Acute Hepatitis Flashcards
Under how many months is it classed as acute?
What are the 2 complications?
What are the 2 main causes of acute hepatitis?
What are some other causes?
< 6 months
Acute liver failure
Progression to chronic hepatitis
Drug overdose - paracetamol Infections - viral hepatitis ====== Autoimmune Pregnancy related Toxins Malignancy Budd-Chari syndrome
Hep A:
Type of transmission?
What the INCUBATION PERIOD?
What causes outbreaks of hep A in the UK?
Clinical features:
- What flu-like prodrome do they have?
- How does acute hepatitis present?
What age group is asymptomatic?
Acute liver failure:
- What increases the risk of this happening?
INV:
LFT’s - Everything is raised
- What else needs to be measured in the bloods relating to liver function?
HEP A serology:
- What is measured for a current infection?
- What is measured for a past infection?
PCR can be used to confirm diagnosis even though it is not commonly used
Faecal-oral route - person-person spread
Contaminated food and drink
28 days (4 wks)
Men who have sex with men IVDU =============== N&V Fever Abdo pain Fatigue
Jaundice
Dark urine/pale stools
RUQ pain
Hepatomegaly
Young children (<6 yrs) ========= Increased risk with age Pre-existing liver disease ========= INR and albumin
IgM - acute infection
IgG - past infection or vaccination
Hep A management:
Supportive care
What infection control is putn place?
As this is a transmittable disease, what needs to be done? - 3
How can it be prevented?
Side room
No food handling
1 wk ===== Inform public health england Contact tracing Hep A vaccine =====
Improved sanitation
Education
Vaccine
Hep E:
2 types - classical and sporadic:
Classical 1 & 2
Sporadic 3 & 4
Endemic countries:
- Where does classical hep E tend to occur?
- Where does sporadic hep E tend to occur?
Transmission:
- Both faecal oral
- What other type of transmission can happen in sporadic hep E? - 3
Sporadic - resource RICH countries (including UK)
Classical - resource - LIMITED countries
Sporadic - undercooked meat, zoonosis (from animals) and blood transfusion
Hep E:
Presentation the same as Hep A.
Also asymptotic in young children
Incubation period for Hep A is 28 days. What is it for Hep E?
Who is at risk of developing chronic hep E?
What extra feature does Hep E have over Hep A?
40 days
The immunocompromised
Extrahepatic manifestations (e.g. neurological)
Hep E:
INV - Same as Hep A:
- Hep E IgM - acute
- Hep E IgG - past infection (NO VACCINE)
Why is hep E PCR done?
Management:
Again, supportive care + prevention same as Hep A:
- Inform public health england
- Contact tracing
- Improved sanitation
- Education
Confirms current infection or for chronic infections
Hep A vs Hep E:
They are both travel associated.
Which one has an increased mortality in pregnancy?
How long does it take for both to resolve?
Hep E
2-3 months
Hep B - ACUTE/CHRONIC:
2 ways to transmit?
Incubation?
Symptoms same as Hep A and E.
Again most children asymptomatic.
What usually happens?
What long term complications can hep B lead to?
Bloods (needles, injury, tattoos, blood transfusions, vertical) Body fluids (sex)
Hep B is cleared straight away
Chronic hep B infection
Chronic liver disease
Hep B - INV:
Serology:
What 3 antigens are tested for?
What antibodies can be tested for each one? - which one has 2 antibodies?
What else can be measured in serology?
Which ones are detected first?
E- antigen - HBV-specific protein that is secreted from virus-infected cells.
Hep B surface Ag - HBsAg
Hep B core Ag - NOT MEASURED
Hep B e Ag - HBeAg
Hep B surface antibody - Anti-HBs
Hep B core antibody (can do either IgG OR IgM)
Hep B e antibody - Anti-HBe
Antigens are detected first - antibodies made weeks later
Hep B - INV:
(1) Acute
(2) Chronic
(3) Past, cleared infection
(4) The vaccine
HB surface antigen (HBsAg) - what 2 of the above options does this appear in?
HB surface antibody (Anti-HBs) - when would this be seen? - 2
HB core IgM - when would this be seen?
HB core IgG - when would this been seen?
HB e antigen - should be seen in (1) & (2) but not reliable!
When is the HBV DNA detected?
Acute and chronic infection
Past or vaccine
=====
IgM - acute infection ONLY
IgG - all the rest
=====
Acute and chronic infection
DNA will go once the infection has cleared as the virus isn’t releasing its DNA
Hep B management:
Supportive care
Indications for Anti-Hep B drugs?
What other hep virus should be screened for?
What other blood borne virus should be screened for?
Prevention - the same as Hep A with a VACCINE as well
Most people clear the infection without any issues. What blood test can be done to check if the infection has cleared?
HIV
Severe acute hepatitis
ALF
Hep D for co-infection
Loss of HB surface antigen and HB surface antibody
Hep B - Prevention:
What can be done to reduce the risk of transmission?
Where is screening for hep B done?
Hep B immunoglobulin (HBIG) - who would this be given to?
Vaccine - What antigen is in the vaccine?
Safer sexual practice
Needle exchanges
Blood products Antenatal screening Screening at-risk groups =========== Those with a high risk exposure (e.g. needle stick injury with a hep B positive patient)
Surface antigen
Hep B Vaccine:
Who is at a high risk of exposure?
Close household contact with HB
Travellers to high prevalent areas
IVDU
Blood products
Other causes of acute viral hepatitis:
Hep C - presents similarly to A/B/E - MOST patients progress to CHRONIC
EBV - what disease does it usually cause?
- How do you usually catch EBV?
CMV - same as above
Infectious Mononucleosis
A group of symptoms caused by EBV. Fever Sore throat Lymphadenopathy Fatigue
Kissing - called kissing disease
