3.13.2. Liver + Biliary Tree Disease - Viral Hepatitis - B

Question 1

What causes Hepatitis B infection?

Answer 1

A Parenteral Virus (HBV)

Question 2

How does HBV enter into the Bloodstream?

Answer 2

It is a Parenternal Virus -

Transmitted through Blood-Blood contact

Question 3

How are most Blood-Blood (Parenternal) Viruses transmitted?

Answer 3

1. I.V. Drug Abusers

2. Sex

Question 4

What type of disease does HBV cause?

Answer 4

Chronic Liver Disease

Question 5

What is the Structure of the Hepatitis B Virus?

Answer 5

1. HBV DNA and DNA Polymerase are contained within an Inner Protein Core (HBcAg)
2. The Inner Protein Core is contained within an Outer Lipid Envelope, containing the Surface Antigen (HBsAg)

Question 6

What happens during Active Replication of the Hepatitis B Virus?

Answer 6

The Inner Protein Core (HBcAg) changes into the Hepatitis E Antigen (HBeAg)

Question 7

What is the significance of HBcAg changing into the Hepatitis E Antigen (HBeAg) during Active Replication?

Answer 7

The Hepatitis E Antigen (HBeAg) can be measured in the Blood, with Hepatitis B Viral Infection

Question 8

What are the Antibodies, produced by the Body, in response to a Hepatitis B infection?

Answer 8

1. Anti-HBs
2. IgM Anti-HBc
3. IgG Anti-HBc
4. Anti-HBe

Question 9

What does Anti-HBs act against? And what purpose does it have?

Answer 9

This acts against the Surface Antigen of the Hepatitis B Virus (HBsAg), for Protection

Question 10

What does IgM Anti-HBc act against? And what purpose does it have?

Answer 10

This acts against the Inner Protein Core of the Hepatitis B Virus (HBcAg), in acute infection

Question 11

What does IgG Anti-HBc act against? And what purpose does it have?

Answer 11

This acts against the Inner Protein Core of the Hepatitis B Virus (HBcAg), in chronic infection

Question 12

What does Anti-HBe act against? And what purpose does it have?

Answer 12

This acts against the Hepatitis E Antigen (HBeAg), present when there is active replication - it is an anti-virus

Question 13

What does acute infection with HBV cause?

Answer 13

Inflammation of the Liver

Question 14

What does chronic infection with HBV cause?

Answer 14

1. No further development (in 60-85% of cases)
2. Progression to Liver Fibrosis / Cirrhosis
3. Progression from 1 or 2 to Hepatocellular Carcinoma
4. Progression from 2 or 3 to End-Stage Liver Disease

Question 15

What are the Clinical Signs of HBV infection?

Answer 15

1. Hepatomegaly
2. Lymphadenopathy
3. Deranged Enzymes
4. Jaundice

Question 16

Why does Hepatomegaly occur?

Answer 16

Due to the Inflammation of the Liver caused by the HBV infection

Question 17

Why does Lymphadenopathy occur?

Answer 17

This is due to the Immune response to the HBV infection

Question 18

Why do Deranged Enzymes appear?

Answer 18

Due to the potential impairment of the Hepatic Function

Question 19

What type of Jaundice occurs?

Answer 19

Intrahepatic

Question 20

Why does Jaundice occur?

Answer 20

Due to the damage of Hepatocytes, they cannot effectively deal with Bilirubin and so there is a back-up into the Blood

Question 21

What are the Symptoms of HBV infection?

Answer 21

1. Nausea and Vomiting

2. Anorexia

Question 22

Why does Nausea and Vomiting occur in an HBV infection?

Answer 22

Due to this being an infection of an Accessory Organ of the Alimenatry Tract, this is the body’s natural response

Question 23

Why does Anorexia occur?

Answer 23

Due to the associated Nausea and Vomiting

Question 24

What investigations are necessary for HBV infection?

Answer 24

1. Blood Inflammatory Markers (PCR and ESR)

2. Serum ELISA looking for the HBsAg (Hepatitis B Surface Antigen)

Question 25

What is the course of action id the HBsAg is negative?

Answer 25

There is no active infection, so the Vaccine Series is Initiated or Completed

Question 26

What is shown if the HBsAg is positive?

Answer 26

There is Chronic or Active Infection

Question 27

What is the course of action if the HBsAg is positive with Clinical Evidence of Infection?

Answer 27

There is a Serum ELISA for IgM Anti-HBc:

1. If this is positive there is Active infection present
2. If this is negative there is Chronic infection present

Question 28

What is the course of action if the HBsAg is positive without Clinical Evidence of Infection?

Answer 28

There is Chronic Infection present, so there is Evaluation for ongoing monitoring and treatment

Question 29

What is the course of action if the HBsAg is positive, and the IgM Anti-HBc is negative?

Answer 29

There is Chronic Infection present, so there is Evaluation for ongoing monitoring and treatment

Question 30

What is the shown if the HBsAg is positive, and the IgM Anti-HBc is positive?

Answer 30

There is acute infection

Question 31

What is the treatment for HBV infection?

Answer 31

Lamivudine

Question 32

What is Lamivudine?

Answer 32

An antiviral which inhibits HBV reverse transcriptase, safely suppressing HBV replication during long-term use

Question 33

What can advanced stage HBV lead to?

Answer 33

Liver Cirrhosis