4- viral hepatitis

Question 1

which hepatitis mostly cause acute viral hepatitis?

Answer 1

hepatitis A,B, E mostly

Question 2

what tests help diagnosis of acute viral hepatitis?

Answer 2

• raised ALT & AST
• bilirubin might be elevated
• Alk phos/gamma GT normal

Question 3

what are symptoms of acute viral hepatitis?

Answer 3

abdominal pain, nausea, jaundice, diarrhoea

Question 4

what is treatment for viral hepatitis?

Answer 4

• supportive
• monitor for hepatic failure →jaundice, encephalopathy, clotting

Question 5

what hepatitis commonly cause chronic viral hepatitis?

Answer 5

mainly hepatitis C & B

Question 6

what are common test results for chronic viral hepatitis?

Answer 6

deranged LFT prompts test (mildly elevated ALT/AST)

Question 7

what are symptoms for chronic viral hepatitis?

Answer 7

usually have limited symptoms until advanced disease

Question 8

what can be done to assess liver fibrosis?

Answer 8

→liver biopsy but very invasive so used less now

→liver elastography = assess stiffness of liver, non invasive

Question 9

what hepatitis have faecal oral route of transmission?

Answer 9

hep A & E

Question 10

how is hep A treated?

Answer 10

no chronic state, resolves spontaneously = rare in UK

Question 11

is hep B acute or chronic?

Answer 11

both, most people acute clear spontaneously but if exposed in utero then 90% chance you’ll develop chronic

Question 12

how is hep B spread?

Answer 12

spread blood borne and sexually transmitted

Question 13

what is HBsAg?

Answer 13

= presence of surface antigen = marker of active infection

Question 14

what is HBeAG?

Answer 14

e antigen = shows viral replication

Question 15

what is anti-HBs?

Answer 15

surface antibody = normally associated with if had and cleared yourself or from having vaccine →marker of immunity

Question 16

what is anti-HBe?

Answer 16

antibody developed in defence -indicated clearance of eAg

Question 17

what is anti-HBc?

Answer 17

core antibody →only develop if infected naturally (not vaccine)

Question 18

what is HBV DNA PCR?

Answer 18

PCR = gives accurate level of how much virus in blood

Question 19

what antigens are present at which stage of infection?

Answer 19

when acutely infected →surface antigen is first detectable and this is when you have symptoms →body develops core antibodies →after a number of weeks symptoms resolve →6 months later they develop surface antigens indicating completely cleared

Question 20

what happens phases of hep infection? (5 phases)

Answer 20

phase 1 = acute infection→enters body and replicates in liver = inflammation →get symptoms and elevated liver enzymes (ALT & AST)

phase 2 = transition phase → lose e antigen and get e antibody →signifies decrease in viral replication and indicate favorable response = good to treat then

phase 3 = quiescent phase →inactive phase, minimal or no inflammation and LFTs normal

phase 4 = chronic infection →virus persist for more than 6 months, prolonged & uncontrolled viral replication →inflammation in liver causing scarring and eventually cirrhosis

phase 5 = flares & reactivation →may still reactivate where ALT & AST may be elevated

Question 21

what are main goals of treatment of hepatitis?

Answer 21

• reduce liver damage & inflammation
• reduce mother to child transmission
• reduce mortality

Question 22

when should you treat hepatitis?

Answer 22

if high viral load or significant liver inflammation/damage

Question 23

is hep C acute or chronic?

Answer 23

chronic infection = active infection for more than 6 months

Question 24

how is hep C spread?

Answer 24

mainly blood spread like injecting drugs, transfusions, surgical procedures

Question 25

when does hep C get symptoms?

Answer 25

most people asymptomatic until develop liver disease

Question 26

what are the steps to diagnosis of hep C?

Answer 26

patient at risk of hep C or signs of chronic liver disease →test for antibody to Hep C →if negative not infected, if positive past or active infection →test for HCV RNA by PCR →if negative then past infection and if positive then active infection

Question 27

what is treatment for hep C?

Answer 27

direct antivirals (usually at least 2 drugs) for 8-12 weeks →very good

Question 28

is hep E acute or chronic?

Answer 28

acute viral hepatitis = vomiting, diarrhoea