What complications can arise from long-term liver fluke infection?
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Complications such as cholecystitis and cholangitis can occur.
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What complications can arise from long-term liver fluke infection?
Complications such as cholecystitis and cholangitis can occur.
How are liver fluke infections diagnosed?
They are diagnosed based on examining the stool for ova and parasites under a microscope.
What is the treatment for infection by Fasciola hepatica?
The treatment includes the anthelmintic drug triclabendazole.
What is the treatment for clonorchiasis and opisthorchiasis?
The treatment includes the anthelmintic drug praziquantel.
What is the intermediate host for Fasciola hepatica?
The intermediate host is a snail.
What are the intermediate hosts for Clonorchis sinensis and Opisthorchis?
The intermediate hosts are snails, then fish.
What are the common symptoms of patients with hepatic abscesses?
Intermittent fevers, right upper quadrant pain, and in some cases CVA tenderness.
What is the treatment for hepatic abscesses?
Percutaneous drainage and a nitroimidazole plus a third-generation cephalosporin, specifically metronidazole and ceftriaxone.
How can drainage of a hepatic abscess be performed?
By percutaneous aspiration with a needle or percutaneous catheter drainage.
What is initiated prior to percutaneous drainage of a hepatic abscess?
IV empiric antibiotics.
What is the most common cause of liver abscess in the United States?
Ascending cholangitis due to E coli infection.
What type of patients are at risk for developing fungal hepatic abscess?
Immunocompromised patients due to candida infection.
What is the main cause of amebic hepatic abscesses in humans?
Entamoeba histolytica.
What is the treatment for amebic hepatic abscess?
Metronidazole followed by an aminoglycoside antibiotic such as paromomycin.
What are the life cycle stages of Fasciola hepatica?
Adult, eggs, miracidia, cercaria, and metacercaria.
How can Clonorchis sinensis and Opisthorchis species be treated?
Using praziquantel.
What are the general histologic abnormalities associated with hepatitis?
Histologic abnormalities vary but can include necrosis, inflammation, and fibrosis, with specific features unique to hepatitis B and C.
What are the key aspects of the epidemiology, presentation, complications, and treatment of viral hepatitis?
Epidemiology includes transmission routes, presentation can vary from asymptomatic to severe liver disease, complications may include cirrhosis and liver cancer, and treatment varies by virus type.
How is hepatitis defined and what is a typical clinical and lab presentation?
Hepatitis is defined as inflammation of the liver, typically presenting with jaundice, elevated liver enzymes, and possible abdominal pain.
What are the common serologic markers used in the diagnosis of hepatitis viruses?
Common serologic markers include HBsAg, anti-HBs, anti-HCV, and others that help differentiate between types of hepatitis.
How do the replication cycles of hepatitis B virus and hepatitis C virus compare?
Hepatitis B virus replicates through a DNA intermediate and integrates into the host genome, while hepatitis C virus replicates in the cytoplasm using an RNA genome.
What is the structure and taxonomical classification of the hepatitis viruses?
Hepatitis viruses are classified into five main types: A, B, C, D, and E, each with distinct structures and transmission routes.
What is the most common cause of hepatitis?
Infectious agents.
What are some non-infectious causes of hepatitis?
Toxins like heavy alcohol ingestion, drugs, metabolic causes, and autoimmune reactions.
What happens to liver function in many cases of hepatitis?
There is a transient decline in liver function.
Are most cases of hepatitis acute or chronic?
Many cases are acute and completely reversible.
What can chronic hepatitis progress to?
Fibrosis, cirrhosis, and end-stage liver disease requiring transplantation.
What are common symptoms of hepatitis?
Fever, anorexia, malaise, jaundice, constipation, grey-colored stools, and hepatomegaly.
What does jaundice indicate in a patient?
It indicates liver dysfunction or disease, often seen in hepatitis.
What are potential chronic complications of hepatitis?
Persistent infection and cirrhosis.
What is the range of disease progression in hepatitis?
It can range from mild and limited to progressive and fatal (fulminant hepatitis).
What lab finding indicates high levels of bilirubin in the serum?
High total serum bilirubin.
What is a common urine finding in hepatitis evaluations?
Urine bilirubin.
What lab findings are associated with high serum liver enzymes?
High serum liver enzymes.
What may indicate declining liver function in more severe cases of hepatitis?
Elevated prothrombin time and elevated ammonia.
What imaging study is commonly performed in hepatitis evaluations?
Liver ultrasound.
What is the purpose of a liver ultrasound in hepatitis evaluations?
To rule out obstructive gallstones and tumors.
When is a liver biopsy generally performed in relation to hepatitis?
A liver biopsy is generally performed when chronic disease is suspected, there is severe hepatic failure, or the history suggests autoimmune hepatitis.
What are the five main viruses that primarily infect hepatocytes?
Hepatitis A, B, C, D, and E.
Is 'Hepatitis virus' a taxonomic category?
No, it is not a taxonomic category; they all cause hepatitis but belong to different viral families.
Which virus, besides hepatitis viruses, can also cause hepatitis?
Cytomegalovirus (CMV).
What family does the Hepatitis A Virus belong to?
Picornaviridae family
What type of virus is Hepatitis A?
Non-enveloped, positive-sense, single-stranded RNA (+ssRNA) virus
What is the shape of the Hepatitis A Virus capsid?
Icosahedral (20-sided) capsid
What is the typical course of Hepatitis E infection?
Acute and typically self-limiting.
What does a positive IgM indicate in the context of Hepatitis E?
Recent HEV infection.
What does a positive IgG indicate regarding Hepatitis E infection?
Clearing infection or prior exposure.
Is Hepatitis E a self-limiting infection?
Yes, HEV is a self-limiting infection.
What common histopathologic features are shared by different types of viral hepatitis?
Lymphocytic inflammation around the portal triads, hepatocyte ballooning, and sometimes spotty necrosis.
What histopathologic feature is typically seen in HBV infection?
Ground-glass hepatocytes, caused by the build-up of HBsAg in the endoplasmic reticulum.
What is observed in a liver biopsy during the acute phase of viral hepatitis?
Lymphocytic inflammation, hepatocyte ballooning, and sometimes spotty necrosis.
How can HAV be prevented?
Through thorough hygiene, hand washing, and washing fruits and vegetables.
Who should be offered immunization for HAV?
High risk populations.
What are the high-risk populations for HBV?
Health care workers, infants, men who have sex with men, people who inject drugs, and people who are incarcerated.
What is the focus of HBV prevention?
Education and vaccination.
How many vaccines are available for HBV?
Two vaccines.
What are the complications of HBV?
Chronic active hepatitis, which can progress to cirrhosis.
Is treatment with antiviral drugs generally done for acute hepatitis B?
No, it is not generally done.
What factors determine treatment for chronic hepatitis B?
HBeAg serology, viral load, and the presence or degree of severe liver functional deficits or underlying fibrosis.
What is the primary method of HCV prevention?
Educating high-risk populations.
Is there a vaccine available for hepatitis C virus (HCV)?
No, a vaccine for HCV is not available.
What is one reason it is difficult to create vaccines against HCV?
The high error rate of RNA-dependent RNA polymerase.
How does the HCV genome change during replication?
It changes with each replication cycle.
What is a characteristic of HCV that complicates vaccine development?
It is referred to as a quasi-species because it mutates so quickly.
What are some complications of HCV?
Chronic hepatitis and cirrhosis.
What is the cure rate for new all oral antivirals for HCV?
Upwards of 95%-99%.
What is the primary method of preventing HDV infections?
Education, screening, and treatment of HBV.
How can vaccination against HBV help with HDV?
It can help prevent HDV infections since HDV requires HBV to infect.
How is Hepatitis A Virus transmitted?
Via fecal-oral transmission
Where is Hepatitis A Virus commonly found?
In the food industry, daycare, dormitories, nursing homes, and contaminated water
What type of infection does Hepatitis A cause?
An acute, self-limited infection with generally mild symptoms
What are some common symptoms of Hepatitis A?
Diarrhea, fatigue, nausea, and jaundice
What does a positive IgM antibody for Hepatitis A indicate?
It suggests an acute infection.
What does a positive anti-HAV IgG indicate?
It may indicate previous exposure, prior vaccination, or the end of an active infection.
What happens to the viral load as the anti-HAV IgG is elevated?
The viral load decreases rapidly.
What family does the Hepatitis B virus belong to?
Hepadnaviridae family
What type of virus is the Hepatitis B virus?
Double-stranded DNA (dsDNA) virus with a viral envelope and an icosahedral capsid
How is the Hepatitis B virus transmitted?
By direct contact with the blood, reproductive fluids, or breastmilk of an infected person
What types of infections can the Hepatitis B virus cause?
Both acute and chronic infections
What percentage of acute Hepatitis B infections are completely cleared in adults?
More than 95% of cases
What type of virus is HBV?
HBV is a dsDNA virus.
What is the first step in the HBV replication cycle?
Attachment and penetration via the NTCP receptor.
What happens after the capsid is released in the HBV replication cycle?
Uncoating occurs, releasing rcDNA.
What is formed during the repair process in the HBV replication cycle?
cccDNA is formed during the repair process.
What is the role of mRNA transcription in the HBV replication cycle?
It is the process where mRNA is synthesized from cccDNA.
What occurs after translation in the HBV replication cycle?
Assembly of the viral components takes place.
What is the final step in the HBV replication cycle?
Exocytosis of the mature HBV virion.
What does a positive HBsAg and HBeAg indicate in a patient?
It suggests active HBV infection and that the infection is still contagious if HBeAg is positive.
What does the presence of Anti-HBs IgG indicate?
It indicates past infection or vaccination against hepatitis B.
What does Anti-HBc IgM signify?
It signifies a recent infection with hepatitis B virus.
What does Anti-HBc IgG indicate?
It indicates resolving infection, previous HBV exposure, or chronic HBV infection.
What does a positive HBV antigen with negative antibodies suggest?
It suggests that the patient has an active infection but has not yet synthesized antibodies to it.
What is the significance of Anti-HBe IgG?
It is similar to Anti-HBsAg IgG, indicating a response to hepatitis B infection.
What does a positive HBsAg indicate in the context of hepatitis diagnosis?
It indicates an active hepatitis B virus infection.
What is the significance of Anti-HBc IgM in diagnosing acute hepatitis infection?
A positive Anti-HBc IgM indicates a recent or acute infection.
What does a positive Anti-HBs IgG signify in hepatitis diagnosis?
It signifies recovery from hepatitis B infection or successful vaccination.
In chronic HBV infection, what does a positive Anti-HBc IgG indicate?
It indicates past or ongoing infection with hepatitis B virus.
What does the presence of HBeAg suggest in a hepatitis B infection?
It suggests active viral replication and higher infectivity.
What does a negative HBsAg and positive Anti-HBs IgG indicate?
It indicates that the person has been immunized against hepatitis B or has cleared a past infection.
What does a positive HBeAg and positive HBsAg indicate in the context of acute infection?
It indicates an early acute hepatitis B infection.
What does the presence of HBsAg and absence of Anti-HBs IgG indicate in the later stages of acute infection?
It indicates an ongoing acute hepatitis B infection.
What is the significance of the peak of HBsAg around month 4 in hepatitis infection?
It indicates a high level of viral activity during that time.
What does the peak of HBeAg around month 3 suggest about the hepatitis infection?
It suggests active viral replication and higher infectivity.
What does the presence of Anti-HBc IgM indicate during the hepatitis infection timeline?
It indicates recent infection, peaking around month 5.
What does the plateau of Anti-HBc IgG after month 5 signify?
It signifies the body's immune response to the infection.
What is the clinical significance of the 'Window period' between months 5 and 6?
It is a phase where HBsAg may be undetectable while Anti-HBs IgG is not yet present, complicating diagnosis.
What does the increase in ALT levels indicate in the context of hepatitis infection?
It indicates liver inflammation or damage due to the infection.
What do the curves for Anti-HBs IgG and Anti-HBe IgG appearing in the late phase suggest?
They suggest the resolution of infection and development of immunity.
What family does the Hepatitis C virus belong to?
Flaviviridae family
What type of virus is the Hepatitis C virus?
Positive-sense, single-stranded RNA (+ssRNA) virus with a viral envelope and an icosahedral capsid
How is Hepatitis C virus transmitted?
Through direct contact with blood from an infected person
What is a common outcome of untreated Hepatitis C infection?
Chronic infection leading to cirrhosis and liver failure requiring transplantation
Is Hepatitis C often symptomatic or asymptomatic?
Often minimally symptomatic
What is the first stage of the Hepatitis C virus lifecycle?
Attachment, where the virus particle attaches to a cell membrane.
What occurs during the penetration and entry stage of the Hepatitis C lifecycle?
The virus penetrates and enters the cell.
What happens during the uncoating stage of the Hepatitis C virus lifecycle?
The viral capsid disassembles inside the cell.
What is involved in the replication stage of the Hepatitis C lifecycle?
Viral RNA replication and protein processing occur.
What happens during the assembly stage of the Hepatitis C virus lifecycle?
New virus particles assemble.
What is the final stage of the Hepatitis C virus lifecycle?
Release, where new virus particles are released from the cell.
What does a positive HCV-RNA (PCR) indicate?
It means there is active HCV infection.
What does a positive anti-HCV IgG indicate?
It means the person has been exposed to HCV at some point.
When does HCV-RNA become abnormal after exposure?
Within 2-3 weeks of exposure.
When do anti-HCV antibodies increase to abnormal levels after exposure?
2-3 months after exposure.
What does the ALT line represent in hepatitis diagnostics?
It shows alanine aminotransferase, a common hepatocyte enzyme released during hepatitis inflammation.
When do symptoms typically correlate with ALT levels after exposure?
About 2 months after exposure.
When should people with possible HCV exposure be tested?
About 4 weeks after their exposure, even without symptoms.
What is the genus name of the Hepatitis D Virus?
Deltavirus
What type of genome does the Hepatitis D Virus have?
Antisense, single-stranded RNA (-ssRNA) genome
What is required for Hepatitis D Virus to function?
The presence of Hepatitis B Virus (HBV)
How does Hepatitis D Virus interact with Hepatitis B Virus?
Through its viral envelope containing hepatitis B surface antigens
What are the two ways Hepatitis D Virus can cause hepatitis?
Co-infection with HBV or superinfection in someone already infected with HBV
In which population is Hepatitis D Virus mostly found?
Those who use IV drugs
What does Hepatitis D Virus increase the rate of?
Progression to liver disease
What can the presentation of Hepatitis D Virus infection range from?
Acute liver failure to asymptomatic
What is rarely used in diagnostic serology for Hepatitis D Virus?
Anti-HDV IgG
When is anti-HDV IgG ordered?
In patients newly diagnosed with HBV to assess for HDV co-infection or when a patient with chronic HBV has acutely worsening liver function
What family does the Hepatitis E virus belong to?
Hepeviridae family.
What type of virus is the Hepatitis E virus?
Non-enveloped, positive-sense single-stranded RNA (+ssRNA) virus.
How is Hepatitis E primarily transmitted?
By fecal-oral transmission.
What is a severe complication of Hepatitis E during pregnancy?
Higher rates of hepatic failure (Fulminant Hepatitis).
What treatment option has been used with some success for HDV?
Interferon.
What is the range of presentation for HDV infection?
From asymptomatic to acute liver failure.
What are the prevention methods for HEV?
Thorough hygiene, hand washing, and washing fruits and vegetables.
Is there a vaccine for HEV available outside of China?
No, the vaccine is licensed in China but not available elsewhere.
What is the typical course of acute HEV infection?
It generally clears on its own without therapy.
What type of care is provided for acute HEV?
Supportive care.
What is hepatitis?
Liver inflammation that can be acute or chronic.
What are the common symptoms of acute hepatitis?
Jaundice, scleral icterus, and an enlarged liver, along with elevated bilirubin and liver enzymes like AST and ALT.
What are the most common causes of acute hepatitis?
Hepatitis viruses and alcohol.
Which hepatitis viruses are the most common in the United States?
Hepatitis A, B, and C.
How is Hepatitis A transmitted?
Through fecal-oral contamination.
What are the transmission routes for Hepatitis B and C?
Blood exposure, including IV drugs, perinatal transmission, and health care exposure.
What can chronic hepatitis lead to?
Cirrhosis and end-stage liver disease.
How may chronic viral hepatitis be treated?
With antiviral drugs.
What are the five major viruses that cause viral hepatitis?
HAV, HBV, HCV, HDV, and HEV.
Which hepatitis viruses are self-limiting and do not progress to chronic hepatitis?
HAV and HEV.
What is unique about HDV?
It is a virusoid that requires the presence of HBV for replication.
What are the earliest markers of disease in HBV?
Antigen tests (HBsAg, HBeAg).
What do antibody tests in HBV indicate?
They show resolving or past infection or immunization against the virus.
What are the main serologic tests for HCV?
Anti-HCV IgG and HCV-RNA (PCR).
What are the key aspects to discuss regarding liver fluke infections?
Transmission, geographical distribution, clinical presentation, diagnosis, and treatment.
What is an important component of the life cycle of liver flukes?
The intermediate host.
What organism's life cycle includes transmission, clinical presentation, and diagnosis?
Entamoeba histolytica
What should be described regarding liver abscesses?
Clinical presentation, common causes, and causative organisms.
What are the nonspecific symptoms of a hepatic abscess?
Variable symptoms, with fever being the most consistent finding.
What is the most consistent finding in patients with a hepatic abscess?
Fever that comes and goes.
What pain might patients with a hepatic abscess experience?
Right upper quadrant pain.
What additional tenderness may be present in patients with a hepatic abscess?
Costovertebral angle tenderness (CVA).
What common bacterial cause do liver abscess and pyelonephritis share?
They share a common bacterial cause.
What is the gold standard for diagnosing a hepatic abscess?
CT scans are the gold standard.
What imaging technique is often used initially for diagnosing a hepatic abscess?
Ultrasound is often used initially.
What is required for a definitive diagnosis of a hepatic abscess?
Imaging confirmed with aspiration is required for a definitive diagnosis.
Why can the diagnosis of a hepatic abscess be difficult?
The diagnosis can be difficult due to the need for imaging and confirmation with aspiration.
What is the initial treatment approach for a hepatic abscess?
Empiric antibiotic therapy and percutaneous drainage.
What type of antibiotic therapy is recommended for hepatic abscess treatment?
Broad-spectrum intravenous antibiotics, such as a β-lactam or nitroimidazole plus a third-generation cephalosporin.
What is the purpose of sending the fluid drained from a hepatic abscess to the laboratory?
To identify a causative microorganism.
How does confirmation of a specific microorganism affect treatment for a hepatic abscess?
It confirms the hepatic abscess and directs subsequent treatment, allowing a potential step down to oral antimicrobial therapy.
What imaging technique can be repeated to assess the success of hepatic abscess treatment?
CT imaging.
What are the common causes of hepatic abscesses related to subphrenic abscesses, cholangitis, or gallbladder infections?
Patients experiencing these conditions are at risk for hepatic abscesses.
How can the hepatic artery introduce pathogens into the liver?
In patients with infective endocarditis, the hepatic artery can introduce pathogens into the liver.
What role does the portal vein play in the invasion of the liver by pathogens?
The portal vein can serve as an entryway for pathogens post diverticulitis, appendicitis, and bowel perforation.
What is the most common cause of liver abscess in the United States?
E. coli infection.
What is the most common cause of hepatic abscesses outside the United States?
Entamoeba histolytica.
Why are immunocompromised patients at risk for fungal hepatic abscesses?
They are especially susceptible to fungal infections by Candida species.
What is Entamoeba histolytica endemic to?
Some parts of Asia, Africa, and tropical areas with poor sanitation.
What is the main cause of amebic hepatic abscess in humans?
Post colonic infection by Entamoeba histolytica.
What are the symptoms of intestinal infection with Entamoeba histolytica?
Amebic dysentery, which includes severe diarrhea and abdominal pain.
How does Entamoeba histolytica spread to cause amebic hepatic abscess?
Through hematogenous spread via the portal circulation.
What rare complications can arise from hematogenous spread of Entamoeba histolytica?
Pulmonary, cardiac, and brain involvement.
What are the two stages of the Entamoeba Histolytica life cycle?
Cystic and trophozoite stages.
How does Entamoeba Histolytica infect a host?
Infection occurs when cysts are ingested by a host.
What happens to cysts after they are ingested by a host?
Cysts transform into trophozoites.
What role do trophozoites play in the life cycle of Entamoeba Histolytica?
They invade the colonic epithelium and elicit an assault on the host tissue.
Why is the cystic stage important in the life cycle of Entamoeba Histolytica?
It is vital for transmission and pathogenesis.
What enzymes do trophozoites use to invade host tissue?
Proteases and hydrolytic enzymes.
What is the consequence of the life cycle of Entamoeba Histolytica on water or food supplies?
It can further contaminate water or food supplies.
What are common symptoms of an amebic hepatic abscess?
Fever, right upper quadrant pain, and rarely jaundice.
What is a vital step toward diagnosing amebic hepatic abscess?
History of traveling to tropical or underdeveloped countries.
What imaging modalities are required for diagnosing amebic hepatic abscess?
Comprehensive patient history and imaging modalities are required for diagnosis.
What type of antibodies may be helpful in diagnosing amebic hepatic abscess?
Anti-amebic antibodies.
Why are stool studies not diagnostic for amebic hepatic abscess?
Because they are not specific for E histolytica.
What stool test is recommended for diagnosing E histolytica?
An E histolytica antigen test, which has a higher sensitivity and specificity.
What is the first line treatment for amebic hepatic abscess?
Metronidazole followed by an aminoglycoside antibiotic such as paromomycin.
Why are the drugs for treating amebic hepatic abscess taken sequentially?
To ensure that the pathogen is cleared from both the liver and the intestinal lumen.
What are liver flukes classified as?
Flat, parasitic worms of the Platyhelminthes phylum, Trematoda class.
How are liver fluke infections typically transmitted?
Through the ingestion of freshwater raw fish.
How long can liver flukes remain dormant in the intrahepatic bile ducts?
Up to 30 years.
Name an example of a liver fluke that can invade and infect the biliary tree.
Fasciola hepatica, Clonorchis sinensis, or Opisthorchis species.
What is the first stage in the life cycle of liver flukes?
Adult worms lay eggs that pass through the gastrointestinal system and exit the host through feces.
What happens to liver fluke eggs when they come in contact with water?
They hatch and use freshwater snails as an intermediate host.
What is the role of freshwater snails in the liver fluke life cycle?
They serve as an intermediate host for the liver flukes.
What stage follows the cercaria stage in the liver fluke life cycle?
The cercaria attaches to a plant and encysts itself, progressing to the metacercaria stage.
How do mammals become infected with liver flukes?
By consuming plants that contain the metacercaria cysts.
What occurs after mammals ingest the metacercaria?
The metacercaria emerge from the cyst in the small intestine and invade the intestinal wall, then enter the liver.
What happens to liver flukes once they enter the biliary tree?
They remain dormant and release their eggs into the gastrointestinal system, restarting the life cycle.
What are the common symptoms of liver fluke infections?
Most are asymptomatic, but nonspecific symptoms such as abdominal pain and nausea can occur.
