Childhood Hepatitis Flashcards
HEPATITIS
There are three major types of hepatitis. These are:
__________ hepatitis
______________ hepatitis
__________________ hepatitis.
Acute hepatitis
Chronic persistent hepatitis
Chronic active hepatitis.
ACUTE HEPATITIS
Definition: A __________ inflammation, diffuse ___________________.
self-limiting; liver cell damage
Ætiology:
(a) Viruses – ______________________________ . EBV, CMV, Coxsackie, A & B, Parvovirus B19, etc.
(b) Other organisms: Rickettsia, mycoplasma, systemic fungal infection, septicaemia
(c) Drugs - alcohol, trichloroethylene, iron overdosage, copper sulphate, phosphorus, halothane, antituberculous drugs, antiretroviral drugs, analgesics.
(d) Poisoning – amamit phalloides (toadstool poisoning), aflatoxin (aspergillus contamination of stored food)
(e) Heart failure – intrahepatic cholestasis and centrilobular congestion→Right sided failure, hepatocellular necrosis→Acute Left ventricular failure.
hepatitis viruses, A, B, C, δ, E & G
Epidemiology
The six known hepatotropic viruses are heterogeneous group of viruses that cause similar acute clinical illness, except for the more recent _______ which appears to cause no or mild disease.
HBV is a ______ virus
HAV, HCV, HDV; HEV & HGV are ______ viruses.
_______ & _______ are not known to cause chronic illness; _______, _______, & _______ cause important chronic infections.
HGV causes (acute or chronic?) infection, but unknown adverse effects
Cases of hepatitis without identifiable cause are denoted Non-A, Non-B, Non-C.
HAV(commonest),1/3rd –HBV,HCV(20%),HDV(minority)
HGV ; DNA ; RNA
HAV & HEV
HBV, HCV, & HDV
chronic
HEPATITIS A (____________ hepatitis)-1
____________ viridae family.
A highly contagious disease, spread by ____________ and through ____________.
Infection common in conditions of ____________ and ____________.
Spread occurs readily in __________ centers.
HA rarely, if ever, transmitted by ____________ route.
infectious ; picornaviridae
person-to- person contact; faeco-oral route.
poor sanitation ; overcrowding.
day care centers. ; parenteral
Hepatitis A
It is excreted in stools for up to ___________ before onset of symptoms.
All age groups are susceptible, but most illnesses occur in ___________ and it is (milder or more severe?) than in adults.
Highest incidence occurs in children of __________ age.
two weeks ; childhood
Milder ; school
HEPATITIS A (infectious hepatitis)-2
Sub-clinical and anicteric infections common in children years of age.
Most infants are protected by _____________ during the early months of life.
Incubation period ___________ (mean 28 days) from exposure until the appearance of __________. Mortality is (low or high?) ; patient may be incapacitated for many weeks.
Full recovery is the usual.
Fulminant hepatitis (commonly or rarely?) associated.
(Carrier or No carrier?) state, no chronic liver damage. Immunity is lifelong.
maternal antibody
4-6 weeks ; jaundice.
low; ; rarely
No carrier state,
Hepatitis A in pregnancy or at the time of delivery does not result in clinical disease in the newborn, in teratogenic effects, or in increased risk of abortion.
T/F
T
Hepatitis B Virus is a (small or large ?) (DNA or RNA?) virus
The term serum hepatitis refers to the most common method of transmission, percutaneous or mucous membrane inoculation also occur.
Major route of transmission is by ___________________________.
Even a prick with a contaminated needle can transmit infection.
Those with persistent infection – hepatitis B _________ , represent the main pool of infectious individuals.
Peak incidence occurs during _________ period, _______ childhood, and adolescence
small ; DNA
inoculation with blood of carriers.
carriers ; perinatal
early
HEPATITIS B (Serum Hepatitis)-2
Higher rate of infection in children with __________ living in institutions cf those living in the home with families.
Incubation period is __________ (mean 3 months).
No seasonal prevalence.
Recent renewed awareness of the risk of transmission of viral infections through percutaneous exposure, was due mainly to the ________________.
However, the risk of transmission of HIV through this route is relatively (low or high?) compared with other infectious agents such as hepatitis B and C.
Down syndrome
2-5 months ; HIV pandemic.
low
Hepatitis B
Is transmitted via __________ , ______ally, ______ally or ______ally
In high endemic areas, 50-90% of the population has serological evidence of previous HBV infection
body fluids
parenter; sexu; perinat
Major routes of ransmission are horizontal _______________ ( _____abrasions such as impetigo, scabies, and infected insect bites provide the route into the body of susceptible children with whom they have skin to skin contact such as during wrestling; the sharing of toothbrushes and other personal items)
Vertical transmission
child- to-child
skin
Perinatal Transmission
Perinatal Transmission of Hepatitis B
Transmission: __________ / __________ / __________ contact
Risk: __________
HBeAg __________ (90%)
__________, 3rd trimester (70%)
Seqeulae: __________ carriers
__________
Hepatocellular
Intra-uterine / Labour / maternal contact
Maternal viraemia
positive carrier (90%)
Acute hepatitis 3rd trimester (70%)
Asymptomatic carriers
Chronic liver disease
HEPATITIS B (Serum Hepatitis)-3
Presence of HbeAg in maternal carriers correlate highly with ______________________________ . Transmission through breastfeeding is ___________.
Hepatitis B infection is (milder or more intense ?) in infants and children and is frequently unrecognized.
transmission of infection to their offspring
unproven; milder
Hepatitis B
About 90% of perinatal infections become ____________ ,1-5years(30-50%), cf 5% of infections in adults.
Risk of chronic liver disease or hepatocellular carcinoma later in life is _____eased in these infants.
chronic carriers
incr
Consequence of infection of Hepatitis B
Acute infection- asymptomatic or symptomatic (icteric or anicteric)
Chronic infection - inactive chronic infection; chronic active hepatitis; cirrhosis; hepatocellular carcinoma
Risk of developing chronic infection is determined by the ________ that infection occurs
Infants > ____%;
Early childhood < 5years _______%
Older child/adolescent/Adults <_____%; Elderly _____-____%
age ; 90%;
25-50%
3-5%
20-30%
Hepatitis C Virus
Route of transmission - __________,___________, or ____________
Risk group include people with _________________,_______________ , intravenous drug users, etc.
Incubation period ________ (mean 8 weeksug).
percutaneous inoculation, exposure to blood or blood products.
haemophilia, haemoglobinopathies
2-24 weeks
Clinical manifestations of Hepatitis C
similar to other hepatitis viruses. Acute disease (mild or severe?) and insidious in onset.
Only ____% of patients become jaundiced. Fulminant liver failure (commonly or rarely?) occurs.
About ____% of cases develop chronic liver disease.
Mild; 10
Rarely
85
Hepatitis Delta virus
HDV occurs in only a small percentage of children who must _______________________.
It is An __________ (_________) RNA virus that multiply only in presence of ____________ - requires ________ (__________) to establish infection.
Infections may be concurrent with hepatitis B causing _____________ , which usually resolved.
have HBV infection.
incomplete ;defective
HbsAg ;envelope
co infection
Hepatitis D
More importantly, can occur as _______________ in carriers of HB virus, causing _________ infection, and potentially severe hepatitis.
Infection is chronic in _____% of super-infection cases but only ___% in co- infection with worsening of chronic liver disease.
Transmission is by _________ inoculation. Incubation period ____________ (mean 7 weeks).
Symptoms similar to, but usually (more or less?) severe than other viruses.
May result in fulminant hepatitis.
Increases the likelihood of chronic liver disease in HbsAg carriers.
super-infection ; intercurrent
90% ; 2%
parenteral ; 2-4 months ;more
Hepatitides E & G viruses
Hepatitis E Virus accounts for about 10-30% of non-A, non-B, non-C hepatitis.
The peak age incidence is ______ years.
Its route of transmission is ______ and has caused ______ epidemics in southeast and central Asia, Africa, and North America.
Incubation period similar to that of hepatitis ____, and ____ carrier state has been reported.
Associated with high case fatality rate in ______________.
15-34 years.
faeco-oral ; waterborne
hepatitis A ; no
pregnant women.
Hepatitis G Virus: is new and no clinical infection has been associated with it yet.
Okay
Management
History taking Relevant history:
percutaneous injections
CLINICAL MANIFESTATIONS
In ___________ and ___________, hepatitis resemble the more severe disease seen in adults.
Hepatitis A and E tend to be (acute or chronic ?) in onset, hepatitis B & C have insidious onset.
Pre-icteric phase: Initial symptoms often non-specific - _______, _______, and _______,
GI Symptoms:- nausea, _______, ________, abdominal discomfort
These may be mild or go unnoticed in children.
older children ; adolescents
acute
fever ; headache ; fatigue,
emesis ; anorexia
CLINICAL MANIFESTATIONS-2
(Sharp or Dull?) right upper quadrant pain or epigastric ____________ - may be exaggerated by ____________ or ____________.
Icteric phase: __________ and ________ coloured urine usually after onset of systemic symptoms, but may be presenting signs in children.
____________-coloured stools.
____________ 2° poor nutrition common than ____________.
Young infants may fail to ____________.
Dull ; fullness
exercise ; jolting.
Jaundice ; dark
Light or clay
Constipation ; diarrhoea.
gain weight.
Clinical manifestations of Hepatitis
During convalescence, - gradual return of appetite, exercise tolerance, and feeling of well being.
These presentation is typical of Hepatitis _____ infection.
Hepatitis B infection may be heralded by ___________ or ____________
A; althralgia
skin eruption.
CLINICAL MANIFESTATIONS
Papular acrodermatitis.
Course of infection often _________ and lasts (shorter or longer?) than hepatitis A.
___________ or ___________ may appear during the convalescence.
Other symptoms are similar to that of Hepatitis A.
longer
Haematuria or proteinuria
Clinical manifestations
Physical examination reveals :
_________ skin and mucous membranes.
(Tender or Not tender?) hepatomegaly
Splenomegaly and Lymphadenopathy are (common or rare?) .
Icteric skin
Tender ; common.
Laboratory data
LFT– SerumBilirubin, Serum Transaminases, albumin, PT.
_____eased Serum transaminases Liver transaminases suggests the extent and duration of injury – (AST or ALT ?) is more specific than (AST or ALT?) .
Tests of synthetic function (_________ ans _____________ concentration) assesses severity of the hepatitis.
Increased
ALT ; AST.
PT ; serum albumin
Laboratory data
Hyperbilirubinaemia – ______eased direct and indirect serum bilirubin, Direct fraction more so in the early stage.
_____eased serum Urobilinogen and subsequently, in urine
FBC-Mild leucopaenia with relative lymphocytosis and atypical lymphocytes.
Hepatitis A,B,C viral screening.
Liver biopsy- Chronic hepatitis.
Increased
Increased
Specific Serological tests
Antigens
List them
Antibodies
Anti-HBc(_____illness)
Anti- _________ (distinguishes acute infection/chronic or carrier)
Anti-_____(immunity)
Anti______
u HBsAg(onset)(>6 months indicates carrier)
u HBeAg
u HBcAg
acute; HBcIgm
HBs; HBe
Specific serological tests
_________,__________, and ___________ are detectable early prior to the onset of icterus.
__________ is detected during the acute illness.
Presence of ________ distinguish between an acute infection and a carrier.
————- disappears in resolving infection and _________ appears.
Presence of __________ denotes an increased risk of transmission of HBV infection.
Presence of __________ only, indicative immunity.
In carriers, _________ persists indefinitely.
If _________ remains detectable after _________ patient has become a hepatitis B virus carrier.
DNA polymerase, HBeAg and HBsAg
Anti-HBc; anti-HBcIgM
HBeAg; anti-HBe; HBeAg
Anti-HBs; HBsAg
HBsAg; 6 months
Prevention of Hepatitis-1
These include:
_____________
Simple _________ precautions to control HAV &HEV.
___________ of HBeAg positive carriers
Careful handling and _________ of blood, blood contaminated materials, and instruments.
Contact tracing
hygienic ; Counselling
screening
Prevention of Hepatitis
Passive immunization; Hepatitis A- ____________________________ , Hepatitis B-______________________
Active immunization-vaccine- a ________ dose of _________________ vaccine provides ____-term protection, _____ vaccine is also effective.(plasma derived,Recombinant)
Screen pregnant women for HB virus. If HbsAg +ve, give baby ________ and _________ within ________ of birth.
Repeat HB vaccine at ________ and ________ of age.
normal human immunoglobin ; immunoglobulin (HBIG)
single; inactivated HA ; long; HB
HBIG & HB vaccine ; 12 hours
1 month ; 6 months
Prevention of Hepatitis-2
Give all other infants Hepatitis B vaccine from age _________ of life.
Measures directed at HB virus also generally effective against _______ and _______
6-8 weeks
HCV & HDV
Treatment of Hepatitis:
There is no specific therapy
_________ during the icteric phase appears helpful
Avoid _______
Avoid ___________
Diet- Light diet at the start of illness is preferable. Fruits, vegetables, sugars are well tolerated.
Bed rest; sedatives
corticosteroids
B-complex
Prognosis of Hepatitis
___________ percent of children recover without sequelae in HAV infection.
Also, 95% become HBsAg negative at the time of clinical recovery in HBV infection.
________________________ may occur in children with Down syndrome, leukaemia and those undergoing chronic haemodialysis.
Persistence of neonatally acquired HBsAg is common, and presence of HBeAg in the HBsAg carrier convey a _______ prognosis.
70-85% of hepatitis C develop ________________
Ninety five
Persistent asymptomatic antigenaemia
poorer
chronic liver disease
COMPLICATIONS
Most children recover (eventually or uneventfully?) from hepatitis
A few suffer serious or acute chronic complications
These include:
___________
_____________
________________
Aplastic anaemia
___________ especially in HBV infection
Hepatocellular carcinoma in young adulthood.
Fulminant hepatic failure
Chronic hepatitis
Liver cirrhosis
Nephrosis
FULMINANT HEPATIC FAILURE-1
It is a clinical syndrome resulting from massive __________ of __________ or from severe __________ of hepatocytes in a patient who may or may not have had ______________________.
It usually evolves over a period of less than ___________.
necrosis ; hepatocytes
functional impairment
preexisting liver disease.
8 weeks.
Fulminant hepatic failure
All functions of the liver are severely impaired with ________________________ - an essential diagnostic criterion.
Occurs in ____% of patients with viral hepatitis.
Mechanisms for its development poorly understood.
hepatic encephalopathy -
1-2
Fulminant hepatic failure
Clinical features:
Progressive __________ , _____ hepaticus, fever, _________ , _________ and ______________.
Rapid _______ease in liver size without ________________________ - an ominous sign.
jaundice
fetor hepaticus ; vomiting
anorexia ; abdominal pain.
decrease; clinical improvement
FULMINANT HEPATIC FAILURE-2
Clinical features contd
_________________ and ________ may develop.
Hepatic encephalopathy may present as minor disturbances of ___________ or ___________; ___________ may be present in older children.
May progress rapidly to __________.
Haemorrhagic diathesis ; ascities
consciousness ; motor function
asterixis ; coma.
Fulminant hepatic failure
Laboratory findings:
_____eased direct and indirect bilirubin
_____eased ALT & AST. May _____ease as patient deteriorates
_____eased Blood ammonia concentration.
__________ PT (often (responsive or unresponsive?) to vitamin K) Hypoglycaemia can occur.
Electrolyte and acid-base disturbances common.
Increased
Increased ; decrease
Increased
Prolonged ; unresponsive
FULMINANT HEPATIC FAILURE-3
Treatment:
Management is ___________.
Monitor electrolytes and fluid intake closely
Maintain normal blood _______ - important.
Avoid ________ , ________ and ________
Clotting factors - FFP or EBT with fresh blood.
Restrict or eliminate _______ intake Dexamethasone or _________ for cerebral oedema .
Treat Comatose patients in the intensive care unit.
supportive ; blood glucose
diuretics ; sedatives ; tranquilizers
protein ; mannitol
FULMINANT HEPATIC FAILURE-4
Prognosis:
depth of coma.
no liver cirrhosis.
CHRONIC HEPATITIS-1
This is defined as a continuing hepatic inflammatory process lasting __________ or more.
There are two types
chronic ________ hepatitis
Chronic __________ hepatitis
6 months
persistent
active
chronic persistent hepatitis: this is a (benign or malignant?) inflammatory process of the liver.
Usually follows acute hepatitis due to ______ or ______ infection.
Most cases asymptomatic or have nonspecific complaints e.g. fatigue or anorexia.
Some have minimal ____________ or slight right upper quadrant __________.
Serum transaminases are mildly or moderately raised.
Serum bilirubin may be normal or slightly increased.
Other liver functions may be normal.
Anti-smooth muscle and anti-nuclear antibodies tests are negative.
About one-third of patients are HbsAg positive.
Diagnosis is by ____________ and __________
benign ; HBV or C infection.
hepatomegaly ; tenderness.
Liver biopsy and histology.
CHRONIC persistent HEPATITIS
Treatment:
Chronic asymptomatic(Inactive) HBv carriers – ______ Treatment is required. Prognosis is ________.
Persistent carrier of HbsAg have increased risk of developing _____________.
Antiviral therapy with ________ may be required in active disease. Of recent, ___________ and other nucleoside analogs has been found to be useful in the treatment of this group of patients.
No; good
hepatocellular carcinoma
interferon; lamivudine
chronic active hepatitis: it is characterized by unresolved inflammation, __________, and __________; with the possibility of progression to __________ and __________.
necrosis
fibrosis;
cirrhosis
liver failure.
chronic active hepatitis:
Clinical picture is variable, but associated with: Mild to moderate jaundice
__________, and __________. __________ and __________ of the liver.
Spider telangiectasia
Palmar erythema.
Tenderness
enlargement
CHRONIC active HEPATITIS
Treatment:
Other causes of chronic hepatitis
Autoimmune hepatitis: _________ therapy is the treatment of choice.
Drug Induced hepatitis: __________ of offending drug.
Prognosis improved by treatment
Steroid
Withdrawal
