74. Hepatitis

Question 1

How does hepatitis A spread?

Answer 1

Faecal-oral spread/shellfish

Question 2

What are the presenting symptoms of hep A?

Answer 2

Fever
Malaise
Anorexia
Nausea
Arthlagia

Question 3

How do you detect hep A?

Answer 3

IgM and IgG antibodies not present for 22-40days post infection

ALT and AST doesn’t rise until week 3 then return to normal between 5 and 20 weeks.

Question 4

What is the prognosis and treatment of hep A?

Answer 4

Self limiting, usually doesn’t cause decompensated liver failure (fulminant hepatitis)

Fulminant hepatitis treated with interferon alpha

Question 5

How does hep B spread?

Answer 5

Blood products, needle sharing

Question 6

How does hep B present?

Answer 6

Urticaria
Arthlralgia
Fever
Malaise
Anorexia
Nausea

Question 7

When are the antibodies present for detection?

What do antibodies HBcAg and HBsAg imply?

Answer 7

1-6 moths post infection

HBc- past infection
HBs- past vaccination

Question 8

What are the complications of hep B?

Answer 8

Fulminant hepatitis
Cirrhosis
HCC
Cholangiocarcinoma

Question 9

How do you treat hep B?

Answer 9

Avoid alcohol
Trace contacts
Refer those with chronic inflammation or cirrhosis for antivirals

PEG interferon Alfa 2-a vs long term

Question 10

How is hep C spread?

Answer 10

Blood transfusion, IVDA, sexual contact

Question 11

Discuss the presentation and prognosis of hep C

Answer 11

Silent hepatitis, 85% develop silent chronic infection
25% develop cirrhosis
4% hepatocellular carcinoma

Question 12

How is hep c treated?

Answer 12

Depends on type (1-6) typically ledipasvir and sofosbuvir

Interferon free regimes eliminate barriers to treatment such as side effects and long regimes

Question 13

How is hep D treated?

Answer 13

Interferon alpha has limited success, liver transplantation May be needed

Question 14

Which hepatitis are associated with each other

Answer 14

Hep B and D

Question 15

Which hepatitis have a vaccine?

Answer 15

Hep A, B (b covers b and d)

Question 16

Which hepatitis is associated with HIV?

Answer 16

Hep C

Question 17

How is the liver affected by alcohol?

Answer 17

Inflammation
Fatty liver
Alcoholic hepatitis
Cirrhosis

Question 18

How does alcohol affect the CNS?

Answer 18

Self neglect
Decreased memory and cognition
Cortical atrophy
Neuropathy
Fits and falls
Korsakoff’s and wernickes

Question 19

How does alcohol affect the gut

Answer 19

Obesity
D&V
Gastric erosions
Peptic ulcers
Varices
Pancreatitis
Oesophageal rupture (shock and surgical emphysema in the neck)

Question 20

How does alcohol affect the heart and the blood?

Answer 20

Increased MCV
aneamia 
GI bleeding
Cardiomyopathy 
Sudden death in binge drinkers

Question 21

What are the signs of withdrawl?

Answer 21

Increased pulse
Low BP
Confusion
Fits
Hallucinations

Question 22

How do you treat withdrawing alcoholics?

Answer 22

Chlordiazepoxide (benzo)
Refeeeing vitamins
Pabrinex

Question 23

What drugs can be given to reduce alcohol intake?

Answer 23

Acamprostate- helps anxiety, insomnia, cravings

Disulfiram- causes people to react very badly when they ingest alcohol

Question 24

How do you treat alcoholic hepatitis?

Answer 24

Hospitalise- urinalysis catheter and CVP
Vit K
Thiamine
Optimise nutrition
Steroids in severe disease