8. Viral Hepatitis Flashcards by Amy Brown

Which types of hepatitis can form chronic viral infections?

Hep B and C

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Why are Hep B and C referred to as hepatotropic infections?

They replicate specifically in hepatocyte, causing hepatocyte destruction.

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How do the incubation periods of Hep B and C differ?

B: 6 weeks - 6 months
C: 6-12 weeks

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What is the structure of Hep B?

dsDNA

enveloped

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What is the structure of Hep C?

ssRNA

Enveloped - icosahedral

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What would you expect to see in the blood test results of a patient with hepatitis?

Abnormal LFT’s - AST, ALT, bilirubin raised

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Which enzyme is an indicator of extra-hepatic jaundice?

Alkaline phosphatase (ALP) is raised if there is extra hepatic jaundice.

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Concentration of protein is an indicator of liver function?

Albumin

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What do ALT and AST levels provide an indicator of?

Hepatocyte damage/integrity (not function!)

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What other tests can be used to assess liver function?

Tests of coagulation - clotting factors synthesised in liver

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What type of jaundice occurs in hepatitis?

Intrahepatic

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What is pre-hepatic jaundice and when is it likely to occur?

When a condition/infection increases RBC breakdown, increasing bilirubin levels.
E.g malaria, sickle cell anaemia, thalassaemia, spherocytosis

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What is intra-hepatic jaundice and when is it likely to occur?

Liver not functioning properly, so cannot process bilirubin properly.
E.g cirrhosis, hepatitis (viral and alcoholic)

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What extra-hepatic jaundice and when is it likely to occur?

Bile duct damaged, inflamed or obstructed so gallbladder unable to release bile into duodenum.
Gallstones, biliary stricture, carcinoma

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How can Hep B be transmitted?

Vertically
Sexual contact
Drug injecting
HCW needlestick

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What is the most common mode of Hep B transmission globally?

Vertical (75% cases globally)

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What symptoms are associated with acute Hep B?

Up to 50% have no/vague symptoms
Jaundice
Fatigue
Abdominal pain
Anorexia/nausea/vomiting
Arthralgia

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What is the outcome of Hep B infections in adults?

Most clear the infection in 6 months

Becomes chronic in <10% of adults.

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How do the outcomes of Hep B differ in children?

90% become chronic if infected in infancy

What 3 surface antigens are used in HepB serology?

HBsAg (surface antigen)
HBeAg
HBcAg (core antigen)

How does core antigen detection differ to e-antigen and surface antigen?

Core antigen can only be detected in liver tissue itself, it is not present in the blood.

Which 3 antibodies are detected in HepB serology?

HBsAb
HBeAb
HBcAb (antibody is detectable in the blood)

How can the viral load of Hep B be measured?

PCR of HBV DNA - detect how much viral DNA is present in the blood.

Which sequence are the antigens and antibodies detected in Hep B?

Surface antigen
E-antigen
Core antibody IgM
E-antibody
Suface antibody
Core antibody IgG

Which serology marker indicated the most infectious stage of Hep B?

E-antigen

Which antibody is the first to appear?

Core antibody igM

How soon after infection does surface antigen appear?

6 weeks

What stage indicates the disappearance of e-antigen and infectivity?

E-antibody

Which antibody signified clearance of the virus/recover?

Surface antibody - last antibody to appear

Which antibody is present for life?

Core antibody IgG

How is chronic Hep B diagnosed?

Persistence of HBsAg (surface antigen) after 6 months

What are the complications of chronic Hep B infection?

25% develop liver cirrhosis | 5% develop hepatocellular carcinoma

What is the treatment for chronic Hep B?

No cure - DNA is integrated into host genome. | Life-long antivirals to suppress viral replication

Is there a vaccination against Hep B?

Yes

Which response does the Hep B vaccination generate?

Surface antibody response | 3 doses + boosters required

Which population are most at risk of Hep C?

IV drug users represent > 90% of those with Hep C

Other than IV drug use, how can Hep C be transmitted?

Sexual contact Vertically Blood transfusion HCW needlestick injury

What percentage of people with Hep C develop chronic infection?

80%

What symptoms are associated with Hep C?

80% have no symptoms | 20% vague symptoms - fatigue, anorexia, nausea, abdo pain

How can Hep C be diagnosed?

Serology - anti-Hep C antibody (positive life-long) | Viral PCR to confirm if on-going infection and not previous

Is there a Hep C vaccine?

Can Hep C be cured?

Yes 8-12 week course of anti-virals Can get re-infected

Which antibodies/antigens will be present in someone suffering from acute Hep B infection?

Surface antigen Core antibody - IgM Surface antibody may or may not be present

Which antibodies/antigens will be present in someone who has had Hep C in the past?

Core antibody - IgG | Surface antibody

Which antibodies/antigens will be present in someone who has chronic hep B?

Surface antigen | Core antibody IgG

Which antibodies/antigens will be present in someone who has been vaccinated for Hep B but never infected?

Surface antibody