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)
