Acute/ Chronic hepatits 1B Flashcards
What is the duration of an acute hepatitis
< 6months
What are the causes of acute hepatitis infection?
hepatitis A and hep E virus 🦠
What are the examples of faeco-oral transmission and what type of hepatitis infection does this cause?
food 🍲, water 💧, sex and this causes an acute hepatitis infection
What is the incubation period of hepatitis A virus 🦠?
30 days (2-4weeks)
What is the incubation period of hepatitis E virus ?
50 days (2-9 weeks)
What is the incubation period of hepatitis C virus?
40 days
What is the incubation period of hepatitis B virus?
90 days
What other viruses can cause hepatitis?
cytomegalovirus (CMV), herpes simplex virus (HSV), Esptein-Barr virus (EBV)
Hepatitis viruses that are parenteral?
And examples of how they can be transmitted = hepatitis B&C, vertical transmission, subcutaneously, IVDU, sexually
In terms of prevalence what is the worldwide prevalence of hepatitis B and what ethnic group is it most commonly found?
1/20 worldwide prevalence and most commonly found in Asian migrants in the UK 🇬🇧
In the pathophysiology of hepatitis, what causes liver cell damage out of the following options ? A) Is it due to the virus inoculation and multiplication or B) due to the virus changing the antigen structure on the surface of hepatocytes?
B- due to the virus changing the antigen structure on the surface of hepatocytes
In the pathophysiology of hepatitis what happens to new hepatocytes?
the body recognises them as foreign and starts destroying them
What is the mechanisms hepatocellular destruction in hepatitis and how does this happen?
self-mediated immune damage and this happens via apoptosis, fibrosis and necrosis
Due to the cellular pathophysiology of hepatitis, what type of hepatitis virus makes this most dangerous and why?
hepatitis B&C have a high chance of chronicity, therefore they lay dormant for years and this leads to liver cell damage , fibrosis —> cirrhosis and destruction of liver architecture
What’s a method of organising the signs and symptoms presenting in a patient with hepatitis?
prodromal/preicteric phase, icteric phase and convalescent phase
What is significant about the preicteric phase in regards to the symptoms?
symptoms are due to viremia (presence of virus in the blood) but not due to liver damage
What are the symptoms of viremia?
“flu-like symptoms” i.e. fever, headache, fatigue, anorexia, nausea, anthralgia & myalgia, skin rashes
What chemical signals are produced by the body due to viremia?
IL-1 and TNF-A
What is the icteric phase?
actual phase of illness due to liver damage
Classic symptoms seen in the icteric phase?
jaundice (caused by both conjugated and unconjugated bilirubin), hepatomegaly,deranged bloods (liver profile)
What particular group of bloods are indicative of the icteric phase?
deranged transaminases (increased AST & ALT), due to the leakage of the enzymes from the ductules which are also made up of hepatocytes which are also damaged via self-mediated immune damage
A pathological symptom of unconjugated bilirubin is?
dark urine
What is the convalescent phase and what is the duration for acute hepatitis and chronic hepatitis?
this is the recovery period and in acute hepatitis (Hep A & hep E)- 1-2 months and in chronic hepatitis (Hep B & hep C)- 3-4months
What is the difference in presentation for hepatitis B in adults vs children ?
adults are more symptomatic than children during an acute attack whereas children are asymptomatic. This is because the virus has probably been dormant and chronic and in the 20s the immune system attempt to clear the infection resulting in acute hepatitis (increase in ALT esp) however because the hepatocytes have been damaged this usually results in more symptoms present whereas in children the immune system is less developed hence there is less damage to the hepatocytes
Examples of bacterial differential diagnosis for hepatitis?
leptospirosis, brucella, coxiella, mycobacterium
Examples of non-infectious differentials for hepatitis?
obesity, ischaemic hepatitis, autoimmune hepatitis, Wilson’s disease
What drugs should be excluded for the cause of hepatitis?
Rifampicin, nsaids, isoniazid
When investigating hepatitis B virus, what is an important consideration?
check if patient is +ve for HDV because it is usually present with HBV
What investigation is use for for hepatitis A virus?
HAV IgM
What blood investigation is used for hepatitis B virus?
HBs Ag
In chronic hepatitis what is the gold standard investigation/ procedure to detect and rule out cirrhosis?
Transient elastography (fibroscan)
Do LFTs rise slowly or faster in HCV compared to in HAV and HBV? And why?
Slowly because its more of a chronic conditions
What is seen in someone who has just recovered from hepatitis B?
HBs Ab
In terms of management, infection control is usually notified to screen and vaccinate contacts in which case of hepatitis virus?
HAV and HBV
In an acute liver failure due to HBV what medication can be offered?
lamivudine, tenofovir and entecavir
In chronic infection, alcohol should be avoided in the case of which hepatitis virus especially?
HCV
What is the more common complication screened for in HCV?
Cirrhosis detection with transient elastography 2-yearly
What is complication is screened for in Hep B&C?
3-yearly OGD for varies detection and HCC (6monthly US and AFP)
HBV medication should be started when?
if LFTS change, increase in HBV DNA or in the case of cirrhosis
What medication is given in Hep B virus, the route of administration and how long?
peginterferon alpha 2a subcutaneously for 48wks , or tenofovir and entecavir orally OD until 6 months after seroconversion
What class of medication is given in HCV?
Direct acting antiviral (DAA) regimen for 12 weeks
Examples of a DAA for Hep C?
Sofosbuvir or velpatasivir
Glomerulnephriits is complication associated with which hepatitis virus?
HBV
Hep A vaccine is made up of what?
Inactive Hep A
Hep B vaccine is made up of what?
recombinant inactive HBs Ag
What is definitive of alcohol hepatitis?
acute onset (<3months) of jaundice, liver failure and systemic inflammation due to heavy alcohol consumption usually of long duration
On examination, what signs may be seen in alcohol hepatitis?
jaundice and enlarged liver
What is the AST/ALT ratio in alcohol hepatitis?
> 2
What is the management of alcohol hepatitis?
prednisolone PO 4weeks
What is the scoring system for alcohol hepatitis and what is is based on?
Maddrey score >32 (based on PT & BR)
