepatitis is usually self limiting, how do you decide when to start antiviral therapy?
Must have 2/3: bilirubin >10mg/dl, INR>1.6, hepatic encephalopathy; mortality in cirrhosis
500
How can Hepatitis C lead to Hepatocellular carcinoma?
Excessive liver tissue damage and necrosis leads to new hepatocyte formation at a fast rate, leads to genomic instability and increases likelihood of mutations such as those p53
500
How can the pathogenesis of Hepatitis B and C contribute to headaches?
Hepatic Enchepalitis; Damage in liver leads to increase in ammonia which leads to hyeprammonia that crosses the BBB.
500
A 39-year-old man comes to the physician because of anorexia, malaise, dark urine and upper abdominal discomfort. His temperature is 37.9ºC (100.2ºF). Physical examination shows scleral icterus and moderate right upper quadrant tenderness. The liver is palpable below the right costal margin. Laboratory studies show:
- HBsAg: positive
- HBsAb: negative
- Anti-HBc IgM: positive
- HBeAg: positive
Which of the following will most likely change in his serologic findings when this patient enters the window period?
A. He will become HBcAg-positive
B. He will become HBc IgG-positive
C. He will become HBeAg-negative
D. He will become HBsAb-positive
E. He will become HBsAg-negative
This patient has acute hepatitis B. The “window period” refers to that period in infection when neither hepatitis B surface antigen (HBsAg) nor its antibody (HBsAb) can be detected in the serum of the patient. It is an immunologically mediated phenomenon caused by the precipitation of antigen-antibody complexes in their zone of equivalent concentrations and, thereby, their removal from the circulation.
Because of this, the first thing that will happen in the window period is that the serum will become negative for the surface antigen (HBsAg) as that antigen is precipitated out of the serum by developing levels of its specific antibody (HBsAb). Serologic tests conducted during the window period will be positive for HBcAb and HBeAb.
500
A hepatitis panel is ordered for a 25-year-old woman as part of a routine work-up for abdominal pain. Results of serologic testing are negative for HBeAg and HBsAg, but positive for HBsAb and IgG HBcAb. Which of the following is the appropriate conclusion?
(A) The patient has been exposed to hepatitis B but was never infected
(B) The patient has been exposed to hepatitis B and has completely recovered
(C) The patient has been exposed to hepatitis B and is in the acute disease phase
(D) The patient has been exposed to hepatitis B and is in the window phase
(E) The patient has not been exposed to hepatitis B
The correct answer choice is B. The patient has been exposed to hepatitis B and has completely recovered. This is because the patient tested negative for both HBeAg and HBsAg, which rules out the acute disease phase and carrier state. However, the patient tested positive for HBsAb, indicating exposure to hepatitis B, and IgG HBcAb, indicating past infection and recovery. The presence of IgG HBcAb suggests that the patient is in the completely recovered phase, rather than the window phase, as IgM HBcAb would be present in the latter. Therefore, option (B) is the most appropriate conclusion.
500
What is dermatological condition that we learned about (Unit 2) that can be caused by Hepatitis C? What causes it?
Lichen Planus (Autoimmune activation)