Acute Hepatitis Flashcards
What condition is described and what blood test results would you expect to find abnormal:
Liver cell necrosis with inflammatory cell infiltration. Lasting less than 6 months.
Acute hepatitis
LFT: Raised ALT (+++) and bilirubin. ALP may also be raised, but to a lesser extent than ALT.
?Leukopenia but with lymphocytosis
?Serum marker positive for hepatitis viruses
Hepatitis B vaccination also protects against which other virus?
Hepatitis D
HDV can only infect a patient who already has HBV as it relies on HBV for co-infection. Therefore, if a person is immune to HBV, they are also protected from contracting HDV.
Which causes of viral hepatitis are transmitted through the faecal-oral route?
Hep A and C
Which causes of viral hepatitis are transmitted through exposure to bodily fluids, such as blood and semen?
Hep B, C and D
Which hepatitis viruses can lead to chronic hepatitis (and what % risk)?
Hep A: No Hep B: Yes (10% chance) Hep C: Yes (55-85% chance) Hep D: Yes (<5% of co-infectious, >80% of super-infectious) Hep E: No
What symptoms are associated with acute hepatitis?
Pain in RUQ Anorexia Malaise Dark urine Pale stools Vomiting Headaches Confusion/reduced GCS Jaundice
What signs might you find on examination of a patient with acute hepatitis?
Hepatomegaly Splenomegaly Lymphadenopathy Peripheral oedema Bleeding
What are the causes of acute hepatitis?
Viral (commonest):
Hep A-E (usually), EBV, CMV
Non-viral infections:
Toxoplasma gondii; Coxiella burnetti (Q fever)
Alcohol
Drugs:
Anti-TB (isoniazid); halogenated anaesthetics; paracetamol OD
Others:
Pregnancy, poisons, Wilson;s disease
What risk factors are linked with acute hepatitis?
Alcohol abuse
IV drug use
Sex workers, multiple sexual partners, MSM
Healthcare workers
Exposure to blood/ recipient of transfusions or organ donation
Define ‘acute hepatitis’
inflammation of the liver leading to cell injury and necrosis lasting <6 months.
What are the usual causes of acute hepatitis?
Most common: Hepatitis viruses (Hep A - E)
Other infections: EBV, CMV, yellow fever, leptospirosis, malaria, Q fever, syphilis
Drugs: alcohol, paracetamol toxicity
What are the clinical features of acute hepatitis?
Often subclinical presentation
Flu-like prodrome may precede jaundice by 1-2 weeks (N and V, anorexia, headaches, malaise)
May progress to clinical jaundice (scleral icteric):
- Pale stools, dark urine
- Hepatosplenomegaly, RUQ tenderness
- Cervical lymphadenopathy
What differentials should you consider when investigating acute hepatitis?
Viral infection
Alcoholic hepatitis
Drugs, toxins, immune-mediated
Gilbert’s syndrome
What serology tests constitute the diagnostic panel for HBV and what does each mean?
HBsAg
Hep B surface antiGEN = active infection
HBcAb
Hep B CORE antiBODY = infection (past or current)
HBsAb
Hep B SURFACE antiBODY = Immune (prior vax or infection)
How would you interpret these results:
HBsAg -
HBcAb -
HBsAb -
Never infected by HBV; susceptible (consider vaccination)
HBsAg
Hep B surface antiGEN = active infection
HBcAb
Hep B CORE antiBODY = infection (past or current)
HBsAb
Hep B SURFACE antiBODY = Immune (prior vax or infection)
How would you interpret these results:
HBsAg -
HBcAb +
HBsAb +
Resolved HBV infection
HBsAg
Hep B surface antiGEN = active infection
HBcAb
Hep B CORE antiBODY = infection (past or current)
HBsAb
Hep B SURFACE antiBODY = Immune (prior vax or infection)
How would you interpret these results:
HBsAg -
HBcAb -
HBsAb +
Vaccinated, never had HBV
HBsAg
Hep B surface antiGEN = active infection
HBcAb
Hep B CORE antiBODY = infection (past or current)
HBsAb
Hep B SURFACE antiBODY = Immune (prior vax or infection)
How would you interpret these results:
HBsAg +
HBcAb +
HBsAb -
Current HBV infection
*IgM + would suggest acute phase, IgM - would suggest chronic phase
HBsAg
Hep B surface antiGEN = active infection
HBcAb
Hep B CORE antiBODY = infection (past or current)
HBsAb
Hep B SURFACE antiBODY = Immune (prior vax or infection)
What is the general treatment plan for acute hepatitis (regardless of aetiology)?
Supportive care (hydration)
Usually spontaneous resolution
Severe infection may need antivirals (entecavir)
Hospitalisation if: encephalopathy, coagulopathy, severe vomiting, hypoglycaemia
What complications are associated with acute hepatitis?
Cholestasis: most commonly Associated with HAV infection
Hepatocellular necrosis: AST, ALT >10-20x normal, ALP and bilirubin minimally increased, increased cholestasis
What indicators suggest acute hepatitis might have a poor prognosis?
Comorbidities; persistently high bilirubin (>340 mmol; 20 mg/dL); increased INR; decreased albumin; hypoglycaemia.
What is the most common cause of chronic hepatitis?
Hepatitis B infection
What % of patients with hep C will go on to develop chronic hepatitis?
70-80%
What metabolic diseases commonly lead to chronic hepatitis?
Wilson’s disease
Haemochromatosis
Alpha-1-antitrypsin deficiency (A1AT)
