3.13.3. Liver + Biliary Tree Disease - Viral Hepatitis - C

Question 1

What causes Hepatitis C infection?

Answer 1

A Parenteral Virus (HCV)

Question 2

How does HCV 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 HCV cause?

Answer 4

Chronic Liver Disease

Question 5

What is the Structure of the Hepatitis C Virus?

Answer 5

1. HCV RNA is contained within a Nucleocapsid (Inner Layer

2. The Nucleocapsid is contained an Envelope, containing Glycoproteins

Question 6

What can be detected during Active Replication of the Hepatitis C Virus?

Answer 6

HCV RNA

Question 7

What antibody is produced in response to HCV infection?

Answer 7

Anti-HCV

Question 8

What does Acute HCV infection cause?

Answer 8

Inflammation of the Liver

Question 9

What does exposure of HCV lead to?

Answer 9

1. It being Resolved (in 15% of cases)
2. It becoming Chronic Stable (in 80% of the Unresolved cases / 68% of Total Cases)
3. It becomes Chronic Slowly Progressive / Cirrhotic (in 75% of the Chronic Unstable cases / 13% of Total Cases)
4. It will develop into Hepatocellular Carcinoma (25% of the cases which are Slowly Progressive / 4% of Total Cases)

Question 10

What are the Clinical Signs of HCV infection?

Answer 10

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

Question 11

Why does Hepatomegaly occur?

Answer 11

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

Question 12

Why does Lymphadenopathy occur?

Answer 12

This is due to the Immune response to the HCV infection

Question 13

Why do Deranged Enzymes appear?

Answer 13

Due to the potential impairment of the Hepatic Function

Question 14

What type of Jaundice occurs?

Answer 14

Intrahepatic

Question 15

Why does Jaundice occur?

Answer 15

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

Question 16

What are the Symptoms of HCV infection?

Answer 16

1. Asymptomatic
2. Nausea an Vomiting
3. Anorexia
4. Flu-like symptoms

Question 17

When will HCV remain Asymptomatic until?

Answer 17

Cirrhosis occurs

Question 18

Why does Nausea and Vomiting occur in an HCV infection?

Answer 18

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

Question 19

Why does Anorexia occur?

Answer 19

Due to the associated Nausea and Vomiting

Question 20

Why do Flu-Like Symptoms occur?

Answer 20

Due to the presence of infection rapidly damaging Hepatocytes - this is the body’s natural reponse

Question 21

What investigations are necessary for HCV infection?

Answer 21

1. Serum Inflammatory Markers (PCR and ESR)
2. Serology (and ELISA)
3. Abdominal Ultrasound / CT Scan
4. Cirrhosis investigation

Question 22

What is the Serology (and ELISA) looking for?

Answer 22

1. HCV RNA which indicates current infection

2. Anti-HCV Antibody which indicates there has been HCV infection

Question 23

What is the purpose of the Abdominal Ultrasound / CT Scan?

Answer 23

To view the liver to see if Cirrhosis has occurred

Question 24

What are the Treatments for HCV infection?

Answer 24

1. Daclatasvir
2. PEGylated Interferon
3. Oral Ribavirin

Question 25

What is the action of Daclatasvir?

Answer 25

This inhibits the production of the HCV Non-Structural Protein, preventing successful replication

Question 26

What is the action of PEGylated Interferon?

Answer 26

This causes the T-Helper cells (associated with the infection) to become T2-Helper Cells, to invoke a quicker and more powerful immune response

Question 27

What is the action of Oral Ribavirin?

Answer 27

This makes the native drug resemble Adenosine / Guanosine which is incorporated into the RNA and is fatal to the Virus

Question 28

What can occur in advanced stage HCV infection?

Answer 28

Liver Cirrhosis