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infection > 8.1 Viral hepatitis > Flashcards

8.1 Viral hepatitis Flashcards

1
Q

Liver = …1… organ positioned in the ..2.. of the abdomen

A
  1. peritoneal
  2. right upper quadrant (RUQ)
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2
Q

List some functions of liver

A
  • Production of bile
  • Filtering of toxins
  • Excretion of bilirubin cholesterol/hormones/drugs
  • Breakdown of carbohydrates, fats, protein
  • Activation of enzymes
  • Storing glycogen, minerals, ADEK
  • Synthesise blood proteins
  • Synthesise clotting factors
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3
Q

hepatitis means ?

A

inflammation of liver

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4
Q

5 main types of hepatitis viruses ?

A
  • A
  • B
  • C
  • D
  • E
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5
Q

all viral hepatitis infections are ..1.. diseases

A

notifiable

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6
Q

Who would need to be notified about notifiable diseases apart from partner of an infected patient ?

A
  • Local health protection board member
  • CDC
  • health protection agency
  • UKHSA
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7
Q

Name some different strains that are included in enteroviruses

A
  • group A and group B coxsackieviruses
  • the echoviruses
  • the plioviruses
  • hepatitis A virus
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8
Q

Normal site of replication for hepatitis

A

GI tract

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9
Q

When viral infection damages the liver what can be damaged ?

A

all of the liver’s essential functions

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10
Q

When may the symptoms of viral hepatitis occur ?

A
  • instant
  • or occur months or years after the infection itself
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11
Q

list symptoms of viral hepatitis

A
  • jaundice - yellowing of skins & eyes
  • abdominal pain & distention
  • dark urine
  • light coloured stool
  • vomiting
  • fatigue
  • weight loss
  • coma brought on by accumulation of waste products
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12
Q

When the host immune system responds to the infection within the liver cells the response ..1.. liver cells ands causes ..2..

A
  1. kills
  2. the liver damage
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13
Q

What can chronic hepatitis infection cause ?

A
  • permanent liver damage
  • liver failure
  • cancer
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14
Q

Virus type of hepatitis A virus ?

A

non-enveloped ss RNA virus

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15
Q

Hepatitis A infection replicates in ..1.. interfering with ..2… and causing ..3..

A
  1. hepatocytes
  2. cell function
  3. inflammation
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16
Q

transmission of hepatitis A ?

A

faecal-oral route

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17
Q

Hepatitis A transmission happens via …1…. often occurs in ….2… to places where the virus is ..3….

A
  1. contaminated food or water
  2. travellers
  3. highly endemic
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18
Q

Where are the highest risk areas for UK travellers for Hepatitis A ?

A
  • Indian sub-continent
  • sub-saharan africa
  • middle east
  • south east
  • east asia
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19
Q

Why is infection uncommon among adults living in countries which are the highest risk areas for UK travellers for Hepatitis A ?

A

most people are exposed at a young age and acquire lifelong immunity

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20
Q

Although HAV is uncommon in the UK, list some of the risk groups :

A
  • travel - those travelling to endemic areas
  • sexual - high risk activities, multiple partners, MSM, analingus
  • haematological disorders - factor 8 & 9 concentrates have been implicated in transmission
  • occupational risks - for example lab or sewage workers
  • IVDU - known to be at INC risk
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21
Q

clinical features of hepatitis A infection ?

A
  • most children and 1/2 adults = asymptomatic
  • symptoms common to all acute viral hepatitis
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22
Q

Illness type of hepatitis A infection is usually…?

A

self-limiting

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23
Q

4 clinical phases of hepatitis A infection ?

A
  1. Incubation
  2. prodromal
  3. icteric
  4. convalescent
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24
Q

Incubation phase of Hep A
1. days
2. symptoms

A
  1. ~ 30
  2. no symptoms
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25
Q

prodromal phase of Hep A
1. days
2. symptoms

A
  1. 3-10
  2. flu-like symptoms, general fatigue, joint pain , low grade fever, GI symptoms e.g. nausea, vomiting , RUQ discomfort
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26
Q

Icteric phase of Hep A
1. days
2. symptoms

A
  1. 1-3 weeks (can persist < 12 weeks)
  2. jaundice, pale stools, dark urine, pruritus (itching), hepatomegaly
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27
Q

convalescent phase of Hep A
1. days
2. symptoms

A
  1. (up to 6 months)
  2. malaise, anorexia, muscle weakness, hepatic tenderness
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28
Q

Investigations for Hep A ?
1. … testing
2. IgM during … , IgG ….
3. Acute infection - IgM … , IgG ….
4. vaccination / past infection - IgM …. , IgG ….

A
  1. antibody testing - HAV IgM , HAV IgG
  2. IgM detectable during acute infection (and slightly after), IgG persists
  3. IgM positive, IgG positive
  4. IgM negative, IgG positive
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29
Q

Investigations for hepatitis A that isn’t antibody testing

A
  • liver function test - ALT (raised)
  • bilirubin (elevated)
  • ALP (elevated)
  • prothrombin time, clotting function tests (prolonged)
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30
Q

management of hepatitis A ?

A
  • notify HPU
  • paracetamol / analgesia (not liver impairment)
  • anti emetics
  • provide information to patient e.g …
  • follow up: repeat LFTs & admit to hospital if seriously unwell
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31
Q

management of hepatitis A involves providing information such as what ?

A
  • avoid alcohol
  • avoid work
  • school until no longer infectious
  • ensure proper hygiene
  • avoid handling food
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32
Q

Hepatitis A vaccine is recommended to who ?

A
  • those at risk of infection
  • at risk of complications of infection
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33
Q

List individuals who should be offered vaccination for Hep A

A
  • travel (to endemic areas)
  • chronic liver disease
  • sexual (MSM, high risk activities)
  • occupational risks
  • IVDU
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34
Q

HBV is an infection of the ..1.. caused by ..2..

A
  1. liver
  2. HBV
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35
Q

What is the most common liver infection globally ?

A

Hepatitis B infection

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36
Q

HBV is a …1… partially double-stranded ..2… virus

A
  1. circular
  2. DNA
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37
Q

What are the 3 surface antigens that are commonly tested for in clinical practice ?

A
  • surface antigen
  • E antigen
  • core antigen
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38
Q

Transmission of HBV ?

A
  • blood - direct blood to blood contact
  • sex - direct contact with sexual fluids
  • mother to child during birth
  • tattoos, piercings, barbers
  • sharing needles
  • household contact, sharing hygiene equipment
  • unsterile healthcare practices
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39
Q

Where is the highest burden of HBV infection ?

A
  • western pacific
  • african regions
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40
Q

Risk factors for HBV ?

A
  • perinatal exposure
  • sexual transmission (MSM, multiple sexual partners)
  • IVDU
  • living in or travel to highly endemic region
  • incarceration
  • family history of HBV
  • diagnosis of chronic liver disease / HCC
41
Q

Typical symptoms of acute HBV infection include ?

A
  • weight loss, fever, fatigue
  • nausea
  • anorexia
  • RUQ pain
  • jaundice
  • skin rash
42
Q

Chronic clinical features of HBV ?

A
  • no physical signs
  • can present with symptoms if they develop HCC, cirrhosis or liver failure

Due to HCC: distended abdomen, well-circumscribed, solid and relatively homogenous HCC tumour nodule

43
Q

What groups are considered high-risk for hepatitis B in the UK?

A

people who are at a high risk of exposure to hepatitis B virus (HBV) or who are at risk of complications from HBV infection.

can include healthcare workers, people with multiple sexual partners, IVDU, individuals with certain chronic conditions

44
Q

What antigen does the hepatitis B vaccine contain?

A

inactivated hepatitis B surface antigen (HBsAg)

45
Q

What type of immune response is generated by the hepatitis B vaccine?

A

induces the production of antibodies against the hepatitis B surface antigen (HBsAb)

46
Q

Why must serology be considered in context with clinical features and liver function test (LFT) results?

A

to accurately diagnose and assess the stage and severity of HBV infection

providing a comprehensive understanding of the patient’s condition

47
Q

Can patients with acute HBV infection have no jaundice?

A

Yes, some patients with acute HBV infection may experience subclinical hepatitis, which means they have no associated jaundice and may have minimal or no symptoms.

48
Q

What might elevated LFTs indicate in the context of HBV infection?

A

may indicate:
* acute HBV infection
* chronic HBV infection
* observed after infection has been resolved

49
Q

Is it possible for LFTs to be normal in a patient with chronic HBV infection?

A

Yes, LFTs may be normal in a patient with chronic HBV infection, especially if they have a low viral load.

50
Q

What is the typical outcome for most adults with acute HBV infection?

A

will achieve seroconversion, developing HBsAb (antibodies to the hepatitis B surface antigen), without the need for antiviral treatment.

51
Q

What type of treatment is generally recommended for immunocompetent patients with acute HBV infection?

A

Supportive treatment

52
Q

What does supportive treatment for acute HBV infection involve?

A

managing symptoms and ensuring the patient’s comfort, hydration, and nutritional needs are met while monitoring liver function.

53
Q

In what scenarios might antiviral therapy be required for acute HBV infection?

A

patients with acute HBV infection who develop acute liver failure

or have a severe course of infection, such as presenting with ascites (accumulation of fluid in the abdomen) or encephalopathy (brain dysfunction due to liver failure).

54
Q
  1. What is the ultimate goal of treatment for chronic HBV infection?
  2. how is this marked by ?
A
  1. ameliorate hepatic dysfunction and achieve a disease-free state
  2. seroconversion from HBsAg-positive to HBsAg-negative and the production of anti-HBs (HBsAb).
55
Q

Overall eradication of HBV is rare so primarily goal is what ?

A

suppression of HBV DNA to undetectable levels

56
Q

Antivirals are often used in patients with chronic HBV infection in patients with what ?

A
  • cirrhosis
  • elevated ALT levels / evidence of histological disease
  • positive HBeAg or elevated HBV DNA levels
57
Q

In management of chronic HBV infection, what are antivirals considered to reduce risk of ?

A

perinatal transmission

58
Q

Hepatitis C what type of virus ?

A

single stranded, enveloped RNA

59
Q

Hep B virus transmitted by ?

A

blood exposure

60
Q

Hep C transmitted by blood exposure: situations ?

A
  • IVDU
  • sexual activity
  • perinatal
  • intranasal drug use
  • blood products
  • injection
61
Q

Hep C risk factors ?

A
  • IVDU
  • blood transfusion recipients
  • country with high prevalence of HCV e.g. Africa, Asia, Pacific islands
  • Babies born to mothers with HCV
  • prisoners
  • HIV-positive
  • MSM
  • healthcare workers e.g. needlestick injuries
62
Q

Acute clinical presentaiton of Hep C ?

A
  • maj patients are asymptomatic ~ 30% have fatigue, jaundice > ALT
  • some patients spontaneously clear virus within 12 months
  • maj of patients develop chronic infection
63
Q

Chronic hep C infection is generally defined as … ?

A

persistence of HCV RNA in blood for at least 6 months

64
Q

Chronic clinical presentation of Hep C ?

patients usually ..1.. but may present with features of …2.. or …3… carcinoma

occasionally patients may present with ..4.. manifestations

A
  1. asymptomatic
  2. decompensated cirrhosis
  3. hepatocellular
  4. extrahepatic
65
Q

Examples of features of decompensated cirrhosis involves ?

A
  • jaundice
  • ascites
  • signs of hepatic encephalopathy
66
Q

HCV screenign antibody test positive result indicates what ?

A

current infection (either acute/ chronic) or past resolved infection

67
Q

If antibody test for HCV is positive then what confirms current HCV infection ?

A

positive HCV RNA testing

68
Q

Why is HCV RNA testing important after a positive HCV antibody test?

A

it differentiates between a current active infection and a past resolved infection, helping to determine if the virus is actively replicating

69
Q

Which liver function test (LFT) is particularly important in the context of HCV infection?

A

ALT (Alanine Aminotransferase) test

70
Q

What can elevated ALT levels indicate in a patient with HCV infection?

A

inflammation or damage, which may be due to an active HCV infection

71
Q

When is treatment initiated for HCV infection?

A

Initiated in all patients with active HIV infection

72
Q

Are the treatment regimens different for chronic and acute HCV infection?

A

no, the same regimens are used for both chronic and acute HCV infection

73
Q

What type of treatment is given to patients with HCV infection?

A

antiviral treatment is given to all patients

74
Q

What type of antivirals are used in the treatment of HCV infection ?

A

direct-acting oral agents (DAAs)

75
Q

What is considered equivalent to a ‘cure’ for HCV infection ?

A

undetectable HCV levels in the blood after treatment

76
Q

What type of virus is hepatitis D ?

A

enveloped RNA virus

77
Q

Can hepatitis D infect individuals on its own ?

A

No, Hep D can only survive in patients who also have a Hep B infection

It attaches itself to the HBsAg and cannot survive without this protein

78
Q

What are the two ways Hepatitis D can infect an individual?

A

co-infection or superinfection

79
Q

what is co-infection in relation to Hep D ?

A

where a person is infected simultaneously with both HDV and HBV

80
Q

What is superinfection in relation to Hep D ?

A

occurs when a person already infected with Hep B contract Hep D

81
Q

Co-infection with HBV leads to ….1… which is usually a ….2… illness

A
  1. acute HDV and HBV infection
  2. self-limited
82
Q

Hep D effct on Hep B ?

A

Hep D increases the complications and disease severity of Hep B

83
Q

how is Hep D virus transmitted ?

A

via contaminated blood or blood products through precutaneous per mucosal and sexual transmission

84
Q

What is HDV more likely than acute HBV infection alone to do ?

A

lead to severe illness and acute liver failure

85
Q

HDV progression to chronic ifnection mirrors that of ….1… infection with ..2.. age at infection predicting higher risk of …3…. (~2%)

A
  1. chronic
  2. younger
  3. chronicity
86
Q

How does superinfection HBV and HDV present ?

A
  • as severe hepatitis - either in someone not known to have chronic HBV infection or as a flare of disease in someone with chronic HBV infection
87
Q

Clinical presentation of hep D virus infection ranges from what ?

A
  • asymptomatic to acute liver failure
  • cirrhosis
  • chronic liver disease
  • hepatic decompensation
  • hepatocellular carcinoma
88
Q

Why are patients with risk factors for HBV infection also at risk for HDV infection ?

A

since HDV infection occurs in the setting of HBV infection

89
Q

What do Anti-HDV IgG and IgM tests indicate?

A

Anti-HDV IgG and IgM antibodies appear 3-4 weeks after HDV infection.

They may persist even after the clearance of the infection, indicating past exposure or ongoing immunity.

90
Q

When is HDV-RNA testing recommended?

A

In cases of suspected ongoing HDV infection. A positive result indicates active viral replication.

91
Q

What does HDV antigen testing indicate?

A

Detects presence of HDV antigens , indicative of current HDV infection

92
Q

Why is it important to perform HDV serology tests alongside HBV serology?

A

HDV requires HBV for its life cycle and replication.

Therefore, HDV serology tests should always be done alongside HBV serology tests to assess co-infection or superinfection.

93
Q

What is the significance of persistent Anti-HDV antibodies after clearance of infection?

A

Persistent Anti-HDV antibodies suggest prior exposure to HDV or ongoing immunity against the virus, even if the infection has been cleared.

94
Q

How is Hepatitis E transmitted?

A

primarily by the faecal-oral route, often through contaminated water or food

95
Q

Where is Hepatitis E most commonly found?

A

Southeast Asia, Africa, Mexico, Hong Kong, and China

96
Q
  1. What is the typical course of Hepatitis E infection?
  2. what do most patients not require ?
A
  1. usually causes a mild illness that resolves on its own within about a month.
  2. specific treatment.
97
Q

What is the likelihood of Hepatitis E progressing to chronic hepatitis and liver failure?

A

rare , occuring in less than 5% of cases

typically in immunocompromised individuals

98
Q

Is there a vaccine available for hepatitis E ?

A

no

infection (33 decks)

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