Medicine Marrow Pg No 1035-1044 (Hepatology)
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Questions and Answers

Which mode of transmission has the highest percentage risk for Acute Hepatitis B?

  • Vertical
  • Blood Transfusion
  • Percutaneous (correct)
  • HCV Risk

    • Feco-oral transmission is a known mode of transmission for Acute Hepatitis B.

    False

    What is the primary marker that indicates an acute hepatitis infection with high infectivity?

    HBsAg

    The most reliable test for acute hepatitis is the HBV ______ load.

    <p>DNA</p> Signup and view all the answers

    Match the following serum markers with their interpretation:

    <p>HBsAg = Indicates the presence of the virus HBeAg = High infectivity and replication Anti-HBc IgM = Acute infection Anti-HBs = Recovery from infection or vaccination</p> Signup and view all the answers

    What condition is characterized by HBsAg conversion after immunosuppressive therapy?

    <p>Seroconversion</p> Signup and view all the answers

    High replicative hepatitis is always caused by HBeAg positivity.

    <p>False</p> Signup and view all the answers

    What is the most common symptom of chronic hepatitis?

    <p>fatigue</p> Signup and view all the answers

    In low replicative hepatitis, HBV DNA is less than ______ IU/mL.

    <p>20,000</p> Signup and view all the answers

    Match the following HBV markers with their descriptions:

    <p>HBsAg -ve = Indicates no active Hepatitis B virus infection Anti-HBc IgG +ve = Indicates past infection or immunity to HBV HBeAg +ve = High infectivity and associated with liver injury HBV DNA &lt; 20,000 IU/mL = Low risk of liver injury and low infectivity</p> Signup and view all the answers

    Which phase of Hepatitis B infection is characterized by normal ALT levels and positive HBeAg status?

    <p>Phase I</p> Signup and view all the answers

    Phase IV of Chronic Hepatitis is associated with severely symptomatic patients.

    <p>True</p> Signup and view all the answers

    What are the symptoms of Acute Hepatitis B?

    <p>Fever, malaise, vomiting</p> Signup and view all the answers

    The presence of _____ is indicative of a chronic infection without inflammation and minimal fibrosis.

    <p>HBSAg Negative</p> Signup and view all the answers

    Which statement is true regarding the Immune Tolerant Phase of Hepatitis B?

    <p>Patients have a chronic infection without significant symptoms.</p> Signup and view all the answers

    Match the following hepatitis B phases with their characteristics:

    <p>Phase I = Chronic infection, HBeAg Positive, Normal ALT Phase II = Mildly symptomatic, HBeAg Positive, Elevated ALT Phase III = Chronic infection, HBeAg Negative, Normal ALT Phase V = Chronic infection, HBsAg Negative, Minimal fibrosis</p> Signup and view all the answers

    The HBV DNA level in Phase II is ____.

    <p>decreased</p> Signup and view all the answers

    What laboratory feature is confirmed in Chronic Hepatitis Phase IV?

    <p>Quantitative HBsAg greater than 1000 IU/ml</p> Signup and view all the answers

    What is the initial investigation used for chronic hepatitis?

    <p>Fibroscan</p> Signup and view all the answers

    Tenofovir Alafenamide has more side effects compared to Tenofovir Disoproxil.

    <p>False</p> Signup and view all the answers

    What is the target of treatment for HBeAg-negative patients in chronic hepatitis?

    <p>Seroconversion, ALT Normal, Suppress HBV DNA</p> Signup and view all the answers

    Lamivudine can lead to ______ due to the YMDD mutation.

    <p>Resistance</p> Signup and view all the answers

    Match the following antiviral drugs with their characteristics:

    <p>IFN-α = 30% Seroconversion, not used in HBeAg-ve patients Lamivudine = Nephrotoxic, subject to resistance Tenofovir Disoproxil = 300mg OD with potential bone mineral disease Entecavir = 0.5mg OD, effective against HBV</p> Signup and view all the answers

    What is the possible outcome of chronic hepatitis B infection?

    <p>Liver failure</p> Signup and view all the answers

    Vertical transmission of Hepatitis B from mother to child can occur at any time during the pregnancy.

    <p>False</p> Signup and view all the answers

    What is the initial percentage risk of transmission through a needle prick from an HBsAg positive patient?

    <p>6-30%</p> Signup and view all the answers

    If Anti HBs levels are between 10 and 100, a ______ dose of the vaccine is required.

    <p>booster</p> Signup and view all the answers

    Match the following Hepatitis B transmission methods with their characteristics:

    <p>Sexual = Transmitted through intimate contact Percutaneous = Transmitted via skin punctures Blood transfusion = Transmitted through contaminated blood Vertical = Transmitted from mother to child</p> Signup and view all the answers

    What is the primary genetic material of the Hepatitis B virus?

    <p>dsDNA</p> Signup and view all the answers

    Genotype C of Hepatitis B virus carries a higher risk for hepatocellular carcinoma compared to other genotypes.

    <p>True</p> Signup and view all the answers

    Name the surface protein coded by the S-gene of the Hepatitis B virus.

    <p>HbsAg</p> Signup and view all the answers

    The percentage chance of transmission during pregnancy when the mother is HBeAg positive is ______.

    <p>90</p> Signup and view all the answers

    Match the following Hepatitis B genes with their corresponding significance:

    <p>S-gene = Surface protein (HbsAg) C-gene = Core protein (HbcAg) Pre C-gene = Qualitative marker for infectivity P-gene = Reverse transcriptase enzyme</p> Signup and view all the answers

    What is the process by which HBV integrates its sub genomic mRNA into host DNA called?

    <p>Integration</p> Signup and view all the answers

    What type of infection is characterized by Acute HBV infection combined with Acute HDV infection?

    <p>Coinfection</p> Signup and view all the answers

    HBV can be easily eradicated due to its ability to integrate into host DNA.

    <p>False</p> Signup and view all the answers

    What is the viral structure that is formed at the end of the HBV life cycle?

    <p>Virion (Dane particle)</p> Signup and view all the answers

    Chronic hepatitis D virus infection typically has a better prognosis than other forms of hepatitis.

    <p>False</p> Signup and view all the answers

    What antibody is present during a superinfection of hepatitis D on top of chronic hepatitis B?

    <p>Anti HDV IgM</p> Signup and view all the answers

    HBV enters the host cell through the action of the ______ enzyme.

    <p>host</p> Signup and view all the answers

    Match the following stages of the HBV life cycle with their descriptions:

    <p>Integration with Host DNA = HBV DNA is integrated into host DNA Transcription = Sub genomic mRNA is translated into x-Protein DNA replication = Strands of DNA are replicated, resulting in plus and minus strands Virion formation = Formation of 42 nm Dane particles</p> Signup and view all the answers

    The presence of _______ is associated with chronic HDV related cirrhosis.

    <p>Anti LKM-3 Antibody</p> Signup and view all the answers

    Match the following features of hepatitis D with their descriptions:

    <p>Coinfection = Acute HBV infection + Acute HDV infection Superinfection = Chronic HBV + Acute Hepatitis D Anti HBC IgM +ve = Coinfection marker Chronic HDV related cirrhosis = Bad prognosis usually associated with superinfection</p> Signup and view all the answers

    What is the common cause of portal hypertension in Asia?

    <p>EHPVO</p> Signup and view all the answers

    NCPF/IPH has a negligible risk for cirrhosis.

    <p>True</p> Signup and view all the answers

    What is the characteristic appearance of collaterals in EHPVO during investigation?

    <p>Cavernoma</p> Signup and view all the answers

    The primary treatment approach for EHPVO includes _______ variceal ligation.

    <p>endoscopic</p> Signup and view all the answers

    Match the following features with the correct condition (EHPVO or NCPF/IPH):

    <p>1st order portal vein involvement = EHPVO Obliterative portal venopathy = NCPF/IPH Massive spleen with hypersplenism = EHPVO Massive UGI bleed = NCPF/IPH</p> Signup and view all the answers

    What is indicated by an HBV DNA load greater than 20,000 IU/mL?

    <p>High infectivity, high replication</p> Signup and view all the answers

    The presence of Anti-HBc IgM indicates chronic Hepatitis B infection.

    <p>False</p> Signup and view all the answers

    What does a positive HBsAg and negative Anti-HBs indicate about the patient's Hepatitis B status?

    <p>Acute or chronic hepatitis B with high infectivity</p> Signup and view all the answers

    A pre-core/basal core mutant is associated with an increased risk for __________.

    <p>Hepatocellular Carcinoma</p> Signup and view all the answers

    Match the following marker patterns with their interpretations:

    <ul> <li>HBsAg, - Anti-HBs, - Anti-HBc IgM, + HBeAg = Acute hepatitis B, high infectivity</li> </ul> <ul> <li>HBsAg, + Anti-HBs, - Anti-HBc IgM = Recovery from Hepatitis B</li> </ul> <ul> <li>HBsAg, - Anti-HBs, + Anti-HBc IgM, - HBeAg = Late acute hepatitis B or Chronic hepatitis B, low infectivity</li> <li>HBsAg, - Anti-HBs, - Anti-HBc IgM, - HBeAg = Chronic hepatitis B, low infectivity (Precore-mutant)</li> </ul> Signup and view all the answers

    What does a negative HBsAg and positive Anti-HBc suggest?

    <p>Recovery from past infection</p> Signup and view all the answers

    The window period of Hepatitis B infection is characterized by the presence of HBsAg and heterotypic anti-HBs.

    <p>True</p> Signup and view all the answers

    What would indicate a conversion of HBsAg to Anti-HBs after an immunization event?

    <p>Positive Anti-HBs after immunization</p> Signup and view all the answers

    Study Notes

    Hepatitis B Phases

    • Hepatitis B infection phases are categorized by HBeAg status (positive or negative)
    • Phase I/HBeAg Positive is characterized by high HBV DNA levels and normal ALT levels, usually lasting 10-30 years
    • Phase II/HBeAg Positive involves a decrease in HBV DNA levels and an increase in ALT levels, with mild symptoms
    • Phase III/HBeAg Negative is the most common phase, with low levels of HBV DNA and normal ALT levels
    • Phase IV/HBeAg Positive is characterized by high levels of HBV DNA and ALT, and associated with chronic hepatitis
    • Phase V/HBSAg Negative) is a phase with no inflammation and minimal fibrosis, indicating a chronic infection
    • Immune Tolerant Phase lacks an immune response to HBV infection
    • Immune Clearance Phase is an optimal time for treatment due to the immune system actively clearing the virus
    • Reactivation Phase is another optimal time for treatment, as there is a resurgence of the virus after a period of inactivity

    Acute Hepatitis B

    • Symptoms include fever, malaise, and vomiting
    • Laboratory Features include increased serum bilirubin and liver enzymes
    • Mode of transmission can be vertical, percutaneous, sexual, through blood transfusion, and via HCV risk
    • No transmission through fecal-oral route or breast milk
    • Post Transfusion Hepatitis is hepatitis arising after a blood transfusion
    • Anti-HAV IgM is commonly associated with acute hepatitis in children
    • Anti-HEV IgM is commonly associated with acute hepatitis in adults
    • HBSAg, HBeAg, and anti-HBc IgM are markers used to diagnose acute hepatitis B

    Chronic Hepatitis

    • Confirmation of Phase IV chronic hepatitis involves high quantitative HBsAg ( >1000 IU/ml), severe symptoms and very high HBV DNA load
    • Clinical Features include fatigue, fever, and extrahepatic manifestations like membranous nephropathy and polyarteritis nodosa
    • Low Replicative Chronic Hepatitis is characterized by low HBV DNA levels (<20,000 IU/mL) and low risk of liver injury
    • High Replicative Chronic Hepatitis is characterized by high HBV DNA level > 20,000 IU/mL and an HBeAg positive status , with increased infectivity and liver injury risk
    • High Replicative Chronic Hepatitis with HBeAg Negative status can occur due to precore mutations, indicating high HBV DNA levels > 2000 IU/mL, anti-HBc reactivity, progressive liver injury with a poor prognosis
    • Initial Investigations for chronic hepatitis involve a Fibroscan
    • Treatment Options include IFN-α, lamivudine, lamivudine + Adefovir, Tenofovir Disoproxil, Entecavir, and Tenofovir Alafenamide

    HBV Virus Structure & Progression

    • Structure: HBV is a hepadnavirus with partially double-stranded DNA, containing an incomplete (+) strand and a complete (-) strand
    • Infective Particle (virion): 42nm Dane particle
    • Genotypes: 10 genotypes of HBV exist
    • Open Reading Frames (ORFs): Four ORFs are present in the HBV genome
      • S-gene: Codes for HBsAg, a surface protein
      • C-gene: Codes for HbcAg, a core protein, with intracellular anti-HBcAg found in the blood
      • Pre C-gene: Part of the C-gene that codes for HBeAg, a qualitative marker of infectivity and replication
      • P-gene: Codes for polymerase, a reverse transcriptase enzyme
      • X-gene: Codes for Hbx Ag, associated with hepatocellular carcinoma (HCC)
    • Progression: 95-99% of HBV infections result in recovery, while 1-5% progress to chronic hepatitis
    • Chronic hepatitis can lead to portal hypertension, cirrhosis, HCC, and liver failure
    • Infectivity: HBV is highly infectious, 100x greater than HIV and 10x greater than HCV
    • Genotype A is the most common
    • Genotype C poses the highest risk for HCC
    • Presence in Body Fluids: HBV is found in all body fluids excluding stools
    • Pregnancy: 90/10 rule applies for HBV transmission during pregnancy:
      • HBeAg(+ve): 90% chance of transmission
      • HBeAg(-ve): 10% chance

    HBV Life Cycle

    • Entry: HBV enters the host cell using host enzymes
    • Integration: HBV integrates its sub genomic and pre genomic mRNAs into host DNA
    • Transcription: Sub genomic mRNA is translated into x-Protein, while pre genomic mRNA is transcribed into DNA using RNA dependent DNA polymerase
    • DNA Replication: DNA replication occurs using DNA-dependent DNA polymerase to create more DNA
    • Virion Formation: Virions, 42 nm Dane particles, are formed

    Hepatitis D Virus

    • Delta virus, RNA is a dependent virus, requiring HBV infection to replicate
    • Anti LKM-3 Antibody is associated with chronic HDV infection
    • Coinfection: Involves acute HBV and acute HDV infections
    • Superinfection (Acute on Chronic): Occurs in patients with chronic HBV and acute hepatitis D
    • Fulminant Hepatitis: Potential outcome of HDV coinfection (5-20% chance)
    • Chronic HDV related cirrhosis: Outcome of HDV superinfection, carrying a poor prognosis
    • Higher Risk of Fulminant Hepatic Failure in Pregnancy: HEV infections in pregnancy carry a higher risk of fulminant hepatic failure

    Hepatology

    • Serological patterns of Hepatitis B infection are defined by combinations of HBsAg, anti-HBs, anti-HBc IgM, HBeAg, and anti-HBe
    • Chronic Hepatitis is diagnosed with HBsAg +ve and anti-HBc IgG +ve
    • Acute reactivation of hepatitis B can occur after a period of inactivation.
    • Pre-Core/Basal Core Mutant is associated with very poor prognosis, increased risk of HCC, cirrhosis, and decompensation
    • Follow-up after 24 weeks from initial exposure or symptoms:
      • HBsAg to Anti-HBsAg conversion
      • Anti-HBc IgG to Anti-HBc IgM conversion

    Non-Cirrhotic Diseases

    • EHPVO (Extrahepatic Portal Venous Obstruction) is a condition primarily seen in children (3-8 years)
    • NCPF/IPH (Non-Cirrhotic Portal Fibrosis/Idiopathic Portal Hypertension/Hepatoportal Sclerosis) is common in Asian males (20-40 years)
    • Outcome: EHPVO has a good prognosis with minimal risk for cirrhosis, while NCPF/IPH has a good prognosis but a negligible risk of cirrhosis
    • Portal Vein Involvement: EHPVO primarily affects 1st order portal veins, while NCPF/IPH affects 3rd order portal veins
    • Cause: EHPVO is often linked to umbilical sepsis and thrombotic states, while NCPF/IPH is associated with E. coli, arsenic, and hypervitaminosis A
    • Presentation: Both conditions present with massive UGI bleeds, massive splenomegaly, anemia, and thrombocytopenia
    • Prognosis: EHPVO has a good prognosis with no risk for cirrhosis
    • Investigations: In EHPVO, CT is the initial investigation, showing cavernous collaterals.
    • Investigations: In NCPF/IPH, Doppler is the initial investigation, and biopsy is considered the gold standard and reveals obliterative portal venopathy.
    • Complications: EHPVO can lead to stunted growth and portal biliopathy.
    • Treatment: Endoscopic variceal ligation or endoscopic sclerotherapy are used for EHPVO
    • Most common cause of PHTN: Asia: EHPVO, World: Biliary atresia
    • Images: Images of CECT, color Doppler, and sclerotic portal tracts can be used for diagnosis.

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    Test your knowledge on the various phases of Hepatitis B infection. This quiz covers HBeAg status, HBV DNA levels, and associated symptoms during different stages of the infection. Explore the immune response phases as well as treatment opportunities in the context of Hepatitis B.

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