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STG 2017 > CHRONIC HEPATITIS > Flashcards

CHRONIC HEPATITIS Flashcards

1
Q

Chronic hepatitis

A

chronic inflammation of the liver of more than 6
months duration, with persistently elevated liver function tests.

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2
Q

Chronic hepatitis can progress to………

A

Liver cirrhosis
Portal hypertension with upper
gastrointestinal bleeding
Hepatic encephalopathy
Hepatocellular
carcinoma

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3
Q

Long-term monitoring for patients with chronic hepatitis B

A

Disease activity Hepatocellular
carcinoma screening Six-monthly Hepatitis B viral DNA quantification
LFTs
Abdominal ultrasound Alpha fetoprotein

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4
Q

Causes of chronic hepatitis

A

Hepatitis B virus (HBV)
Hepatitis C virus (HCV)
Hepatitis E virus (genotype 3)

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5
Q

Symptoms of chronic hepatitis

A

Recurrent fever
Arthralgia
Malaise
Jaundice
Lethargy

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6
Q

Signs of stigmata of chronic liver disease

A

Palmar erythema
Clubbing
Dupuytren’s contracture
Parotid enlargement
Gynaecomastia
Testicular atrophy
Spider naevi

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7
Q

Signs of decompensated liver disease

A

Jaundice
Ascites
Encephalopathy
Peripheral oedema
Purpura/skin bruising

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8
Q

Peripheral edema in decompensated liver disease is due to

A

Hypoalbuminemia

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9
Q

Manifestations of coagulopathy in decompensated chronic liver disease

A

Purpura or skin bruising

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10
Q

Investigations in chronic hepatitis

A

FBC
LFTs
INR
HIV
Baseline alpha-feto-protein
Abdominal ultrasound scan
Chronic Hepatitis B screen
Chronic Hepatitis C screen

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11
Q

Parameters in chronic hepatitis B screen

A

Hepatitis B surface Antigen (HBsAg)
HBc IgG
Hepatitis-B-e-antigen (HBeAg) & Anti-HBe
Hepatitis B Viral Load

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12
Q

Parameters in chronic hepatitis C screen

A

Hepatitis C Virus (HCV) antibody testing
HCV RNA
HCV genotyping

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13
Q

Treatment objectives in chronic hepatitis

A

To prevent disease progression and complications
To prevent hepatic encephalopathy
To prevent disease progression and complications
To prevent hepatic encephalopathy

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14
Q

Non-pharmacological management of chronic hepatitis

A

Prevention of transmission to partners
Lifestyle/dietary advice
Spouse/household screening

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15
Q

Ways of preventing transmission of hepatitis to partner

A

Protected sex
Not sharing of toothbrushes and sharps, blades, needles, body piercings,
tattoos, cultural scarification practices, circumcisions etc.

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16
Q

First line management of chronic active hepatitis B

A

Pegylated Interferon alfa-2a, subcutaneous,
Or
Tenofovir, oral,
Or
Entecavir, oral,

17
Q

Second line management of chronic active hepatitis B

A

Lamivudine, oral,

18
Q

First line for management of decompensated liver cirrhosis/ Fulminant Liver failure from
Chronic Hepatitis B

A

Tenofovir, oral,
Or
Entecavir, oral,

19
Q

Second line for management of decompensated liver cirrhosis/ Fulminant Liver failure from
Chronic Hepatitis B

A

Lamivudine

20
Q

First line management for patients with Chronic Hepatitis B undergoing chemotherapy or
immunosuppressive treatment

A

Tenofovir, oral,
Or
Entecavir, oral,

21
Q

Second line management for patients with Chronic Hepatitis B undergoing chemotherapy or
immunosuppressive treatment

A

Lamivudine, oral

22
Q

Four main actions done in post-exposure management of healthcare workers after
occupational exposure to Hepatitis B infection

A
  1. Post-exposure testing
  2. Post-exposure prophylaxis
  3. Post-vaccination Anti-Hbs
23
Q

Post exposure testing involves

A
  1. Testing the surce patient
  2. Measuring healthcare worker Anti-Hbs
24
Q

Post-exposure prophylaxis of Hepatitis B involves

A
  1. Hepatitis B immunoglobulin (HBIG)- 0.06ml/Kg
  2. HBV vaccination
25
Q

Post-exposure management of healthcare workers after
occupational exposure to Hepatitis B infection - for a Documented Responder (> 3 Doses Received)

A

No action required

26
Q

Post-exposure management of healthcare workers after occupational exposure to Hepatitis B infection
- Documented
Non- Responder (After > 6 Doses)

A

If post exposure test of source patient is positive;
a. Hepatitis B Immunoglobulin (0.06 ml/kg IM) twice, one month apart

If post exposure test of source patient is negative;
no action is required

27
Q

Post-exposure management of healthcare workers after occupational exposure to Hepatitis B infection when Response Unknown (After >3 Doses)

A
  1. If post-exposure testing of source patient is positive or unknown and HCW
    Anti-HBs is <10 MIU/ml;
    a. Give HBIG 0.06ml/Kg once
    b. Revaccinate patient c. Post-Vaccination Anti-HBs testing
  2. If post-exposure testing of source patient is negative and HCW Anti-HBs is <10 MIU/ml;
    a. Revaccinate patient
    b. Post-Vaccination Anti-HBs testing
  3. If HCW
    Anti-HBs is >10 MIU/ml
    No action is required
28
Q

Post-exposure management of healthcare workers after occupational exposure to Hepatitis B infection- in an unvaccinated/
incompletely vaccinated health care worker

A
  1. If post-exposure testing of source patient is positive or unknown;
    a. HBIG 0.06ml/kg once
    b. Complete vaccination
    c. Post-Vaccination Anti-HBs testing
  2. If post-exposure testing of source patient is negative;
    a. Complete vaccination
    b. Post-Vaccination Anti-HBs testing
29
Q

When should Post-Vaccination Anti-HBs be performed

A

1-2 months after last dose of HBV vaccination
series but ~ 4-6 months after HBIG to avoid detection of passively administered
Anti-HBs.

30
Q

What does Documented Responder mean

A

Person with Anti-HBs > 10 MIU/ml after 3 or more HBV vaccination
doses

31
Q

What does documented non-responder mean

A

Person with Anti-HBs < 10 MIU/ml after 6 or more HBV vaccination
doses

32
Q

These group of healthcare workers should undergo HBsAg screening as soon as possible after exposure
and follow up testing ~ 6 months later (HBsAg + Anti-HBc) when they sustain exposure to a source patient who is HBsAg-positive/ unknown
HBsAg status

A
  1. Those who have Anti-Hbs < 10 MIU/ml
  2. unvaccinated or incomplete vaccination
33
Q

First line treatment for chronic hepatitis C infections

A

Pegylated Interferon alfa-2a, subcutaneous,
Or
Pegylated Interferon alfa-2b, subcutaneous,
And
Ribavirin, oral,

STG 2017 (88 decks)

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