I. Virology
Lecture - Viral Hepatitis
- Infectious causes
- Hepatitis A-E virus
- Epstein Barr virus (mononucleosis)
- Cytomegalovirus
- Yellow fever
- Q fever: Coxiella burnetii (pneumonia) which can cause hepatitis
- HIV
- Lyme disease
- Syphilis
- Non Infectious causes
- Alcohol (ASH), drugs (antibiotics, statins, chemotherapy)
- Steatosis (NASH) associated with obesity
- Autoimmune
- Ischemic
- Wilson’s disease
- Acute Hepatitis
- Clinical presentation
- Asymptomatic
- Flu like symptoms: fatigue, malaise, nausea, myalgia
- Pain RUQ
- Jaundice
- Acute liver failure (days/weeks)
=> NO CIRRHOSIS
- Chronic Hepatitis
- Clinical presentation
- Asymptomatic -> fibrosis -> end stage liver disease (cirrhosis,
hepatocellular carcinoma, liver failure) -> death
- End stage liver disease: liver may shrink (-> not detectable via
palpation)
- Symptoms (cirrhosis):
- portal hypertension
- Ascites
- Splenomegaly: backflow to the spleen
- Esophageal varices: lower third
- Nausea, vomiting, aspiration (-> respiratory failure):
bleeding in the stomach
- Caput medusae
- Liver Failure
- Markers:
, - Coagulation abnormality: INR > 1.5, increased prothrombin time: low
clotting factor production
- Encephalopathy: ammonia
- Decreased albumin, increased bilirubin, hypoglycemia,
- Renal failure: hepatorenal syndrome
- Hepatitis B
- Characteristics: DNA virus envelope, different genotypes have different prevalent
locations
- Transmission: parenterally, sexually, vertically/perinatally (mother to child
transmission = MTCT), blood-blood
- Incubation: 1-6 months
, - Inactive HepB can become active: pregnancy, immunosuppression (via
infections, chemotherapy, etc)
- Patient has cleared the
virus
- HBsAG: produced acutely to
clear the infection
- Anti-HBs: only produced if the
infection is cleared
- Anti HBc: proves the patient
was in contact with the virus
(not just the vaccine)
- Patient will not clear the virus
Lecture - Viral Hepatitis
- Infectious causes
- Hepatitis A-E virus
- Epstein Barr virus (mononucleosis)
- Cytomegalovirus
- Yellow fever
- Q fever: Coxiella burnetii (pneumonia) which can cause hepatitis
- HIV
- Lyme disease
- Syphilis
- Non Infectious causes
- Alcohol (ASH), drugs (antibiotics, statins, chemotherapy)
- Steatosis (NASH) associated with obesity
- Autoimmune
- Ischemic
- Wilson’s disease
- Acute Hepatitis
- Clinical presentation
- Asymptomatic
- Flu like symptoms: fatigue, malaise, nausea, myalgia
- Pain RUQ
- Jaundice
- Acute liver failure (days/weeks)
=> NO CIRRHOSIS
- Chronic Hepatitis
- Clinical presentation
- Asymptomatic -> fibrosis -> end stage liver disease (cirrhosis,
hepatocellular carcinoma, liver failure) -> death
- End stage liver disease: liver may shrink (-> not detectable via
palpation)
- Symptoms (cirrhosis):
- portal hypertension
- Ascites
- Splenomegaly: backflow to the spleen
- Esophageal varices: lower third
- Nausea, vomiting, aspiration (-> respiratory failure):
bleeding in the stomach
- Caput medusae
- Liver Failure
- Markers:
, - Coagulation abnormality: INR > 1.5, increased prothrombin time: low
clotting factor production
- Encephalopathy: ammonia
- Decreased albumin, increased bilirubin, hypoglycemia,
- Renal failure: hepatorenal syndrome
- Hepatitis B
- Characteristics: DNA virus envelope, different genotypes have different prevalent
locations
- Transmission: parenterally, sexually, vertically/perinatally (mother to child
transmission = MTCT), blood-blood
- Incubation: 1-6 months
, - Inactive HepB can become active: pregnancy, immunosuppression (via
infections, chemotherapy, etc)
- Patient has cleared the
virus
- HBsAG: produced acutely to
clear the infection
- Anti-HBs: only produced if the
infection is cleared
- Anti HBc: proves the patient
was in contact with the virus
(not just the vaccine)
- Patient will not clear the virus
