FN: Viral Hepatitis

Question 1

Hep A
Spread
Cause

Answer 1

FO

Seafood, especially abroad

Question 2

Hep B
Spread
Cause

Answer 2

IV

Blood, body fluids, babies (vertical)

Question 3

Hep C
Spread
Cause

Answer 3

IV

Mainly blood, less vertical cf, HCV

Question 4

Hep D
Spread
Cause

Answer 4

IV

Dependant on prior HBV infection

Question 5

Hep E
Spread
Cause

Answer 5

Developing world

Question 6

Presentation Prodromal Phase

Answer 6

􏰀 Seen particularly in HAV and BV
􏰀 Flu-like, malaise, arthralgia, nausea
􏰀 Distaste for cigarettes in Hep A

Question 7

Icteric Phase

Answer 7

􏰀1.  Acute jaundice in A>B>C (99, 75 and 25%)
􏰀 2. Hepatitis
􏰁 - Abdo pain
- 􏰁 Hepatomegaly
-􏰁 Cholestasis: dark urine, pale stools

􏰀2. Extrahepatic features due to complexes (esp. Hep B) 􏰁 
- Urticaria or vasculitic rash
􏰁 - Cryoglobulinaemia
􏰁 - PAN
􏰁-  GN
- 􏰁 Arthritis

Question 8

Chronic Phase

Answer 8

􏰀 Mainly HCV and childhood HBV

􏰀 Cirrhosis → ↑ risk of HCC

Question 9

Hep B

Answer 9

􏰀 Carrier: 10%
􏰁 HBsAg +ve > 6mo
􏰀 Chronic hepatitis: 10%
􏰀 Cirrhosis: 5%

Question 10

Hep C

Answer 10

􏰀 Carrier: 80%
􏰁 HCV RNA+ve >6mo
􏰀 Chronic hepatitis: 80%
􏰀 Cirrhosis: 20%

Question 11

Ix

Answer 11

• FBC, LFTs, clotting

􏰀- Hep A/B/C serology

Question 12

Rx

Answer 12

􏰀 Supportive
􏰁 - No EtOH
- 􏰁 Avoid hepatotoxic drugs (e.g. aspirin)
􏰀 Anti-viral
- 􏰁 Indicated in chronic disease
􏰁-  HBV: PEGinterferon
􏰁 - HCV: PEGinterferon + ribavarin
- 􏰁 Seroconversion: HBV – 40%, HCV – 10%