Hepatitis

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Clinical Chemistry
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1

Viral Hepatitis

Inflammation of the liver; types A, B, C, D, and E; includes Epstein-barr, herpes, cytomegalovirus, coxsackie virus, and rubella; presents with antigens and antibodies;

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type A

known for hepatitis outbreaks

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50%

type B incidence

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20%

type C incidence

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30%

type A incidence

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Hepatitis A

Fecal-oral route, outbreaks caused by fecal contaminated food or drinking water, crowded conditions, poor sanitation & hygiene, undeveloped countries, shellfish from contaminated water

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2-6 weeks post exposure

occurrence of viremia in Hepatitis A during which ALT, AST and serum bilirubin are elevated; antigen is not detectable

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4-10 weeks

occurrence of IgM antibody detection of hepatitis A

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5 weeks for life

occurrence of IgG antibody detection

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Hepatitis B

Percutaneous, permucosal, or perinatal exposure, sexually transmitted disease; 100x more infectious than HIV and can live on dry surface for 7 days

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hepatitis B carrier state

antigen HBsAg for 6-12 months

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hepatitis B immunity

antigen to anti-HBs-Ag

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susceptible

HBsAg negative, Total anti-HBc negative, and anti-HBs negative

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immune due to natural infection

HBsAg negative, total anti-HBc negative, and anti-HBs positive

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immune due to vaccination

HBsAg negative, total anti-HBc negative, and anti-HBs positive

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acutely infected

HBsAg positive, total anti-HBc positive, IgM anti-HBc positive, anti-HB negative

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chronically infected

HBsAg positive, total anti-HBc positive, IgM anti-HBc negative, and anti-HBs negative

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interpretation unclear

HbsAg negative, total anti-HBc positive, and anti-HBs negative; possibly resolved infection, false positive, low level chronic infection, or resolving acute infection

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Hepatitis C

Transmission- percutaneous; At risk: IV drugs, bld transfusion, hemodialysis, tattooing, hi risk sexual behavior, organ transplants, health care workers; High rate of progression to chronic hepatitis

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HCV Ab

screening test for hepatitis C

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HCV RNA qual or quan

confirmation test for hepatitis C

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Hepatitis D

Delta virus: Single stranded un-enveloped RNA; Transmission - percutaneous; Can turn mild or chronic hep B into severe, chronic, progressive, active hepatitis & cirrhosis; Can occur as coinfection with hep B or as superinfection

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Hepatitis E

Transmission – fecal-oral route, esp contaminated drinking water; Enteric non-A, non-B hepatitis; Occurs in developing countries, epidemics in India, Asia, Mexico, Africa. In US rarely, only after a person traveled

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chronic hepatitis

Hepatic inflammation has been documented (elevations of liver enzymes) for greater than 6 months; Caused by viral, autoimmune or drug inducted agents; Approximately 10% are caused by HBV: HBs AG Pos, and HBc IgM positive; Fifty percent are caused by Hepatitis C; Rarely are caused by Hepatitis A