CA - Hepatitis

Question 1

Whats hepatitis?

Answer 1

1. inflammation of the liver due to infection or injury
2. often self-limiting,
3. some cases can cause extensive liver damage.

Question 2

What are the causes of hepatitis?

Answer 2

1. Viral
   - caused by hepatitis viruses A, B, C, D, or E
2. Non-viral
   - alcohol
   - medications like acetaminophen
   - exposure to certain chemicals like herbicides
   - autoimmunity -> immune system attacks the liver -> autoimmune hepatitis.

Question 3

What’s the mode of transmission of Hepatitis A virus?

Answer 3

1. fecal-oral route
   - through contaminated food or water
   - through person-to-person contact

Question 4

What are the risk factors of Hepatitis A virus?

Answer 4

1. living or working in nursing homes
2. daycare centers
3. living in or travelling to countries with poor access to clean water, sanitation, and hygiene
4. sexual contact with an infected individual.

Question 5

What’s the mode of transmission of Hepatitis B, C, D viruses?

Answer 5

blood and other body fluids

Question 6

What are the risk factors of Hepatitis B, C, D viruses?

Answer 6

1. IV drug use, blood transfusions, hemodialysis
2. working as a HCP
3. high-risk sexual behaviour -> multiple partners, not using protection.
   - Hep B can also be transmitted vertically to the baby before or after birth
   - hepatitis D virus can’t cause an infection in the absence of hepatitis B virus -> most important risk factor for hep D infection is a hep B infection

Question 7

What are the risk factors of Hepatitis E virus?

Answer 7

• fecal-oral route
• mostly through consuming contaminated food or water.

Question 8

Whats the difference between acute and chronic hepatitis? DN TO KNOW

Answer 8

Acute:
- quick and severe damage to the liver
- usually self-limiting, < 6 months
- some can develop fulminant hepatitis - life-threatening condition - severe liver function impairment.

Chronic
- progressive damage to the liver > 6 months.

• at first liver can function but as damage progresses -> liver deteriorates
• Liver damage can manifest as hepatic cytolysis, where liver cells are destroyed and leak out enzymes like aspartate transaminase, or AST; alanine transaminase, or ALT; and gamma glutamyl transferase, or GGT
• when the liver is damaged -> can’t process bilirubin anymore, so this compound builds up in the blood and gets deposited in various tissues around the body.

In the long run:
- liver damage -> regeneration -> fibrosis & scarring of liver -> cirrhosis
- further impairs liver function -> ammonia builds up in the blood -> can cross BBB & impair central nervous system function -> hepatic encephalopathy. cirrhosis = risk for developing hepatocellular carcinoma.

Question 9

What are clinical features of acute hepatitis?
IDT NEED TO KNOW

Answer 9

Mostly asymptomatic
General flu onset: Malaise, fatigue, myalgia, arthralgia, headache
Anorexia, nausea and vomiting
Change in olfaction and taste
Low grade fever (<39) (frequent in HAV and HEV)
Dark urine or clay colour stools (1-5 days prior to jaundice onset)
RUQ tenderness
Splenomegaly/ Lymphadenopathy

Question 10

What are clinical features of chronic hepatitis? IDT NEED TO KNOW

Answer 10

1. Can initially be asymptomatic, or present with mild symptoms like malaise & fatigue

Progressive liver damage can over time cause:
2. jaundice
3. ascites fluid accumulation in the peritoneal cavity, on account of reduced albumin production
4. easy bruising or bleeding due to reduced clotting factors.

On rare occasions, chronic hepatitis can cause:
5. gynecomastia or breast enlargement in clients assigned male at birth
6. skin manifestations, such as palmar erythema and spider angiomas.
7. Sometimes: signs of encephalopathy, like tremor, confusion, somnolence or coma.