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Infection > 8. Viral Hepatitis > Flashcards

8. Viral Hepatitis Flashcards

1
Q

Which types of hepatitis can form chronic viral infections?

A

Hep B and C

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2
Q

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

A

They replicate specifically in hepatocyte, causing hepatocyte destruction.

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3
Q

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

A

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

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4
Q

What is the structure of Hep B?

A

dsDNA

enveloped

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5
Q

What is the structure of Hep C?

A

ssRNA

Enveloped - icosahedral

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6
Q

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

A

Abnormal LFT’s - AST, ALT, bilirubin raised

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7
Q

Which enzyme is an indicator of extra-hepatic jaundice?

A

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

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8
Q

Concentration of protein is an indicator of liver function?

A

Albumin

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9
Q

What do ALT and AST levels provide an indicator of?

A

Hepatocyte damage/integrity (not function!)

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10
Q

What other tests can be used to assess liver function?

A

Tests of coagulation - clotting factors synthesised in liver

PT

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11
Q

What type of jaundice occurs in hepatitis?

A

Intrahepatic

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12
Q

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

A

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

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13
Q

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

A

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

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14
Q

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

A

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

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15
Q

How can Hep B be transmitted?

A

Vertically
Sexual contact
Drug injecting
HCW needlestick

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16
Q

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

A

Vertical (75% cases globally)

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17
Q

What symptoms are associated with acute Hep B?

A 
Up to 50% have no/vague symptoms
Jaundice
Fatigue
Abdominal pain
Anorexia/nausea/vomiting
Arthralgia
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18
Q

What is the outcome of Hep B infections in adults?

A

Most clear the infection in 6 months

Becomes chronic in <10% of adults.

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19
Q

How do the outcomes of Hep B differ in children?

A

90% become chronic if infected in infancy

20
Q

What 3 surface antigens are used in HepB serology?

A

HBsAg (surface antigen)
HBeAg
HBcAg (core antigen)

21
Q

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

A

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

22
Q

Which 3 antibodies are detected in HepB serology?

A

HBsAb
HBeAb
HBcAb (antibody is detectable in the blood)

23
Q

How can the viral load of Hep B be measured?

A

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

24
Q

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

A
  1. Surface antigen
  2. E-antigen
  3. Core antibody IgM
  4. E-antibody
  5. Suface antibody
  6. Core antibody IgG
25
Q

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

A

E-antigen

26
Q

Which antibody is the first to appear?

A

Core antibody igM

27
Q

How soon after infection does surface antigen appear?

A

6 weeks

28
Q

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

A

E-antibody

29
Q

Which antibody signified clearance of the virus/recover?

A

Surface antibody - last antibody to appear

30
Q

Which antibody is present for life?

A

Core antibody IgG

31
Q

How is chronic Hep B diagnosed?

A

Persistence of HBsAg (surface antigen) after 6 months

32
Q

What are the complications of chronic Hep B infection?

A

25% develop liver cirrhosis

5% develop hepatocellular carcinoma

33
Q

What is the treatment for chronic Hep B?

A

No cure - DNA is integrated into host genome.

Life-long antivirals to suppress viral replication

34
Q

Is there a vaccination against Hep B?

A

Yes

35
Q

Which response does the Hep B vaccination generate?

A

Surface antibody response

3 doses + boosters required

36
Q

Which population are most at risk of Hep C?

A

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

37
Q

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

A

Sexual contact
Vertically
Blood transfusion
HCW needlestick injury

38
Q

What percentage of people with Hep C develop chronic infection?

A

80%

39
Q

What symptoms are associated with Hep C?

A

80% have no symptoms

20% vague symptoms - fatigue, anorexia, nausea, abdo pain

40
Q

How can Hep C be diagnosed?

A

Serology - anti-Hep C antibody (positive life-long)

Viral PCR to confirm if on-going infection and not previous

41
Q

Is there a Hep C vaccine?

A

No

42
Q

Can Hep C be cured?

A

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

43
Q

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

A

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

44
Q

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

A

Core antibody - IgG

Surface antibody

45
Q

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

A

Surface antigen

Core antibody IgG

46
Q

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

A

Surface antibody

Infection (15 decks)

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