Hepatitis Quiz

Viral Hepatitis: Key Points

• Chronic HDV treatment includes pegylated interferon alpha and is effective in about 25% of individuals, with new treatments in clinical development.
• Hepatitis E Virus (HEV) is most common in Asian and African countries, transmitted by the fecal-oral route through contaminated water or uncooked meat, and has animal reservoirs including domestic pigs, wild boars, deer, mongoose, and rabbits.
• HEV is more prevalent among adults, with the highest mortality in pregnant women and immunosuppressed individuals, and diagnosis is based on detection of anti-HEV IgM, with effective treatments being ribavirin and pegylated interferon.
• Pathologic lesions of hepatitis are similar to those caused by other viral infections and include hepatic cell necrosis, scarring, Kupffer cell hyperplasia, and infiltration by mononuclear phagocytes, with regeneration of hepatic cells beginning within 48 hours of injury.
• Hepatitis B and C cause the most severe damage, with hepatitis B associated with acute liver failure and a high mortality rate, but complete recovery can occur.
• Clinical manifestations of viral hepatitis include nausea, malaise, abdominal pain, and jaundice, with the spectrum of manifestations ranging from absence of symptoms to fulminating hepatitis.
• Acute viral hepatitis causes abnormal liver function test results and consists of four phases: incubation, prodromal, icteric, and recovery phases.
• The prodromal phase of hepatitis begins about 2 weeks after exposure, with symptoms such as fatigue, anorexia, malaise, nausea, vomiting, headache, and low-grade fever, and about 10% of individuals may develop extrahepatic symptoms.
• The icteric phase begins about 1 to 2 weeks after the prodromal phase and lasts 2 to 6 weeks, with hepatocellular destruction and intrahepatic bile stasis causing jaundice.
• The recovery phase begins with resolution of jaundice, with most cases seeing liver function test results return to normal within 2 to 12 weeks after the onset of jaundice, while chronic active hepatitis is associated with HBV, HCV, and HDV infection.
• Diagnosis and treatment for different types of hepatitis viruses were previously described, with physical activity potentially being restricted and a low-fat, high-carbohydrate diet being beneficial if bile flow is obstructed.
• A combined vaccine for HAV and HBV is available, and hepatitis B immunoglobulin provides passive prophylactic immunity against HBV, while there should be no direct contact with blood or body fluids of individuals with hepatitis B or hepatitis C.