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Danny's MD3002 GI System > 10-02-23 – Viral Hepatitis > Flashcards

10-02-23 – Viral Hepatitis Flashcards

1
Q

Learning outcomes

A
  • Recognise the various stages of infection with the hepatitis viruses A-E
  • Describe the treatment and prevention of hepatitis caused by hepatitis viruses A-E
  • Identify the main features of the different hepatitis viruses A-E
  • Recognise the importance of the use of serological markers for hepatitis B virus
  • Explain how the different hepatitis viruses A-E are transmitted
  • List the viruses which can cause hepatitis
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2
Q

What is hepatitis?

What are 4 different types of causes of hepatitis?

A
  • Hepatitis is liver inflammation
  • 4 different types of causes of hepatitis:

1) Infectious
* Hepatitis A-E
* Cytomegalovirus
* Epstein barr virus

2) Drugs
* Alcohol
* Paracetamol overdose
* Co-amoxiclav

3) Autoimmune

4) Ischaemic

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3
Q

What are 7 different functions of the liver?

A
  • 7 different functions of the liver:
    1) Synthesis of clotting factors
    2) Production of complement factors
    3) Synthesis of albumin
    4) Production of bile salts
    5) Conjugation of bilirubin
    6) Metabolism of drugs and hormones and toxins
    7) Carbohydrate metabolism
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4
Q

What are 6 symptoms of hepatitis?

A
  • 6 symptoms of hepatitis:
    1) Asymptomatic
    2) Fever
    3) Jaundice
    4) Malaise
    5) Diarrhoea/Vomiting
    6) Acute liver failure – bruising (due to lack of clotting factor), ascites, encephalopathy
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5
Q

What is liver cirrhosis?

A
  • Liver cirrhosis is when normal liver tissue is replaced by fibrotic/scar tissue
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6
Q

What are 4 risk factors for Liver Cancer/Hepatocellular carcinoma?

How can be detect liver cancer?

What is the most common cause of liver cancer in the world and in Europe?

A
  • 4 risk factors for Liver Cancer/Hepatocellular carcinoma:
    1) Hepatitis B/C
    2) Alcohol
    3) Obesity
    4) Smoking
  • We can detect liver cancer by measuring alpha fetoprotein, with elevated levels suggesting liver cancer
  • Chronic hepatitis B infection is the most common cause of liver cancer worldwide.
  • Hepatitis C infection is the most common cause of liver cancer in Europe
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7
Q

What type of virus is hepatitis A?

How is it spread?

How can it be contracted from sea-life?

Where can there be Hep A endemics?

What are 5 common symptoms of Hepatitis A?

A
  • Hepatitis A is a non-enveloped positive single stranded RNA virus
  • Spread by faeco-oral route e.g contaminated water – can cause water borne epidemics
  • Blood-borne transmission is rare
  • Sometimes hepatitis A is associated with consuming undercooked shellfish
  • There can be endemics of Hep A in countries with poor hygiene and sanitation
  • 5 common symptoms of Hepatitis A:
    1) Hepatomegaly – 80%
    2) Jaundice – 70%
    3) Fatigue
    4) Arthralgia
    5) Poor appetite
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8
Q

Hep A serology.

What do certain antibodies tell us about Hepatitis A infection?

How can vaccines for Hep A affect our immunity?

A
  • Hep A serology
  • Hep A IgM antibody detected – positive in acute Hep A infection
  • Hep A IgG antibody detected – indicates Hep A immunity
  • We can have life-long Hep A immunity with occasional vaccines
  • These vaccines can be given more frequently to those at higher risk
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9
Q

How is Hep A normally treated?

How often does Hep A cause liver failure?

Can Hep A infections be chronic?

How does lifelong immunity from Hep A occur?

A
  • Hep A is normally a self-resolving infection, and is treated using supportive treatment (only affects symptoms – doesn’t cure)
  • 0.1%-0.3% of those infected with Hep A develop acute liver failure, so a transplant is needed
  • No cases of chronic hepatitis A
  • Once infected, we develop lifelong immunity from Hep A
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10
Q

What type of virus is Hepatitis B?

Where is the highest prevalence of Hep B?

How is it transmitted?

What are 4 methods of horizontal transmission of Hep B?

What is a vertical transmission method of Hep B?

A
  • Hep B is a Partially double stranded DNA virus
  • Highest prevalence in Africa, Asia and the Western Pacific Rim
  • Also common in Sothern and Eastern Europe
  • Hep B is a blood-borne virus
  • 4 methods of horizontal transmission of Hep BL:
    1) Unprotected intercourse
    2) Contaminated needles – drug use, needlestick injuries, reuse of tatto needles
    3) Breaks in mucous membranes
    4) Blood transfusion
  • Vertical transmission method of Hep B - From mother to child e.g. during childbirth
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11
Q

Life cycle of Hep B diagram

A
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12
Q

Describe 7 different markers that can be tested for in Hep B infections.

What interpretation can be drawn from each one (in picture)?

A
  • 7 different markers that can be tested for in Hep B infections (in picture)
  • Ab – antibody
  • Ag – antigen
  • HBc – Hep B core protein
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13
Q

Describe the antibody graph for Self-limited hepatitis B infection (in graph)

A
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14
Q

What is a chronic Hep B infection?

Describe the antibody graph for Chronic Hepatitis B infection?

A
  • Chronic Hepatitis B infection is defined as infection persisting beyond 6 months of diagnosis It is usually characterized by persistent positive HBVsAg without development of sAb
  • Antibody graph for Chronic Hepatitis B infection in picture
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15
Q

What are 4 common serological profiles of Hep B to understand (in picture)

A
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16
Q

What is the Severity of Hepatitis B infection based on?

What are complications of Hep B infection due to?

How does immune response affect damage to hepatocytes?

A
  • The severity of Hep B infections I based on immune response
  • Complications of hepatitis B are due to host T cell activity
  • The better the immune response the more damage to hepatocytes
17
Q

When are babies vaccinated for Hep B?

When is there an accelerated and intensified vaccine schedule for babies?

What are 4 other reasons to vaccinate for Hep B?

A
  • Since 2017 all new born children are vaccinated against Hepatitis B at 8, 12 and 16 weeks
  • Babies born to hepatitis B infected mother have an accelerated and intensified schedule
  • 4 other reasons to vaccinate for Hep B:
    1) Uninfected household contacts
    2) Occupational or travel risk
    3) Lifestyle risk
    4) Co-existing medical conditions
18
Q

What is the aim of Hep B treatment?

Why is it important that patients adhere to treatment?

What must we also remember to do regarding treatment of Hep B?

What are 2 different treatment options for Hep B.

What is their:
* Action
* Administration
* Drugs
* Side-effects
* Duration of treatment

A
  • There is no ‘cure’ for hepatitis B.
  • Treatment aims to suppress viral replication, as this can lower transmissibility and can potentially make the virus undetectable
  • It is important that patients adhere to medications, as without medication, the infection can come back and potential be resistant to the medication
  • Remember also to screen and vaccinate household contacts
  • 2 treatment options for Hep B are nucleotide analogues and Pegylated alpha interferon (in photo)
19
Q

When is the likelihood of developing chronic hepatitis higher?

How does Hep B infection affect risk developing hepatocellular carcinoma?

Describe the complications flow chart for Hep B infection (in picture)

A
  • The likelihood of developing chronic hepatitis is higher after vertical transmission
  • The risk of developing hepatocellular carcinoma is 200 times higher in people who have had Hepatitis B infection
  • Complications flow chart for Hep B infection (in picture)
20
Q

What type of virus is Hep C?

What is it the most common cause of?

What countries does it typically affect?

How is it transmitted?

A
  • Hep C is an Enveloped single stranded RNA virus
  • It is the Most common cause of chronic viral hepatitis
  • Hep C typically affects Africa, Asia, Southern and Eastern Europe
  • Hep C is a blood borne virus
21
Q

What % of Hep C cases are asymptomatic?

What are 5 symptoms of Hep C in those that are symptomatic?

A
  • 85% of Hep C cases are asymptomatic
  • 5 symptoms of Hep C in those that are symptomatic:
    1) Poor appetite
    2) Myalgia
    3) Fever
    4) Jaundice
    5) Tender hepatomegaly
22
Q

What 2 investigations can be done for Hepatitis C?

What can they indicate?

A
  • 2 investigations can be done for Hepatitis C:
    1) Hepatitis C RNA – can indicate active infection
    2) Anti-Hepatitis C antibody – can indicate recovery or chronic Infection
23
Q

Describe the antibody graph for acute hepatitis C infection (in picture)

A
24
Q

What is defined as a chronic Hepatitis C infection?

Describe the antibody graph for chronic hepatitis C infection (in picture)

A
  • Chronic Hepatitis C infection is defined as infection persisting beyond 6 months of diagnosis
  • Antibody graph for chronic hepatitis C infection (in picture)
25
Q

What are 4 methods of horizontal transmission of Hepatitis C?

What is a method of vertical transmission of Hepatitis C?

What do a 1/3rd of those with hepatitis C not have?

A
  • 4 methods of horizontal transmission of Hepatitis C:
    1) Contaminated needles – drug use, needlestick injuries, reuse of tattoo needles
    2) Blood transfusion
    3) Breaks in mucous membranes
    4) Unprotected intercourse
  • Method of vertical transmission of Hepatitis C - From mother to child e.g., during childbirth
  • 1/3 of people with Hepatitis C have no identifiable risk factors
26
Q

Describe the natural history of Hepatitis C flowchart (in picture)

A
  • Natural history of Hepatitis C:
  • 80% chance of progression to chronic disease
  • 20% chance of cirrhosis due to chronic Hepatitis C
  • 2-5% a year chance of development to Hepatocellular carcinoma due to cirrhosis
27
Q

What are 5 different types of Extrahepatic manifestations of Chronic Hepatitis C?

A
  • 5 different types of Extrahepatic manifestations of Chronic Hepatitis C:

1) Autoimmune
* Thyroid disease

2) Haematological
* Lymphoma

3) Pulmonary
* Fibrosis

4) Renal
* Membranous proliferative Glomerulonephritis

5) Skin
* Lichen Planus
* Porphyria Cunea Tardia

28
Q

What are 3 different types of anti-virals used to treat Hepatitis C?

How effective are they?

How long does treatment last?

What % of cases are cured?

Why is there no vaccine for hepatitis C?

A
  • 3 different types of anti-virals used to treat Hepatitis C:

1) Protease Inhibitors
* Paritaprevir

2) NS5A Inhibitors
* Ledipasvir

3) RNA Polymerase inhibitors
* Sofosbuvir

  • Direct acting antivirals are a highly effective new treatment
  • Treatment duration is shortening (some regimens now only 8 weeks)
  • Cure of Hepatitis C is achieved in 95%
  • There is no vaccine available for hepatitis C due to rapid emergence of genetic variants
29
Q

Life-cycle of Hepatitis C diagram (in picture)

A
30
Q

What type of virus is hepatitis D?

When can you contract Hep D?

What countries does it affect?

What is it transmitted?

What is transmission associated with?

How do we distinguish between Hep B and D?

A
  • Hep D is an RNA virus
  • Only possible to be infected with hep D if you already have hepatitis B
  • Seen in Amazonian basin, Central Africa and Middle east
  • Hep D is a blood borne virus
  • Transmission associated with IV drug use
  • We cannot distinguish between hepatitis B and D in terms of clinical presentation
31
Q

Hep D serology.

What do certain antibodies tell us about Hep D infection?

A
  • Hepatitis D IgM antibody detected – acute infection
  • Hepatitis D IgG detected – indicates immunity
32
Q

What are the effects of co-infection with Hep B and Hep D?

What is the only treatment option for Hep D?

A
  • Co-infection with hepatitis B and D represents the most severe form of hepatitis due to the rapid progression of the disease and development of hepatocellular carcinoma
  • Antivirals used for treatment of hepatitis B do not work against hepatitis D
  • Pegylated Interferons are the only treatment options, but we don’t know how well they actually work
33
Q

What type of virus is Hep E?

What kind of disease does it cause?

What is it associated with?

How is Hep E spread?

What group of people is Hep E associated with?

What countries have epidemics of Hep E?

A
  • Hep E is an RNA virus
  • Hep E causes a zoonotic disease, which is an infectious disease that is transmitted between species from animals to humans
  • Associated with pig farming/consumption of pork
  • Hep E is spread via faeco-oral route
  • Hep E is More common in middle aged men
  • Epidemics of Hep E have occurred in Asia and India
34
Q

What % of Hep E cases are asymptomatic?

What groups of people typically are most severely affected?

What are 4 symptoms of Hep E in those who are symptomatic?

A
  • 95% of people infected with Hep E are asymptomatic
  • Typically, males over the age of 50 are most severely affected
  • 4 symptoms of Hep E in those who are symptomatic:
    1) Diarrhoea
    2) Vomiting
    3) Fevers
    4) Neurological symptoms –10%
35
Q

How is Hep E treated?

What is Hep E the most common cause of in the UK?

What % of pregnant women affected with Hep E die?

Is there a vaccine for Hep E?

A
  • Hep E is usually a self-limiting disease that is only treated using supportive care
  • Hep E is the most common cause of acute hepatitis in the UK
  • 25% of pregnant women infected with Hep E die
  • A vaccine for Hepatitis E is available but only licensed for use in China
36
Q

Summary

A
  • Summary
  • Hepatitis A & E usually present with acute hepatitis
  • Both are usually self-limiting but fulminant disease can occur
  • Hepatitis E is dangerous for pregnant women
  • Hepatitis B & C can present as acute or chronic hepatitis
  • Hepatitis A & B are vaccine preventable
  • New anti-viral drugs raise the prospect of effective cure and maybe eradication of hepatitis C
37
Q

Summary of hepatitis

A
38
Q

Summary of hepatitis serology

A

Danny's MD3002 GI System (42 decks)

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