Acute and Chronic Hepatitis Flashcards
Define acute and chronic hepatitis?
Refers to inflammation of the liver either acutely or chronically.
Most common cause worldwide is infection. Other causes include drugs, alcohol related hepatitis and NAFLD.
What are the pathological consequences of hepatitis?
Acute hepatitis may be self limiting, become chronic or cause acute liver failure.
Chronic hepatitis can cause chronic liver failure.
May cause cirrhosis of the liver and in turn predispose to hepatocellular carcinoma.
List the common infective causes of acute hepatitis?
- Hep A: faeco-oral transmission
- Hep B/C: blood borne/other bodily fluids.
- Hep D/E (not common) note Hep D requires to Hep B to replicate so is only present in those with Hep B
HIV/EBV/CMV
Schistosomiasis Hydatid disesase (dog tapeworm)
Describe some of the risk factors for infective hepatitis?
Hep A (poor food hygeine)
Hep B (IVDU, unprotected sex*, tattoos in foreign countries)
Hep D and E are uncommon. Hep D only occurs as a co-infection with Hep B.
What are the typical symptoms in chronic hepatitis?
Infection is often subclinical and asymptomatic patients may have vague symptoms such as fatigue and dyspepsia.
May only present with symptoms as a result of chronic liver disease.
Which viral infections are most commonly responsible for chronic hepatitis?
Hep B, C and D
Describe the typical presentation in Hepatitis A infection?
Incubation period of 2-6 weeks.
After this there may be a prodrome of flu like illness with anorexia, nausea, fatigue, malaise and joint pain. Smoker may note that they lose their taste for tobacco.
Following this jaundice is common occurring 70-80% of adults with acute Hep A. (Often with pale stools and dark urine)
Tender hepatosplenomegaly may occur.
Children tend to asymptomatic and a more likely to have symptoms with increasing age.
Describe the typical presentation in Hep B infection?
Initially may be subclinical or present with a flu like illness.
Incubation period is usually between 60-90 days.
The illness usually starts insidiously - with profound malaise, anorexia and nausea and an ache in the right upper abdomen +/- a mild fever.
Jaundice occurs in 30-50% in adults and occurs with progressively darker urine and paler stools.
May present with signs of decompensated liver failure.
Acute infection may lead to fulminant hepatic failure which is often fatal.
What is fulminant hepatic failure?
Fulminant hepatic failure (FHF) or acute liver failure (ALF) is the rapid development of acute liver injury with:
- severe impairment of the synthetic function
- hepatic encephalopathy
In a patient without obvious, previous liver disease.
Describe the typical presentation of Hep C infection?
It is often asymptomatic.
In acute infection 20-30% may have jaundice and deranged LFTs.
In chronic infection symptoms are non specific including malaise, weakness and anorexia.
May only become apparent with decompensated liver failure. (20-30% will develop cirrhosis after 20 years if untreated)
Describe the different antibody results you would get in Hep A for a patient with a current infection, a past infection and someone that was never infected?
IgM HAV within 3-6 weeks after exposure and remains positive for up to 6 months and is positive in relapsing disease.
IgG HAV appears shortly after the IgM antibodies but stays detectable for life.
Never infected: neither antibody is present
Current infection: IgM positive and usually IgG is also positive.
Past infection: IgM not present and IgG is present.
Describe the different antibodies which are tested for in hepatitis B?
Hepatitis B surface antigen (HBsAg):
A protein on the surface of hepatitis B virus; it can
be detected in high levels in serum during acute or
chronic hepatitis B virus infection. The presence of
HBsAg indicates that the person is infectious.
Hepatitis B surface antibody (anti-HBs):
The presence of anti-HBs is generally interpreted as
indicating recovery and immunity from hepatitis B
virus infection. Anti-HBs also develops in a person
who has been successfully vaccinated against
hepatitis B.
Total hepatitis B core antibody (anti-HBc):
Appears at the onset of symptoms in acute hepatitis B and persists for life. The presence of anti-HBc indicates previous or ongoing infection with hepatitis B virus in an undefined time frame.
IgM antibody to hepatitis B core antigen (IgM anti-HBc):
Positivity indicates recent infection with hepatitis B
virus (less than 6 months). Its presence indicates acute infection.
Interpret the following Hep B antibody results: HBsAg positive anti-HBc positive IgM anti-HBc negative anti-HBs negative
Chronically infected
Interpret the following Hep B antibody results: HBsAg positive anti-HBc positive IgM anti-HBc positive anti-HBs negative
Acutely infected
Interpret the following Hep B antibody results:
HBsAg negative
anti-HBc negative
anti-HBs negative
Susceptible
