AHN 574 GI Exam Guide With
Complete Solution
Hepatitis A Symptoms - ANSWER fatigue, malaise, HA, RUQ pain, nausea,
diarrhea, decreased appetite, weight loss, jaundice, dark urine, clay colored
stools
Hepatitis A Transmission - ANSWER Fecal-oral: undercooked fish, unpeeled
fruit or veggies, tap water while traveling, eating food prepped by infected
person
Hepatitis B Symptoms - ANSWER anorexia, fatigue, malaise, N/V, jaundice,
low grade fever, tender hepatomegaly
Hepatitis B Transmission - ANSWER Blood-borne, body fluids: body piercing
or tattoos, needle sticks, transfusions, hemodialysis, orally or sexually,
mother to child, cocaine use.
Hepatitis C Symptoms - ANSWER similar to HAV and HBV. Symptoms will be
mild with acute HCV, usually asymptomatic, and characterized by waxing and
waning aminotransferase elevations and a high rate (greater than 80%) of
chronic hepatitis. Fatigue is chronic
Hepatitis C Transmission - ANSWER lood-borne- predominantly parenteral,
small risk of sexual/perinatal transmission
Hepatitis D - ANSWER only in association with HBV infection and specifically
only in the presence of HBsAg; it is cleared when the latter is cleared. May
coinfect with HBV or superinfect with chronic H
,Hepatitis D Symptoms - ANSWER anorexia, fatigue, malaise, N/V, jaundice,
low grade fever, tender hepatomegaly
Hepatitis D Transmission - ANSWER blood-borne, body fluids
Hepatitis E geography - ANSWER primarily in Middle East, Central Asia, and
Northern Africa, but should be considered in patients with acute hepatitis
who traveled to those areas.
Hepatitis E Symptoms - ANSWER anorexia, fatigue, malaise, N/V, jaundice,
low grade fever, tender hepatomegaly
Hepatitis E Transmission - ANSWER Fecal-oral, waterborne: may be spread by
swine, having a pet in the home and consuming undercooked organ meats or
infected cow's milk.
Tests to confirm Hepatitis A - ANSWER IgM anti-HAV
IgG anti-HAV
CBC
Liver Enzymes
Urine
IgM anti-HAV - ANSWER -first lab ordered with acute illness with increased
ALT and AST activities and recent icteric illness (<6 months)
-Appears early and disappears in 3-6 months
-Positive- HAV infection within preceding 6 months
-Negative- no HAV infection within preceding 12 months
-IgM- always ACUTE
,-Think "M" = Most sensitive
IgG anti-HAV - ANSWER Rises after 1 month and stays elevated for years (if
found without IgM)
-Positive- reflects the presence of IgG antibody when IgM is negative.
-Presence of IgG indicative of previous exposure and non-infectivity (you are
not infectious).
-Negative- no previous HAV infection
-IgG- "G" means GONE when found alone
Expected values of CBC in Hepatitis - ANSWER Normal to Low WBC
Expected values of Liver Enzymes in Hepatitis A - ANSWER markedly elevated
AST/ALT (early), then ↑↑bilirubin, Alk Phos
Expected values of Urine in Hepatitis A - ANSWER mild proteinuria,
Bilirubinuria may precede jaundice
Tests to confirm Hepatitis B - ANSWER HBsAg
Anti-HBs
IgM Anti-HBc (Core Antigen)
HBe-Ag
CBC
Liver Enzymes
HBsAg - ANSWER - Detectable in serum of patients with active viral
replication (acute HBV infection)
, Anti-HBs - ANSWER -Specific antibody to HBsAg (anti-HBs: antibody to
surface antigen)
-appears in most individuals after clearance of HBsAg and after successful
vaccination against hepatitis B.
-Disappearance of HBsAg and the appearance of anti-HBs signal recovery
from HBV infection, non-infectivity, and immunity. Would show if had HBV in
past, recovered, or immunized.
-If antibody not yet detectable, could miss they had Hep B. To be sure, would
test for Anti-IgM-HBc
IgM Anti-HBc (Core Antigen) - ANSWER -present in ACUTE infection; appears
shortly after HBsAg is detected
-Can help distinguish acute from chronic HBV
-In the setting of acute hepatitis, IgM anti-HBc indicates a diagnosis of acute
hepatitis B, and it fills the serologic gap in rare patients who have cleared
HBsAg but do not yet have detectable anti-HBs.
-IgM anti-HBc can persist for 3-6 months, and sometimes longer. IgM
anti-HBc may also reappear during flares of previously inactive chronic
hepatitis B.
-IgG anti-HBc also appears during acute hepatitis B but persists indefinitely,
whether the patient recovers (with the appearance of anti-HBs in serum) or
chronic hepatitis B develops (with persistence of HBsAg)
Complete Solution
Hepatitis A Symptoms - ANSWER fatigue, malaise, HA, RUQ pain, nausea,
diarrhea, decreased appetite, weight loss, jaundice, dark urine, clay colored
stools
Hepatitis A Transmission - ANSWER Fecal-oral: undercooked fish, unpeeled
fruit or veggies, tap water while traveling, eating food prepped by infected
person
Hepatitis B Symptoms - ANSWER anorexia, fatigue, malaise, N/V, jaundice,
low grade fever, tender hepatomegaly
Hepatitis B Transmission - ANSWER Blood-borne, body fluids: body piercing
or tattoos, needle sticks, transfusions, hemodialysis, orally or sexually,
mother to child, cocaine use.
Hepatitis C Symptoms - ANSWER similar to HAV and HBV. Symptoms will be
mild with acute HCV, usually asymptomatic, and characterized by waxing and
waning aminotransferase elevations and a high rate (greater than 80%) of
chronic hepatitis. Fatigue is chronic
Hepatitis C Transmission - ANSWER lood-borne- predominantly parenteral,
small risk of sexual/perinatal transmission
Hepatitis D - ANSWER only in association with HBV infection and specifically
only in the presence of HBsAg; it is cleared when the latter is cleared. May
coinfect with HBV or superinfect with chronic H
,Hepatitis D Symptoms - ANSWER anorexia, fatigue, malaise, N/V, jaundice,
low grade fever, tender hepatomegaly
Hepatitis D Transmission - ANSWER blood-borne, body fluids
Hepatitis E geography - ANSWER primarily in Middle East, Central Asia, and
Northern Africa, but should be considered in patients with acute hepatitis
who traveled to those areas.
Hepatitis E Symptoms - ANSWER anorexia, fatigue, malaise, N/V, jaundice,
low grade fever, tender hepatomegaly
Hepatitis E Transmission - ANSWER Fecal-oral, waterborne: may be spread by
swine, having a pet in the home and consuming undercooked organ meats or
infected cow's milk.
Tests to confirm Hepatitis A - ANSWER IgM anti-HAV
IgG anti-HAV
CBC
Liver Enzymes
Urine
IgM anti-HAV - ANSWER -first lab ordered with acute illness with increased
ALT and AST activities and recent icteric illness (<6 months)
-Appears early and disappears in 3-6 months
-Positive- HAV infection within preceding 6 months
-Negative- no HAV infection within preceding 12 months
-IgM- always ACUTE
,-Think "M" = Most sensitive
IgG anti-HAV - ANSWER Rises after 1 month and stays elevated for years (if
found without IgM)
-Positive- reflects the presence of IgG antibody when IgM is negative.
-Presence of IgG indicative of previous exposure and non-infectivity (you are
not infectious).
-Negative- no previous HAV infection
-IgG- "G" means GONE when found alone
Expected values of CBC in Hepatitis - ANSWER Normal to Low WBC
Expected values of Liver Enzymes in Hepatitis A - ANSWER markedly elevated
AST/ALT (early), then ↑↑bilirubin, Alk Phos
Expected values of Urine in Hepatitis A - ANSWER mild proteinuria,
Bilirubinuria may precede jaundice
Tests to confirm Hepatitis B - ANSWER HBsAg
Anti-HBs
IgM Anti-HBc (Core Antigen)
HBe-Ag
CBC
Liver Enzymes
HBsAg - ANSWER - Detectable in serum of patients with active viral
replication (acute HBV infection)
, Anti-HBs - ANSWER -Specific antibody to HBsAg (anti-HBs: antibody to
surface antigen)
-appears in most individuals after clearance of HBsAg and after successful
vaccination against hepatitis B.
-Disappearance of HBsAg and the appearance of anti-HBs signal recovery
from HBV infection, non-infectivity, and immunity. Would show if had HBV in
past, recovered, or immunized.
-If antibody not yet detectable, could miss they had Hep B. To be sure, would
test for Anti-IgM-HBc
IgM Anti-HBc (Core Antigen) - ANSWER -present in ACUTE infection; appears
shortly after HBsAg is detected
-Can help distinguish acute from chronic HBV
-In the setting of acute hepatitis, IgM anti-HBc indicates a diagnosis of acute
hepatitis B, and it fills the serologic gap in rare patients who have cleared
HBsAg but do not yet have detectable anti-HBs.
-IgM anti-HBc can persist for 3-6 months, and sometimes longer. IgM
anti-HBc may also reappear during flares of previously inactive chronic
hepatitis B.
-IgG anti-HBc also appears during acute hepatitis B but persists indefinitely,
whether the patient recovers (with the appearance of anti-HBs in serum) or
chronic hepatitis B develops (with persistence of HBsAg)
