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VIRAL HEPATITIS ARTICLE - QUIZ INSTRUCTIONS

VIRAL HEPATITIS ARTICLE - QUIZ INSTRUCTIONS Participants who complete the Quiz found on the last two pages of this Lecture will receive a certificate of credit for one CME hour. Instructions: Read this article Go to the Quiz at the end of the article and print off the Quiz.

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VIRAL HEPATITIS ARTICLE - QUIZ INSTRUCTIONS

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  1. VIRAL HEPATITIS ARTICLE - QUIZ INSTRUCTIONS Participants who complete the Quiz found on the last two pages of this Lecture will receive a certificate of credit for one CME hour. Instructions: • Read this article • Go to the Quiz at the end of the article and print off the Quiz. • Answer the required number of questions correctly • Fax to (876)946-0954with this page and indicate your method of payment. CHECK ONE: c Cash c Credit Card: Card number _______________________Exp. date: ______ Name as it appears on card:______________________________________ c Certified Cheque - Deposit to: (NCB -Jamaica Ltd. Brown's Town Branch a/c# 716409325

  2. Viral HepatitisA to G M. G. Lee MB,BS;DM;FRCPC;FACP;FACG

  3. Viral HepatitisVirus primarily affects liver • HAV • HBV • HCV (nonA nonB) 4. HDV (delta) 5. HEV 6 -- 7. HGV

  4. Viral Hepatitis Incubation Period HAV -- 15 – 50 d HBV -- 50 -150 HCV -- 42 - 56 HDV -- occurs with HBV HEV -- 40 d

  5. Viral Hepatitis Clinical Features 1. Incubation Period • Prodromal Preicteric 3. Icteric 4. Convalescent

  6. Viral Hepatitis Prodromal Phase ( 3d – 3 wks) Acute non-specific symptoms Anorexia Nausea Vomiting Fever Headache Malaise Myalgia Photophobia R upper abdo pain

  7. Jaundice Phase (1 – 4 weeks) Prodromal symptoms diminish Jaundice Pale stools. Dark urine Hepatomegaly (80%) Splenomegaly (20%)

  8. Convalescent Phase Well – being improve progressively Weakness, easy fatiguability may persist Clinical, biochemical recovery – 6 months

  9. Viral Hepatitis Many have sub-clinical infection -- asymptomatic -- non-specific illness Jaundice occurs in minority

  10. Viral HepatitisDiagnosis Preicteric Leucopenia, Lymphopenia Atypical lymphocytes Liver Function Tests -- bilirubin variable -- alkaline phosphatase mildly ↑ --- transaminases elevated

  11. Treatment Symptomatic, supportive measures Bed rest Normal diet No Alcohol – 6 months Majority recover

  12. Viral Hepatitis A Transmission : fecal - oral

  13. Viral Hepatitis A Clinical Features 1. Incubation Period (15 – 50d) • Prodromal Preicteric 3. Icteric (10%) 4. Convalescent (complete recovery)

  14. Viral Hepatitis ADiagnosis Stool Culture • late incubation • early prodromal Anti – HAV - IgM

  15. Hepatitis B DNA virus

  16. Hepatitis B - Transmission • Vertical • Close contact – family members • Sexual • Blood – transfusion - needlestick - contaminated instruments - IV drug abuse

  17. Hepatitis B High Risk Individuals Promiscuous heterosexuals Homosexuals IV drug abusers Partners of HB patient

  18. High Risk Individuals Health care personnel - contact blood Dentists Patients -- neonates HB+ mother -- hemodialysis -- frequent transfusions -- immunosuppressed patients -- mental institution

  19. Hepatitis B infection Clinical Features 1. Incubation Period (50 – 150d) • Prodromal Preicteric 3. Icteric (50%) 4. Convalescent (90% recover)

  20. Serological Events • HBsAg -- 2 – 8 weeks before illness • HBeAg -- transient DNA polymerase • Anti HBc -- persist 4. Anti HBsAg

  21. Fulminant Hepatitis Massive hepatocellular necrosis Related to enhanced immune response Hepatic encephalopathy Coma Liver shrinks rapidly High mortality

  22. Cholestatic Hepatitis Prolonged course jaundice (6 months) Pale stools Dark urine Pruritus Good prognosis

  23. Hepatitis B infectionChronic Carrier HBsAg positive after 6 months 10% will not clear virus Impaired immunity Male:Female – 6:1 0.1% - NA. UK 3% Greece 10% Africa 15% Far East

  24. Hepatitis B infectionChronic Sequelae 1. Chronic carrier 2. Chronic persistent hepatitis 3. Chronic active hepatitis 4. Cirrhosis 5. Hepatocellular carcinoma

  25. Hepatitis B infection Prevention 1. Passive immunization - HB immune globulin -- needle stick, neonates, 2. Active immunization - HB vaccine

  26. Hepatitis C

  27. Hepatitis C Most common, important etiology --- chronic liver disease

  28. Blood transfusion IV drug use Tatooing Acupuncture Dialysis Health care workers Sexual Vertical Household Hepatitis CTransmission

  29. Hepatitis CAcute Incubation - - 50d Most asymptomatic Symptoms mild, non-specific -- fatigue, fever, arthralgia -- 25% jaundice

  30. Hepatitis CDiagnosis Elevated ALT -- May fluctuate in chronic HC infection Hepatitis C antibody -- Positive 1 – 3 months after acute HC -- 2nd generation anti-HCV pos in acute hepatitis Hepatitis C RNA

  31. Hepatitis CSequelae Chronic Hepatitis -- 75% after acute HC Cirrhosis -- 20 – 30% (20 years) Hepatoma (30 years) -- ↑ HBV, alcohol

  32. Hepatitis D Delta hepatitis

  33. Hepatitis DDelta virus Defective RNA virus Requires HBV - - protein cover HBV patient 1. Co-infect 2. Super-infect

  34. Hepatitis DClinical Features 1. Acute Delta Hepatitis - acute HBV infection 2. Acute Delta Hepatitis - chronic HBV infection 3. Chronic Delta Hepatitis - chronic HBV infection

  35. Hepatitis DClinical Features More severe illness More rapid progress

  36. Hepatitis E Single stranded RNA virus Incubation : 40 days

  37. Hepatitis E Transmission - Faecal – oral Infection highest - 15 – 40 years

  38. Hepatitis E Disease mild, self-limiting - No chronic sequelae Mortality Pregnant Women -- 20%

  39. Hepatitis EDiagnosis Prodromal: serum HEV – RNA Jaundice : stool HEV – RNA HEV – IGM HEV - IgG

  40. Hepatitis G

  41. Hepatitis G Flavivirus Transmission Blood transfusion IV drug abuse Sexual Vertical Dialysis Sporodic

  42. Hepatitis G Mild acute illness -complete clinical, biochemical resolution 75% persistent HGV infection - no chronic liver disease

  43. Post- Lecture Quiz*Participants who complete the Quiz for this Lecture will receive a certificate and credit for one CME hour.* Directions: Print and complete the Quiz found on the following pages of this lecture. When complete, fax the Quiz to the attention of Miss Maureen Phillips, Secretary-CCFP at946-0954

  44. Post- Lecture Quiz Name: ______________________________ Address: ______________________________ Contact Tel #: ______________________________ Please answer the following 5 questions. Each question has a main statement and five stems each of which is either True or False. 1. Viral Hepatitis A (a)   has an incubation period of 5 to 10 days (b)leads to most cases becoming icteric (c)usually has complete recovery (d)can be detected by stool cultures in the late incubation phase (e)is transmitted by the fecal-oral route High risk individuals for Hepatitis B include (a)partners of Hep B patients (b)homosexuals (c)individuals undergoing hemodialysis (d)patients on cholesterol lowering drugs (e)promiscuous heterosexuals Cholestatic hepatitis in Hepatitis B infection presents with a transient (5 -10 days) of jaundice symptoms include pale stools produces pruritus has a worse prognosis only occurs if the liver was previously damaged Continued on next page….

  45. Post- Lecture Quiz (cont’d) 4. Hepatitis C infection (a)is mostly asymptomatic (b)can present with fatigue and fever (c)can produce an acute arthritis (d)increases subsequent risk of hepatoma (e)produces elevated ALT Hepatitis E infection (a)is transmitted in a similar way to Hepatitis B (b)usually produces a mild self limiting disease (c)can have up to a 20% mortality in pregnant women (d)is also caused by a DNA virus like Hepatitis B (e)infection is highest in the 15 to 40 year age group You have come to the end of the Quiz. Please print off the Quiz and fax to the attention of Miss Maureen Phillips, Secretary-CCFP at 946-0954 along with a processing payment of US$10. Your certificate for one CME hour credit will be sent to you as soon as possible.

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