4- viral hepatitis Flashcards
which hepatitis mostly cause acute viral hepatitis?
hepatitis A,B, E mostly
what tests help diagnosis of acute viral hepatitis?
- raised ALT & AST
- bilirubin might be elevated
- Alk phos/gamma GT normal
what are symptoms of acute viral hepatitis?
abdominal pain, nausea, jaundice, diarrhoea
what is treatment for viral hepatitis?
- supportive
- monitor for hepatic failure →jaundice, encephalopathy, clotting
what hepatitis commonly cause chronic viral hepatitis?
mainly hepatitis C & B
what are common test results for chronic viral hepatitis?
deranged LFT prompts test (mildly elevated ALT/AST)
what are symptoms for chronic viral hepatitis?
usually have limited symptoms until advanced disease
what can be done to assess liver fibrosis?
→liver biopsy but very invasive so used less now
→liver elastography = assess stiffness of liver, non invasive
what hepatitis have faecal oral route of transmission?
hep A & E
how is hep A treated?
no chronic state, resolves spontaneously = rare in UK
is hep B acute or chronic?
both, most people acute clear spontaneously but if exposed in utero then 90% chance you’ll develop chronic
how is hep B spread?
spread blood borne and sexually transmitted
what is HBsAg?
= presence of surface antigen = marker of active infection
what is HBeAG?
e antigen = shows viral replication
what is anti-HBs?
surface antibody = normally associated with if had and cleared yourself or from having vaccine →marker of immunity
what is anti-HBe?
antibody developed in defence -indicated clearance of eAg
what is anti-HBc?
core antibody →only develop if infected naturally (not vaccine)
what is HBV DNA PCR?
PCR = gives accurate level of how much virus in blood
what antigens are present at which stage of infection?
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
what happens phases of hep infection? (5 phases)
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
what are main goals of treatment of hepatitis?
- reduce liver damage & inflammation
- reduce mother to child transmission
- reduce mortality
when should you treat hepatitis?
if high viral load or significant liver inflammation/damage
is hep C acute or chronic?
chronic infection = active infection for more than 6 months
how is hep C spread?
mainly blood spread like injecting drugs, transfusions, surgical procedures
when does hep C get symptoms?
most people asymptomatic until develop liver disease
what are the steps to diagnosis of hep C?
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
what is treatment for hep C?
direct antivirals (usually at least 2 drugs) for 8-12 weeks →very good
is hep E acute or chronic?
acute viral hepatitis = vomiting, diarrhoea
