Podcast
Questions and Answers
Which subtype of Hepatitis C is most common in the United States?
Which subtype of Hepatitis C is most common in the United States?
What genetic polymorphism predicts response to treatment in Type 1 Hepatitis C?
What genetic polymorphism predicts response to treatment in Type 1 Hepatitis C?
Which factors increase the risk of progression in chronic Hepatitis C?
Which factors increase the risk of progression in chronic Hepatitis C?
What is the typical estimate of cirrhosis development over 20 years in chronic Hepatitis C patients?
What is the typical estimate of cirrhosis development over 20 years in chronic Hepatitis C patients?
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Which non-invasive assessment can be used to evaluate fibrosis in Hepatitis C patients?
Which non-invasive assessment can be used to evaluate fibrosis in Hepatitis C patients?
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What distinguishes acute hepatitis from chronic hepatitis?
What distinguishes acute hepatitis from chronic hepatitis?
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Which of the following causes may lead to the mimicry of acute hepatitis symptoms?
Which of the following causes may lead to the mimicry of acute hepatitis symptoms?
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Which sign is NOT typically associated with acute hepatitis?
Which sign is NOT typically associated with acute hepatitis?
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What can lead to acute liver failure, albeit very rarely?
What can lead to acute liver failure, albeit very rarely?
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Which of the following is a common symptom of both acute and chronic hepatitis?
Which of the following is a common symptom of both acute and chronic hepatitis?
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What is a significant indicator that differentiates acute hepatitis from other liver diseases?
What is a significant indicator that differentiates acute hepatitis from other liver diseases?
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Which group is routinely screened for chronic hepatitis during health checks?
Which group is routinely screened for chronic hepatitis during health checks?
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What is considered a rare complication of acute hepatitis?
What is considered a rare complication of acute hepatitis?
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Which of the following is a common cause of chronic hepatitis?
Which of the following is a common cause of chronic hepatitis?
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What is the typical prevalence rate of chronic Hepatitis B in Southeast Asia?
What is the typical prevalence rate of chronic Hepatitis B in Southeast Asia?
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Which of the following is NOT a cause of chronic hepatitis?
Which of the following is NOT a cause of chronic hepatitis?
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What is the primary mode of transmission for Hepatitis A?
What is the primary mode of transmission for Hepatitis A?
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Which hepatitis virus requires the presence of Hepatitis B for its replication?
Which hepatitis virus requires the presence of Hepatitis B for its replication?
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What is a common histological feature of chronic hepatitis C?
What is a common histological feature of chronic hepatitis C?
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Which method is commonly used for non-invasive assessment of liver fibrosis?
Which method is commonly used for non-invasive assessment of liver fibrosis?
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Which population is at increased risk for severe Hepatitis E illness?
Which population is at increased risk for severe Hepatitis E illness?
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What percentage of Hepatitis B infected adults typically develop chronic infection?
What percentage of Hepatitis B infected adults typically develop chronic infection?
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What is a common extra-hepatic manifestation associated with chronic Hepatitis C?
What is a common extra-hepatic manifestation associated with chronic Hepatitis C?
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What is the primary goal of assessing chronic hepatitis?
What is the primary goal of assessing chronic hepatitis?
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What characterizes acute viral hepatitis histologically?
What characterizes acute viral hepatitis histologically?
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Which of the following hepatitis viruses has a potential chronic carrier state?
Which of the following hepatitis viruses has a potential chronic carrier state?
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Which of the following statements about hepatitis is true? (Select all that apply)
Which of the following statements about hepatitis is true? (Select all that apply)
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Which of the following statements is true regarding acute hepatitis?
A) Acute hepatitis is defined as abnormal liver function persisting for more than 6 months.
B) Acute hepatitis can only be caused by viral infections.
C) Severe acute hepatitis may lead to acute liver failure.
D) All cases of acute hepatitis will progress to chronic hepatitis.
Which of the following statements is true regarding acute hepatitis? A) Acute hepatitis is defined as abnormal liver function persisting for more than 6 months. B) Acute hepatitis can only be caused by viral infections. C) Severe acute hepatitis may lead to acute liver failure. D) All cases of acute hepatitis will progress to chronic hepatitis.
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Which of the following conditions is characterized as causing only chronic hepatitis?
Which of the following conditions is characterized as causing only chronic hepatitis?
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What is a common inflammatory cell found in prototypical cases of hepatitis, regardless of duration?
What is a common inflammatory cell found in prototypical cases of hepatitis, regardless of duration?
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Which of the following causes of chronic liver disease is NOT typically classified under conventional 'chronic hepatitis'?
Which of the following causes of chronic liver disease is NOT typically classified under conventional 'chronic hepatitis'?
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Flares or exacerbations of chronic hepatitis may mimic acute hepatitis. Which of the following conditions may present this way?
Flares or exacerbations of chronic hepatitis may mimic acute hepatitis. Which of the following conditions may present this way?
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Which type of hepatitis is associated with a high proportion of patients developing chronic infection based on age?
Which type of hepatitis is associated with a high proportion of patients developing chronic infection based on age?
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Which of the following is true regarding the persistence of abnormalities in chronic hepatitis?
Which of the following is true regarding the persistence of abnormalities in chronic hepatitis?
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Which of the following is NOT a common cause of acute hepatitis?
Which of the following is NOT a common cause of acute hepatitis?
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Acute hepatitis is defined as diffuse liver damage with inflammation lasting less than how many months?
Acute hepatitis is defined as diffuse liver damage with inflammation lasting less than how many months?
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Which of the following viruses is considered a hepatotropic virus associated with acute hepatitis?
Which of the following viruses is considered a hepatotropic virus associated with acute hepatitis?
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Cute hepatitis may mimic flares or exacerbations of chronic hepatitis. Which of the following conditions can present acutely but has distinctive features?
Cute hepatitis may mimic flares or exacerbations of chronic hepatitis. Which of the following conditions can present acutely but has distinctive features?
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Which of the following statements about drug-induced acute hepatitis is correct?
Which of the following statements about drug-induced acute hepatitis is correct?
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What is the primary characteristic of acute hepatitis?
What is the primary characteristic of acute hepatitis?
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Which of the following is NOT considered a viral cause of acute hepatitis?
Which of the following is NOT considered a viral cause of acute hepatitis?
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Which of the following is the most common symptom of acute hepatitis in adults?
Which of the following is the most common symptom of acute hepatitis in adults?
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In children, acute hepatitis is often characterized by which of the following?
In children, acute hepatitis is often characterized by which of the following?
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Which of the following signs is commonly associated with acute hepatitis? (Select one)
Which of the following signs is commonly associated with acute hepatitis? (Select one)
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What is the typical bilirubin level in patients with acute hepatitis?
What is the typical bilirubin level in patients with acute hepatitis?
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Which of the following laboratory findings is typical in acute hepatitis?
Which of the following laboratory findings is typical in acute hepatitis?
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In the context of acute hepatitis, what does a lengthened PT indicate?
In the context of acute hepatitis, what does a lengthened PT indicate?
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Acute liver failure is considered a common outcome of acute hepatitis. Which of the following statements is true regarding its occurrence?
Acute liver failure is considered a common outcome of acute hepatitis. Which of the following statements is true regarding its occurrence?
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Chronic hepatitis is defined by the persistence of abnormalities for how long?
Chronic hepatitis is defined by the persistence of abnormalities for how long?
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Which of the following is a common cause of ongoing hepatocellular damage in chronic hepatitis?
Which of the following is a common cause of ongoing hepatocellular damage in chronic hepatitis?
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How is chronic hepatitis often diagnosed in the general population?
How is chronic hepatitis often diagnosed in the general population?
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Which of the following symptoms may indicate chronic hepatitis? A) Severe headache B) Vague symptoms like anorexia or malaise C) Persistent fever D) Acute abdominal pain
Which of the following symptoms may indicate chronic hepatitis? A) Severe headache B) Vague symptoms like anorexia or malaise C) Persistent fever D) Acute abdominal pain
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Chronic hepatitis can present with flares that may mimic which condition?
Chronic hepatitis can present with flares that may mimic which condition?
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Chronic hepatitis may be detected during follow-up investigations of which of the following?
A) Acute kidney injury
B) Acute respiratory infections
C) Acute hepatitis (e.g., HBV)
D) Hypertension
Chronic hepatitis may be detected during follow-up investigations of which of the following? A) Acute kidney injury B) Acute respiratory infections C) Acute hepatitis (e.g., HBV) D) Hypertension
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What is a potential consequence of chronic hepatitis?
What is a potential consequence of chronic hepatitis?
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Which of the following is a common cause of chronic viral hepatitis?
Which of the following is a common cause of chronic viral hepatitis?
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Which of the following conditions is characterized as always chronic?
Which of the following conditions is characterized as always chronic?
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Wilson's disease is classified as a cause of chronic hepatitis. What is its characteristic frequency?
Wilson's disease is classified as a cause of chronic hepatitis. What is its characteristic frequency?
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Which of the following is NOT considered a cause of chronic hepatitis?
Which of the following is NOT considered a cause of chronic hepatitis?
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Chronic drug hepatitis is:
Chronic drug hepatitis is:
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What do chronic liver diseases such as PBC and PSC have in common with chronic hepatitis?
What do chronic liver diseases such as PBC and PSC have in common with chronic hepatitis?
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Alpha-1-antitrypsin deficiency is classified as a cause of chronic hepatitis. What is its characteristic prevalence?
Alpha-1-antitrypsin deficiency is classified as a cause of chronic hepatitis. What is its characteristic prevalence?
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Which of the following blood tests is commonly used to assess liver enzyme levels in chronic hepatitis?
Which of the following blood tests is commonly used to assess liver enzyme levels in chronic hepatitis?
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What does viral load measurement assess in chronic hepatitis B and C?
What does viral load measurement assess in chronic hepatitis B and C?
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In the context of liver biopsy, what does the 'grade' refer to?
In the context of liver biopsy, what does the 'grade' refer to?
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What is the purpose of scoring systems in chronic hepatitis assessment?
What is the purpose of scoring systems in chronic hepatitis assessment?
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Which non-invasive assessment method is used to evaluate fibrosis in chronic hepatitis?
Which non-invasive assessment method is used to evaluate fibrosis in chronic hepatitis?
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What is a primary aim of treating chronic hepatitis?
What is a primary aim of treating chronic hepatitis?
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How does the effectiveness of treatment for chronic hepatitis change over time?
How does the effectiveness of treatment for chronic hepatitis change over time?
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What is the characteristic histological pattern associated with piecemeal necrosis in chronic hepatitis?
What is the characteristic histological pattern associated with piecemeal necrosis in chronic hepatitis?
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Which of the following conditions is most commonly associated with piecemeal necrosis and interface inflammation?
Which of the following conditions is most commonly associated with piecemeal necrosis and interface inflammation?
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In the context of liver pathology, what does "interface inflammation" refer to?
In the context of liver pathology, what does "interface inflammation" refer to?
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What is the significance of portal tract inflammation in chronic hepatitis?
What is the significance of portal tract inflammation in chronic hepatitis?
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What does 'piecemeal necrosis' specifically indicate in liver histology?
What does 'piecemeal necrosis' specifically indicate in liver histology?
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Which histological feature is observed in the portal tract during piecemeal necrosis?
Which histological feature is observed in the portal tract during piecemeal necrosis?
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Which chronic hepatitis is least likely to exhibit piecemeal necrosis and interface inflammation?
Which chronic hepatitis is least likely to exhibit piecemeal necrosis and interface inflammation?
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Which of the following viruses is associated with fecal-oral transmission?
Which of the following viruses is associated with fecal-oral transmission?
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Which hepatitis virus is primarily associated with parenteral transmission and has a risk of developing a chronic state?
Which hepatitis virus is primarily associated with parenteral transmission and has a risk of developing a chronic state?
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Which of the following statements is true regarding Hepatitis A and Hepatitis E?
Which of the following statements is true regarding Hepatitis A and Hepatitis E?
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What is the primary mode of transmission for the Yellow fever virus?
What is the primary mode of transmission for the Yellow fever virus?
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Which of the following viruses can lead to coinfection or superinfection?
Which of the following viruses can lead to coinfection or superinfection?
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Which of the following is a characteristic of Hepatitis B and C viruses?
Which of the following is a characteristic of Hepatitis B and C viruses?
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Which of the following best describes the pathological feature of spotty focal necrosis in acute viral hepatitis?
Which of the following best describes the pathological feature of spotty focal necrosis in acute viral hepatitis?
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What is the term used for necrosis that links vascular structures in the liver during acute viral hepatitis?
What is the term used for necrosis that links vascular structures in the liver during acute viral hepatitis?
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In acute viral hepatitis, panacinar necrosis affects which zones of the liver?
In acute viral hepatitis, panacinar necrosis affects which zones of the liver?
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Which type of necrosis is typically observed in acute viral hepatitis, linking vascular structures?
Which type of necrosis is typically observed in acute viral hepatitis, linking vascular structures?
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What pathological feature distinguishes acute viral hepatitis from other forms of hepatitis?
What pathological feature distinguishes acute viral hepatitis from other forms of hepatitis?
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In which zones of the liver does confluent necrosis typically occur during acute viral hepatitis?
In which zones of the liver does confluent necrosis typically occur during acute viral hepatitis?
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Which of the following features is NOT typically associated with acute viral hepatitis?
Which of the following features is NOT typically associated with acute viral hepatitis?
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What is the primary mode of transmission for Hepatitis A?
What is the primary mode of transmission for Hepatitis A?
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Hepatitis A is most commonly associated with which of the following?
Hepatitis A is most commonly associated with which of the following?
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Which group is more likely to experience symptomatic infection from Hepatitis A? (Select one)
Which group is more likely to experience symptomatic infection from Hepatitis A? (Select one)
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Which of the following statements is true regarding the infection in children?
Which of the following statements is true regarding the infection in children?
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Which of the following is a common symptom of Hepatitis A in adults?
Which of the following is a common symptom of Hepatitis A in adults?
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Which of the following is NOT a characteristic of Hepatitis A infection?
Which of the following is NOT a characteristic of Hepatitis A infection?
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Which of the following populations is at increased risk for Hepatitis A infection?
A) Individuals with chronic liver disease
B) People traveling to endemic areas
C) Individuals receiving blood transfusions
D) Healthcare workers
Which of the following populations is at increased risk for Hepatitis A infection? A) Individuals with chronic liver disease B) People traveling to endemic areas C) Individuals receiving blood transfusions D) Healthcare workers
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Which histological feature is commonly observed in Hepatitis A?
Which histological feature is commonly observed in Hepatitis A?
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What are acidophil bodies associated with in Hepatitis A histology?
What are acidophil bodies associated with in Hepatitis A histology?
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What is cholestasis in the context of Hepatitis A histology?
What is cholestasis in the context of Hepatitis A histology?
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What does the term 'Councilman body' refer to in Hepatitis A histology?
What does the term 'Councilman body' refer to in Hepatitis A histology?
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Which of the following features is NOT typically associated with the histology of Hepatitis A?
Which of the following features is NOT typically associated with the histology of Hepatitis A?
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In Hepatitis A histology, which of the following is indicative of acute hepatitis?
In Hepatitis A histology, which of the following is indicative of acute hepatitis?
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The presence of plasma cells in periportal inflammation in Hepatitis A indicates:
The presence of plasma cells in periportal inflammation in Hepatitis A indicates:
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What is the general characteristic of Hepatitis E regarding chronic disease?
What is the general characteristic of Hepatitis E regarding chronic disease?
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The histological features of Hepatitis E are most similar to which other type of hepatitis?
The histological features of Hepatitis E are most similar to which other type of hepatitis?
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What percentage of chronic Hepatitis B patients are at risk of developing liver cancer?
What percentage of chronic Hepatitis B patients are at risk of developing liver cancer?
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What is the primary strategy for the prevention of Hepatitis B transmission?
What is the primary strategy for the prevention of Hepatitis B transmission?
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Which of the following is a characteristic feature of acute Hepatitis B pathology?
Which of the following is a characteristic feature of acute Hepatitis B pathology?
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In chronic Hepatitis B, changes last for more than how many months?
In chronic Hepatitis B, changes last for more than how many months?
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What type of inflammation is observed in the portal tracts during chronic Hepatitis B?
What type of inflammation is observed in the portal tracts during chronic Hepatitis B?
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Which histological feature is variable and observed in Hepatitis B pathology?
Which histological feature is variable and observed in Hepatitis B pathology?
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Spotty hepatocyte necrosis and fibrosis in chronic Hepatitis B primarily occur in which areas?
Spotty hepatocyte necrosis and fibrosis in chronic Hepatitis B primarily occur in which areas?
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What is the significance of immunohistochemistry for HBcAg in the diagnosis of Hepatitis B?
What is the significance of immunohistochemistry for HBcAg in the diagnosis of Hepatitis B?
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What type of virus is Hepatitis B?
What type of virus is Hepatitis B?
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Which component of Hepatitis B is essential for the virus to be infective in blood?
Which component of Hepatitis B is essential for the virus to be infective in blood?
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What does the presence of Hepatitis B surface antigen (HBsAg) indicate?
What does the presence of Hepatitis B surface antigen (HBsAg) indicate?
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Which antigen in the Hepatitis B core is important for viral replication?
Which antigen in the Hepatitis B core is important for viral replication?
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What is the significance of the eight different genotypes of Hepatitis B?
What is the significance of the eight different genotypes of Hepatitis B?
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What is the role of antibodies to HBsAg?
What is the role of antibodies to HBsAg?
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What are the small non-infective particles found in the blood due to excess surface material called?
What are the small non-infective particles found in the blood due to excess surface material called?
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How can you distinguish between an infected individual and an infectious individual in the context of Hepatitis B?
How can you distinguish between an infected individual and an infectious individual in the context of Hepatitis B?
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What is the primary mechanism through which the Hepatitis B virus causes liver damage?
What is the primary mechanism through which the Hepatitis B virus causes liver damage?
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How does the immune response affect the Hepatitis B virus?
How does the immune response affect the Hepatitis B virus?
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What happens to the immune response in infected neonates?
What happens to the immune response in infected neonates?
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How does interferon affect the immune response in Hepatitis B?
How does interferon affect the immune response in Hepatitis B?
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What can lead to fluctuations in the immune response to Hepatitis B?
What can lead to fluctuations in the immune response to Hepatitis B?
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In the context of Hepatitis B, what can cause acute flares of liver damage?
In the context of Hepatitis B, what can cause acute flares of liver damage?
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Which of the following best describes the state of immune control in Hepatitis B?
Which of the following best describes the state of immune control in Hepatitis B?
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What does the presence of the Viral S protein (HBsAg) indicate?
What does the presence of the Viral S protein (HBsAg) indicate?
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What does the presence of the Viral S protein (HBsAg) indicate?
What does the presence of the Viral S protein (HBsAg) indicate?
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Which protein is made by the Hepatitis B virus but does not appear free in the blood?
Which protein is made by the Hepatitis B virus but does not appear free in the blood?
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What does the presence of the Viral E protein (HBeAg) indicate?
What does the presence of the Viral E protein (HBeAg) indicate?
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Which human antibodies are the best markers for indicating active Hepatitis B infection?
Which human antibodies are the best markers for indicating active Hepatitis B infection?
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What does the appearance of anti-E antibodies indicate after Hepatitis B infection?
What does the appearance of anti-E antibodies indicate after Hepatitis B infection?
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What does the presence of the Viral S protein (HBsAg) indicate?
What does the presence of the Viral S protein (HBsAg) indicate?
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Which protein is produced by the Hepatitis B virus but does not circulate freely in the blood?
Which protein is produced by the Hepatitis B virus but does not circulate freely in the blood?
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What does the presence of the Viral E protein (HBeAg) signify?
What does the presence of the Viral E protein (HBeAg) signify?
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What do the human anti-C antibodies (IgM and IgG) indicate?
What do the human anti-C antibodies (IgM and IgG) indicate?
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Which statement is true regarding the human anti-E antibodies?
Which statement is true regarding the human anti-E antibodies?
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If a patient develops human S protein (anti-HBs antibodies), what does it indicate?
If a patient develops human S protein (anti-HBs antibodies), what does it indicate?
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Which of the following best describes Fulminant Hepatitis B?
Which of the following best describes Fulminant Hepatitis B?
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Chronic Hepatitis B is defined by which of the following?
Chronic Hepatitis B is defined by which of the following?
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Which of the following is a significant risk associated with Chronic Hepatitis B?
Which of the following is a significant risk associated with Chronic Hepatitis B?
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What is the typical outcome of Acute Hepatitis B in most patients?
What is the typical outcome of Acute Hepatitis B in most patients?
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Which disease course of Hepatitis B has the highest mortality rate?
Which disease course of Hepatitis B has the highest mortality rate?
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In the context of Hepatitis B, what is the main risk factor for developing hepatocellular carcinoma?
In the context of Hepatitis B, what is the main risk factor for developing hepatocellular carcinoma?
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Which of the following antibodies appears first in response to Hepatitis B infection?
Which of the following antibodies appears first in response to Hepatitis B infection?
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What is the significance of detecting anti-E antibodies shortly after viral E protein?
What is the significance of detecting anti-E antibodies shortly after viral E protein?
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What do the presence of Human S protein and anti-S antibodies indicate?
What do the presence of Human S protein and anti-S antibodies indicate?
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Which antibody is the best marker for active Hepatitis B infection?
Which antibody is the best marker for active Hepatitis B infection?
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In which phase of chronic Hepatitis B infection is the patient typically immune tolerant and HBe antigen positive?
In which phase of chronic Hepatitis B infection is the patient typically immune tolerant and HBe antigen positive?
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Which of the following characterizes Phase 1 of chronic Hepatitis B infection?
Which of the following characterizes Phase 1 of chronic Hepatitis B infection?
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What is a potential risk associated with Phase 1 of chronic Hepatitis B infection?
What is a potential risk associated with Phase 1 of chronic Hepatitis B infection?
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During which phase of chronic Hepatitis B infection does the patient experience liver cell necrosis and elevated transaminase levels?
During which phase of chronic Hepatitis B infection does the patient experience liver cell necrosis and elevated transaminase levels?
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What is the primary characteristic of Phase 2 in chronic Hepatitis B infection?
What is the primary characteristic of Phase 2 in chronic Hepatitis B infection?
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What action is often taken during Phase 2 of chronic Hepatitis B infection due to raised transaminase levels and necrosis?
What action is often taken during Phase 2 of chronic Hepatitis B infection due to raised transaminase levels and necrosis?
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In Phase 3 of chronic Hepatitis B infection, what is the status of the Hepatitis E antigen (HBeAg)?
In Phase 3 of chronic Hepatitis B infection, what is the status of the Hepatitis E antigen (HBeAg)?
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What characterizes Phase 3 of chronic Hepatitis B infection?
What characterizes Phase 3 of chronic Hepatitis B infection?
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What is the primary immune response during Phase 3 of chronic Hepatitis B infection?
What is the primary immune response during Phase 3 of chronic Hepatitis B infection?
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In Phase 3, what is the risk of progression to cirrhosis or hepatocellular carcinoma (HCC)?
In Phase 3, what is the risk of progression to cirrhosis or hepatocellular carcinoma (HCC)?
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In Phase 4 of chronic Hepatitis B infection, what happens to the Hepatitis E antigen status?
In Phase 4 of chronic Hepatitis B infection, what happens to the Hepatitis E antigen status?
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What characterizes Phase 4 of chronic Hepatitis B infection?
What characterizes Phase 4 of chronic Hepatitis B infection?
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During Phase 4, what is indicated for the treatment of patients with raised transaminases?
During Phase 4, what is indicated for the treatment of patients with raised transaminases?
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What characterizes Phase 1 of chronic Hepatitis B infection?
What characterizes Phase 1 of chronic Hepatitis B infection?
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During Phase 2 of chronic Hepatitis B infection, what happens to the liver enzymes?
During Phase 2 of chronic Hepatitis B infection, what happens to the liver enzymes?
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What is the typical immune status in Phase 2 of chronic Hepatitis B infection?
What is the typical immune status in Phase 2 of chronic Hepatitis B infection?
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In Phase 3 of chronic Hepatitis B infection, what is the status of Hepatitis E antigen (HBeAg)?
In Phase 3 of chronic Hepatitis B infection, what is the status of Hepatitis E antigen (HBeAg)?
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Which statement is true regarding the immune response in Phase 1 of chronic Hepatitis B infection?
Which statement is true regarding the immune response in Phase 1 of chronic Hepatitis B infection?
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In a patient experiencing a transition from Phase 3 to Phase 4 of chronic Hepatitis B, which of the following actions should be taken?
In a patient experiencing a transition from Phase 3 to Phase 4 of chronic Hepatitis B, which of the following actions should be taken?
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Which complication is characterized by fever, rash, and arteritis in patients with chronic HBV infection?
Which complication is characterized by fever, rash, and arteritis in patients with chronic HBV infection?
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Which of the following conditions is associated with renal inflammation due to Hepatitis B?
Which of the following conditions is associated with renal inflammation due to Hepatitis B?
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What does the presence of anti-HBe alongside HBsAg indicate in a patient?
What does the presence of anti-HBe alongside HBsAg indicate in a patient?
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Which marker is considered the most reliable indicator of active viral replication in Hepatitis B?
Which marker is considered the most reliable indicator of active viral replication in Hepatitis B?
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What is commonly expected when escape mutant strains of HBV are present?
What is commonly expected when escape mutant strains of HBV are present?
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Which treatment approach may lead to seroconversion of HBsAg?
Which treatment approach may lead to seroconversion of HBsAg?
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When monitoring Hepatitis B infection, which marker should be evaluated after HBeAg clearance?
When monitoring Hepatitis B infection, which marker should be evaluated after HBeAg clearance?
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Which complication of Hepatitis B is specifically associated with renal disease characterized by inflammation?
Which complication of Hepatitis B is specifically associated with renal disease characterized by inflammation?
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What does the presence of anti-HBs antibodies indicate in the context of Hepatitis B?
What does the presence of anti-HBs antibodies indicate in the context of Hepatitis B?
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Which condition is characterized by fever, rash, and arteritis in patients with chronic Hepatitis B infection?
Which condition is characterized by fever, rash, and arteritis in patients with chronic Hepatitis B infection?
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What signifies a chronic Hepatitis B infection in serological markers?
What signifies a chronic Hepatitis B infection in serological markers?
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What percentage of patients with Polyarteritis Nodosa are found to be carriers of Hepatitis B virus?
What percentage of patients with Polyarteritis Nodosa are found to be carriers of Hepatitis B virus?
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What does the absence of HBsAg and presence of anti-HBs in a patient's serology indicate?
What does the absence of HBsAg and presence of anti-HBs in a patient's serology indicate?
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What does the presence of IgM anti-HBc indicate about a patient's Hepatitis B status?
What does the presence of IgM anti-HBc indicate about a patient's Hepatitis B status?
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What does the marker HBeAg indicate about a patient's Hepatitis B infection?
What does the marker HBeAg indicate about a patient's Hepatitis B infection?
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What percentage of patients with untreated chronic Hepatitis C is estimated to develop cirrhosis within 20 years?
What percentage of patients with untreated chronic Hepatitis C is estimated to develop cirrhosis within 20 years?
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What is the estimated average duration for untreated chronic Hepatitis C infection to progress to cirrhosis?
What is the estimated average duration for untreated chronic Hepatitis C infection to progress to cirrhosis?
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In patients with untreated chronic HCV, which factor is NOT recognized as a risk factor for severe liver disease progression?
In patients with untreated chronic HCV, which factor is NOT recognized as a risk factor for severe liver disease progression?
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Which histological finding is commonly observed in untreated chronic Hepatitis C infection?
Which histological finding is commonly observed in untreated chronic Hepatitis C infection?
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What is a common reason that chronic Hepatitis C infection goes undiagnosed in many patients?
What is a common reason that chronic Hepatitis C infection goes undiagnosed in many patients?
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Which of the following describes the term 'piecemeal necrosis'?
Which of the following describes the term 'piecemeal necrosis'?
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What does the 'grade' of liver disease primarily refer to?
A) Extent of necrosis
B) Extent of inflammation +/- necrosis
C) Type of inflammatory cells present
D) Extent of fibrosis
What does the 'grade' of liver disease primarily refer to? A) Extent of necrosis B) Extent of inflammation +/- necrosis C) Type of inflammatory cells present D) Extent of fibrosis
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In liver pathology, which pattern describes necrosis that spans across multiple lobules?
In liver pathology, which pattern describes necrosis that spans across multiple lobules?
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What does trichrome stain primarily highlight in liver tissue?
What does trichrome stain primarily highlight in liver tissue?
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Which of the following is a key feature of decompensated cirrhosis?
Which of the following is a key feature of decompensated cirrhosis?
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Study Notes
Hepatitis
- Hepatitis is an inflammation of the liver.
- Most cases of hepatitis are short-lived (acute) and resolve within six months.
- Some diseases cause only acute hepatitis, for example, Hepatitis A virus (HAV).
- Other causes of hepatitis can lead to ongoing, chronic inflammation of the liver, including autoimmune hepatitis (AIH) and Wilson’s disease.
- Some causes of acute hepatitis can become chronic, such as Hepatitis B (HBV).
- Severe acute hepatitis can cause acute liver failure.
- Lymphocytes are the main inflammatory cells in the liver, regardless of the duration of the infection.
- Flares and exacerbations of chronic hepatitis, regardless of cause (AIH, Wilson’s, chronic HBV or chronic HBV with HDV superinfection), can appear similar to acute hepatitis.
- Other causes of chronic liver diseases have distinctive features:
- Alcohol-related liver disease
- Non-alcoholic fatty liver disease (NAFLD)
- Chronic inflammatory biliary tract diseases (PBC, PSC)
- Hereditary hemochromatosis
Causes of Acute Hepatitis
- Causes of acute hepatitis include viral infections, drug toxicity, and alcohol abuse.
- Viral causes of acute hepatitis include: HAV, HBV, HCV, HEV, Epstein-Barr virus (EBV), cytomegalovirus (CMV), and rubella.
- Drugs can cause acute hepatitis identical to viral hepatitis in adults.
- Symptoms of acute hepatitis can be non-specific, including nausea, anorexia, and malaise.
- Acute liver failure is a rare but serious complication of acute hepatitis.
Signs of Acute Hepatitis
- A swollen, tender liver is a common sign of acute hepatitis.
- Jaundice (yellowing of the skin) is a more severe symptom but can be absent, especially in children.
- The absence of signs of chronic disease, such as clinical, blood, or histological findings, distinguishes it from chronic hepatitis.
Blood Tests for Acute Hepatitis
- Blood tests will show elevated levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), often to very high levels, but normalization within six months.
- Increased levels of bilirubin and normal albumin levels are other characteristic findings.
- A prolonged prothrombin time (PT) reflects mild liver dysfunction, but a significant prolongation is a sign of acute liver failure (ALF).
Chronic Hepatitis
- Chronic hepatitis is a persistent abnormality lasting more than six months.
- It is characterized by ongoing effects resembling acute hepatitis, including hepatocellular damage, observable biochemically, histologically, and clinically.
- Chronic hepatitis is a syndrome with many causes but similar histological features.
- It is usually identified through routine testing, health checks, or investigation of symptoms.
- Chronic hepatitis is often detected during investigations for vague symptoms like anorexia, malaise, or flares, which can resemble acute hepatitis.
- It can be a consequence of untreated acute hepatitis, especially HBV.
- Liver cirrhosis with associated complications can arise from chronic hepatitis.
Causes of Chronic Hepatitis
- The most common causes of chronic hepatitis are chronic viral hepatitis, autoimmune hepatitis, and Wilson’s disease.
- Chronic viral hepatitis is caused by HBV, HCV, or HDV superinfection.
- Other rare causes include chronic drug hepatitis, Alpha-1-antitrypsin deficiency, and Wilson’s disease.
- Other causes of chronic liver disease and damage, including PBC, PSC, alcoholic liver disease, NAFLD, and hemochromatosis, have distinctive features.
- All causes of chronic liver disease share a risk of fibrosis, progression to cirrhosis, and increased risk of hepatocellular carcinoma (HCC).
Assessment of Chronic Hepatitis
- Blood tests are crucial for assessing chronic hepatitis.
- Liver enzymes (ALT/AST) are elevated.
- Viral load and genotype testing for HBV and HCV can determine the extent of the infection.
- Liver biopsy provides valuable information about the stage of fibrosis, grade of necroinflammatory activity, and the degree of liver damage.
- Scoring systems derived from biopsy findings can guide prognosis and treatment options.
- Non-invasive assessments of fibrosis, including FibroScan, are valuable tools in monitoring chronic hepatitis.
- Treatment aims to eliminate, reduce, or delay the progression towards cirrhosis and reduce the risk of HCC.
Piecemeal Necrosis/Interface Inflammation
- Piecemeal necrosis is a hallmark of chronic hepatitis, particularly HBV and autoimmune hepatitis.
- It is seen as inflammation blurring the interface between the portal tract (center and bottom right) and the liver parenchyma (upper left).
- This interface inflammation causes damage to the involved liver cells.
Viral Hepatitis
- Hepatotropic viruses cause viral hepatitis.
- HAV and HEV are primarily associated with fecal-oral/enteral transmission and do not typically cause chronic infection.
- HBV and HCV are associated with parenteral transmission, posing a risk of chronic infection.
- Other viral causes of acute hepatitis include EBV, CMV, and rubella.
- Coinfection or superinfection is possible with infections like HCV/HBV/HIV or HBV+HDV.
Acute Viral Hepatitis
- Acute viral hepatitis is characterized by pathological features that include:
- Spotty focal necrosis of individual hepatocytes
- Confluent bridging necrosis, which connects vascular structures, typically in zones 1 and 2
- Panacinar necrosis, involving all three zones (1, 2, and 3)
Hepatitis A
- HAV spreads by the fecal-oral route through enteral transmission.
- It is most associated with travel to endemic areas and can manifest as a mild illness or be asymptomatic.
- Symptomatic infection (jaundice and fever) is more common in adults.
- Childhood infection is often silent, contributing to the reservoir of infection.
- ALF is a rare outcome, and jaundice can be prolonged.
- No chronic disease or carrier state exists.
Hepatitis A – Histology
- Histological features of HAV resemble those of acute hepatitis in general:
- Periportal inflammation with plasma cells
- Cholestasis
- Acidophil bodies
- Apoptosis
- Councilman bodies
Hepatitis A (Continued)
- Anti-HAV antibody provides lifelong immunity.
- IgM anti-HAV indicates a recent (acute) infection.
- Active immunization is recommended for those at risk, inducing protective anti-HAV antibodies.
Hepatitis E
- Hepatitis E is similar to hepatitis A in terms of its illness and epidemiology.
- It is prevalent in developing countries and is often associated with water-borne outbreaks.
- It is the most common cause of ALF in South Asia (genotype 1) and is found sporadically in non-endemic countries (zoonotic, genotype 3)
- Serological and molecular tests are available for diagnosis.
- HEV infection is mostly subclinical or mild, but can rarely lead to acute liver failure.
- Pregnant women have a higher risk of more severe disease.
- There is generally no chronic infection or carrier state.
- Chronic infection is linked to immunosuppression.
- Histology resembles Hepatitis A.
Hepatitis B
- Chronic HBV disease affects 300 million worldwide, making it a leading cause of chronic hepatitis, cirrhosis, and liver cancer.
- Annual deaths from HBV-related complications reach 1 million.
- Prevalence ranges from 0.1% to 10%, depending on location and risk factors.
- SE Asia, China, and Africa have high prevalence (over 8%).
- Intermediate prevalence (2-8%) is found in S Asia and the Middle East.
- Low prevalence (under 2%) is found in North America, Europe, Australia, and New Zealand.
- Childhood infection carries a 20-30% risk of developing chronic infection.
- Adults have a much lower (2%) prevalence.
- Pregnant women are a high-risk group, as their infants are vaccinated and receive Hepatitis B immunoglobulin (HBIG).
- Patients undergoing immunosuppression also face increased risk.
- High-risk groups for HBV include intravenous drug users (IDUs), individuals with frequent sex partners/men who have sex with men (MSM), contacts of infected individuals, and children of parents from high-prevalence areas (over 8%).
Hepatitis D
- Hepatitis D (delta agent) is an RNA virus that requires the presence of HBV for replication.
- This virus can either coinfect with HBV or superinfect an individual already infected with HBV.
- It increases the risk of developing chronic HBV infection.
- Hepatitis D is commonly found in IDUs and is rare in Ireland.
Hepatitis C
- Prior to the identification of HCV in 1987, blood or blood-product associated hepatitis was referred to as non-A, non-B hepatitis.
- HCV is a major cause of chronic liver disease worldwide, impacting an estimated 180 million.
- Prevalence varies greatly between locations.
- Six genotypes of HCV exist, each impacting disease behavior and treatment response.
- Transmission occurs primarily through blood, IDUs, and sporadic routes.
- The exact pathogenesis of HCV is not fully understood.
- Acute HCV infection is typically silent and often goes unrecognized.
- Over 80% of cases progress to chronic infection.
- Chronic HCV infection is frequently detected incidentally.
- Vague symptoms like fatigue and arthralgia are common in chronic HCV infection.
- A small percentage of patients develop extrahepatic manifestations.
Hepatitis C Worldwide Prevalence
- Prevalence varies widely depending on region.
- In the US, prevalence is estimated at 1.5% of the population.
- In Europe, the prevalence is approximately 1%.
- In Egypt, the prevalence is estimated at 10%.
- Eastern Asia has prevalence rates between 1-3%.
Diagnosis of Hepatitis C
- Serological testing for anti-HCV antibodies indicates exposure to the virus but does not confirm active infection.
- The presence of HCV RNA in the blood confirms an ongoing infection.
- Quantifying HCV RNA levels provides insight into the extent of infection.
Hepatitis C Histology
- Chronic HCV infection is characterized by mild chronic hepatitis with a variety of histological findings.
- These findings include:
- Portal tract lymphoid aggregates and follicles
- Bile duct infiltration by lymphocytes
- Fatty change
- Portal and lobular granulomas
- Giant cell formation
Hepatitis C Extrahepatic Manifestations
- Extrahepatic manifestations of HCV infection include:
- Arteritis
- Cryoglobulinaemia with glomerulonephritis
- Porphyria cutanea tarda (PCT)
- Increased incidence of diabetes
- Association with lichen planus, Sjogren's syndrome, and non-Hodgkin lymphoma
Diagnosis of Hepatitis C (Continued)
- Genotyping is essential in HCV management:
- Genotype 1a is the most common in the US but is least responsive to interferon therapy.
- Genotype 1b is most prevalent in Europe.
- Types 2 and 3 are found in other regions.
- Polymorphism in the IFNL3/IL28B gene is a strong predictor of treatment response in genotype 1.
- A sustained virological response (SVR) – undetectable HCV RNA after 12 or 24 weeks of treatment – is the goal of treatment.
- SVR significantly reduces progression to cirrhosis and HCC.
Hepatitis C Clinical Course
- The risk of progression varies in chronic HCV infection, with increased vulnerability in men, older individuals, and those coinfected with HIV or HBV, or who abuse alcohol, or are obese.
- Progression towards cirrhosis can take 20-30 years and is estimated to occur in 20% of patients over 20 years.
- Histological assessment of liver damage through biopsies is vital for predicting progression.
- Previously, interferon-based regimens were guided mainly by genotype 1.
- Non-invasive assessments of fibrosis, like FibroScan, are now used.
- Biochemical abnormalities and clinical symptoms may be absent in chronic HCV, making it a silent disease.
Clinical Course of Untreated HCV Infection
- The clinical course of untreated HCV infection involves a gradual progression over years.
- The risk of cirrhosis and HCC increases with time.
- Progressive liver damage and fibrosis can lead to liver decompensation, portal hypertension, and hepatic encephalopathy.
- Untreated chronic HCV infection represents an increasing risk to public health.
Extrahepatic Complications of Hepatitis B
- Hepatic encephalopathy is not an extrahepatic complication of Hepatitis B.
- Polyarteritis nodosa affects 30-50% of Hepatitis B virus carriers.
- Serum sickness-like syndrome manifests as fever, rash, and arteritis in patients with chronic HBV infection.
- Glomerulonephritis, a renal inflammation, can be a complication associated with Hepatitis B.
Hepatitis B Serology
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HBsAg indicates current HBV infection.
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Anti-HBs signifies immunity to Hepatitis B.
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IgM anti-HBc suggests a recent acute infection.
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Anti-HBc is the best indicator of past exposure to Hepatitis B virus.
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The absence of HBsAg and the presence of anti-HBs indicate recovery or vaccination from Hepatitis B.
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HBeAg indicates high viral replication and infectivity.
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Anti-HBe antibodies imply low infectivity and low viral replication.
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HBeAg seroconversion to HBeAg- is primarily aimed at developing anti-HBe antibodies during Hepatitis B treatment.
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Escape mutant strains of HBV lack the e antigen and may not be detected by standard serological tests.
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HBV DNA levels are the most reliable marker of active viral replication and infectivity in Hepatitis B.
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HBsAg positivity with the presence of anti-HBe suggests chronic infection with low infectivity (inactive carrier).
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Both interferon therapy and antiviral therapy may lead to HBsAg seroconversion.
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After HBeAg is cleared, the next significant marker to check for in monitoring Hepatitis B infection is anti-HBe.
Chronic Hepatitis C Infection
- Untreated chronic Hepatitis C infection often remains asymptomatic for years.
- The estimated average duration for untreated chronic Hepatitis C infection to progress to cirrhosis is 20-30 years.
- 20% of patients with untreated chronic Hepatitis C are estimated to develop cirrhosis within 20 years.
- A common histological finding in untreated chronic Hepatitis C infection is lymphocytic infiltration in portal tracts and periportal regions.
Risk Factors for Progression
- Male gender is a risk factor for progression to more severe liver disease in patients with untreated chronic HCV.
- Age over 50 is a risk factor for progression to more severe liver disease in patients with untreated chronic HCV.
- Co-infection with HIV or HBV is a risk factor for progression to more severe liver disease in patients with untreated chronic HCV.
Diagnosis and Monitoring
- FibroScan is a non-invasive method used to assess liver fibrosis in patients with chronic Hepatitis C instead of a biopsy.
- Chronic Hepatitis C infection often goes undiagnosed because routine screening is not conducted in the general population.
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Description
Test your knowledge on hepatitis, an inflammation of the liver, and its various causes and types. This quiz covers acute and chronic hepatitis, as well as specific conditions such as autoimmune hepatitis and Wilson's disease. Explore the key features and classifications of liver diseases in this informative quiz.