CNUR 204 Exam Questions With 100%
Verified Solutions
Complications of hepatitis - ANSWER -•Mortality rate of acute viral hepatitis is
less than 1%.
•Complication rate is higher in older adults & the individuals with debilitating
conditions (e.g., existing liver disease).
•Complications include
-Fulminant hepatic failure(=acute liver failure)
•Characterized by severe impairment of liver function and hepatic encephalopathy,
and an elevated PT/INR
•Most common cause- Overuse of acetaminophen with alcohol use
-Chronic hepatitis
-Cirrhosis
-Hepatocellular carcinoma
General diagnostic studies- Hepatitis - ANSWER -•Viral serological tests
-Viral antigens and antibodies
•Serum liver enzymes
-AST (Aspartate aminotransferase)
-ALT (Alanine aminotransferase
-ALP (Alkaline phosphatase)
-GGT (gamma-glutamyl transferase)
•Liver function test
-Serum albumin, bilirubin, prothrombin time (PT) and INR (international
normalized ratio), Antigens- IgG, IgM, etc.
ALP- can be increased with gall stones, bone cancer
GGT- alcohol abuse, liver damage causes levels to be increased
Albumin with be decreased, bilirubin increased, PT/ INR- increased
Hepatitis A Virus - ANSWER -•RNA virus
•Self limited condition- usually does not become chronic
,•Incubation 15-50 days
•Fecal-oral transmission via consumption of contaminated food or water/poor
sanitization/overcrowding
•More than 70% adults with HAV will have symptoms (Lai & Chopra, 2018)
•No chronic carrier state as long as there is no coinfection with other forms of
hepatitis
•Nearly all patients will have complete recovery by six months.
•Prevention- e.g., immunization/hygiene..
•Serum markers
-Anti HAV immunoglobulin M (IgM)
-Anti-HAV immunoglobulin G (IgG), Symptoms- n/v, abdominal pain, kids may
not have symptoms (less than 6 yr old)
Prevention- food handling
Acute infection- positive IgM, positive IgG will show previous infection and you
have gained immunity (could also be from a immunization)
Hepatitis B virus - ANSWER -•DNA virus/incubation (45-180 days) & more
infectious than HIV
•Can live on a surface for 7 days
•Transmission occurs when
-When the virus (infected blood/body fluids) enters the body of a person who is not
immune to the virus
-E.g., IV drug use and sharing needles; perinatal infection by mothers with HBV;
unprotected sex
-Mucosal exposure to infectious blood or body fluids (e.g., semen)
•Neonates with HBV at birth develop chronic HBV (~90%)
•30-50% risk of developing chronic infection in children under age 6
•Usually HBV can be cleared in adults (>95%)-except in people with
immunocompromised conditions.
•15% to 25% of chronically infected persons die from chronic liver disease
•Acute vs Chronic (chronic HBV-risk for hepatocellular carcinoma), If you are
immune- you will not get virus
With chronic HBV- cirrhosis can happen
,Hepatocellular carcinoma- cancer, need healthy liver, •Surface antigen (HBsAg);
Core antigen (HBcAg); E antigen (HBeAg); Anti-HBe; Anti-HBc; Anti-HBc IgM;
Anti-HBs IgG
•Presence of Hepatitis B surface antibodies (anti-HBs IgG) indicates immunity
from HBV vaccine or past HBV infection
•Prevention: Immunization/patient teaching
•Post-exposure treatment: the vaccine and Hep B immune globulin
•Treatment
-Nucleoside and nucleotide analogues (e.g., tenofovir; lamivudine)
-Interferon, •Positive- surface antigen, core antigen (measured by liver not serum),
E antigen
•IgG- IMMUNITY
Hepatitis C Virus - ANSWER -•RNA virus/incubation (14-180 days)
•The most likely to cause long term liver damage and chronic infection occurs up
to about 80% in individuals with hepatitis C
•Chronic HCV infection often follows a progressive course over many years and
can ultimately result in cirrhosis, hepatocellular carcinoma, and the need for liver
transplantation (Chopra & Pockros, 2018)
•Anti-HCV (+ means past exposure or current infection) & HCV RNA (viral load)
•Transmission: Perinatal contact; high risk sexual contact; primarily through
exposure to infected blood (percutaneously)
•Treatment of choice- Depending on the genotype.
-Direct acting antivirals (DAAs): sofosbuvir; sofosbuvir + ledipasvir; daclatasvir,
elbasvir+grazoprevir. •There is now treatment
•Most common hepatitis that causes a need for liver transplant
•6 different genotypes
•Can have single, duo, triple treatment (duo is most common)
Hepatitis D virus - ANSWER --RNA (incubation: 2-26 weeks)
-Also called delta virus
-Defective single-stranded RNA virus
-Cannot survive on its own-requires the helper function of HBV to replicate
-Transmission - Same as HBV
, -HBV/HDV co-infection increases risk of fulminant hepatitis and cause more
severe disease
-Prevention-Immunization for Hep B, •Transmission- HBV vaccine for prevention
Hepatitis E virus - ANSWER -§RNA virus (incubation period: 15-64 days)
§Transmission: fecal-oral route, usually caused by drinking contaminated water
§Occurs primarily in developing countries
§Self limited condition
§Most of patients will spontaneously clear the virus, but may develop
complications (i.e., hepatic failure) in patients with immunosuppression. Similar to
HAV
Collaborative care- hepatitis - ANSWER -•Drug adherence
•Well-balanced diet
•Vitamin supplements
•Rest
•Avoidance of alcohol & hepatotoxic drugs
•Prevention (e.g., safe needle exchange program; safe sex practice; proper food
handling; water quality monitoring; sanitization & personal and environmental
hygiene; vaccination...), Well balanced diet- provide nutrients, eat small amounts
throughout the day
Alcohol in history- folic acid, thymine
Rest is required, so liver can recover
Acetaminophen- can give to pt with liver failure but limit dosage, normal do not
exceed 4 g/ day, liver failure can take up to 2 g/day
Non-alcoholic fatty liver disease (NAFLD) - ANSWER -•A spectrum of disease
that ranges from simple fatty liver (w/o inflammation) disease to severe liver
scarring (cirrhosis)
-Non-alcoholic steatohepatitis (NASH)- fat build-up causes inflammation/cell
injury: can cause liver cancer or failure
•#1 cause- Obesity
•Usually asymptomatic
-First sign- elevation of liver enzymes (ALT, AST)
Verified Solutions
Complications of hepatitis - ANSWER -•Mortality rate of acute viral hepatitis is
less than 1%.
•Complication rate is higher in older adults & the individuals with debilitating
conditions (e.g., existing liver disease).
•Complications include
-Fulminant hepatic failure(=acute liver failure)
•Characterized by severe impairment of liver function and hepatic encephalopathy,
and an elevated PT/INR
•Most common cause- Overuse of acetaminophen with alcohol use
-Chronic hepatitis
-Cirrhosis
-Hepatocellular carcinoma
General diagnostic studies- Hepatitis - ANSWER -•Viral serological tests
-Viral antigens and antibodies
•Serum liver enzymes
-AST (Aspartate aminotransferase)
-ALT (Alanine aminotransferase
-ALP (Alkaline phosphatase)
-GGT (gamma-glutamyl transferase)
•Liver function test
-Serum albumin, bilirubin, prothrombin time (PT) and INR (international
normalized ratio), Antigens- IgG, IgM, etc.
ALP- can be increased with gall stones, bone cancer
GGT- alcohol abuse, liver damage causes levels to be increased
Albumin with be decreased, bilirubin increased, PT/ INR- increased
Hepatitis A Virus - ANSWER -•RNA virus
•Self limited condition- usually does not become chronic
,•Incubation 15-50 days
•Fecal-oral transmission via consumption of contaminated food or water/poor
sanitization/overcrowding
•More than 70% adults with HAV will have symptoms (Lai & Chopra, 2018)
•No chronic carrier state as long as there is no coinfection with other forms of
hepatitis
•Nearly all patients will have complete recovery by six months.
•Prevention- e.g., immunization/hygiene..
•Serum markers
-Anti HAV immunoglobulin M (IgM)
-Anti-HAV immunoglobulin G (IgG), Symptoms- n/v, abdominal pain, kids may
not have symptoms (less than 6 yr old)
Prevention- food handling
Acute infection- positive IgM, positive IgG will show previous infection and you
have gained immunity (could also be from a immunization)
Hepatitis B virus - ANSWER -•DNA virus/incubation (45-180 days) & more
infectious than HIV
•Can live on a surface for 7 days
•Transmission occurs when
-When the virus (infected blood/body fluids) enters the body of a person who is not
immune to the virus
-E.g., IV drug use and sharing needles; perinatal infection by mothers with HBV;
unprotected sex
-Mucosal exposure to infectious blood or body fluids (e.g., semen)
•Neonates with HBV at birth develop chronic HBV (~90%)
•30-50% risk of developing chronic infection in children under age 6
•Usually HBV can be cleared in adults (>95%)-except in people with
immunocompromised conditions.
•15% to 25% of chronically infected persons die from chronic liver disease
•Acute vs Chronic (chronic HBV-risk for hepatocellular carcinoma), If you are
immune- you will not get virus
With chronic HBV- cirrhosis can happen
,Hepatocellular carcinoma- cancer, need healthy liver, •Surface antigen (HBsAg);
Core antigen (HBcAg); E antigen (HBeAg); Anti-HBe; Anti-HBc; Anti-HBc IgM;
Anti-HBs IgG
•Presence of Hepatitis B surface antibodies (anti-HBs IgG) indicates immunity
from HBV vaccine or past HBV infection
•Prevention: Immunization/patient teaching
•Post-exposure treatment: the vaccine and Hep B immune globulin
•Treatment
-Nucleoside and nucleotide analogues (e.g., tenofovir; lamivudine)
-Interferon, •Positive- surface antigen, core antigen (measured by liver not serum),
E antigen
•IgG- IMMUNITY
Hepatitis C Virus - ANSWER -•RNA virus/incubation (14-180 days)
•The most likely to cause long term liver damage and chronic infection occurs up
to about 80% in individuals with hepatitis C
•Chronic HCV infection often follows a progressive course over many years and
can ultimately result in cirrhosis, hepatocellular carcinoma, and the need for liver
transplantation (Chopra & Pockros, 2018)
•Anti-HCV (+ means past exposure or current infection) & HCV RNA (viral load)
•Transmission: Perinatal contact; high risk sexual contact; primarily through
exposure to infected blood (percutaneously)
•Treatment of choice- Depending on the genotype.
-Direct acting antivirals (DAAs): sofosbuvir; sofosbuvir + ledipasvir; daclatasvir,
elbasvir+grazoprevir. •There is now treatment
•Most common hepatitis that causes a need for liver transplant
•6 different genotypes
•Can have single, duo, triple treatment (duo is most common)
Hepatitis D virus - ANSWER --RNA (incubation: 2-26 weeks)
-Also called delta virus
-Defective single-stranded RNA virus
-Cannot survive on its own-requires the helper function of HBV to replicate
-Transmission - Same as HBV
, -HBV/HDV co-infection increases risk of fulminant hepatitis and cause more
severe disease
-Prevention-Immunization for Hep B, •Transmission- HBV vaccine for prevention
Hepatitis E virus - ANSWER -§RNA virus (incubation period: 15-64 days)
§Transmission: fecal-oral route, usually caused by drinking contaminated water
§Occurs primarily in developing countries
§Self limited condition
§Most of patients will spontaneously clear the virus, but may develop
complications (i.e., hepatic failure) in patients with immunosuppression. Similar to
HAV
Collaborative care- hepatitis - ANSWER -•Drug adherence
•Well-balanced diet
•Vitamin supplements
•Rest
•Avoidance of alcohol & hepatotoxic drugs
•Prevention (e.g., safe needle exchange program; safe sex practice; proper food
handling; water quality monitoring; sanitization & personal and environmental
hygiene; vaccination...), Well balanced diet- provide nutrients, eat small amounts
throughout the day
Alcohol in history- folic acid, thymine
Rest is required, so liver can recover
Acetaminophen- can give to pt with liver failure but limit dosage, normal do not
exceed 4 g/ day, liver failure can take up to 2 g/day
Non-alcoholic fatty liver disease (NAFLD) - ANSWER -•A spectrum of disease
that ranges from simple fatty liver (w/o inflammation) disease to severe liver
scarring (cirrhosis)
-Non-alcoholic steatohepatitis (NASH)- fat build-up causes inflammation/cell
injury: can cause liver cancer or failure
•#1 cause- Obesity
•Usually asymptomatic
-First sign- elevation of liver enzymes (ALT, AST)
