Gastro - Viral Hepatitis Flashcards
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What does it mean that hepatitis is notifiable?
UK HSA must be notified of all cases
What are the other causes of hepatitis?
Alcoholic hepatitis
Non-alcoholic steatohepatitis
Autoimmune hepatitis
Drug induced hepatitis
What can cause drug induced hepatitis?
Paracetamol overdose
How does viral hepatitis present?
Nausea and vomiting
Jaundice
Pruritis
Muscle and joint aches
Abdominal pain
Fatigue
Flu-like illness
What does a hepatic picture look like on LFTs?
High ALT
High AST
Slightly elevated ALP
Why does AST and ALT rise in hepatitis?
Transaminases released into the blood due to inflammation
What is the most common form of viral hepatitis?
Hepatitis A
What type of virus is Hepatitis A?
RNA virus
How is Hepatitis A spread?
Faecal-oral route
Contaminated water or food
Is there vaccination for Hepatitis A?
Yes
What does Hepatitis A cause?
Cholestasis
Pruritis
Significant jaundice
Dark urine
Pale stools
What is diagnosis of Hepatitis A based on?
IgM antibodies
What can Hepatitis A potentially cause?
Acute liver failure (fulminant hepatitis)
How is Hepatitis A managed?
Usually resolved without treatment
Supportive management
What type of virus is Hepatitis B?
Double-stranded DNA virus
How is Hepatitis B spread?
Direct contact with blood or bodily fluids during sexual intercourse or sharing needles
Vertical transmission
How long are patients affected by Hepatitis B?
1-3 months
5-15% become chronic hepatitis B carriers
What happens in chronic Hepatitis B carriers?
Virus DNA integrated into cell nucleus
Continue to produce viral proteins
What are the different antigens and antibodies in Hepatitis B?
Surface antigen HBsAg
Active infection
E antigen HBeAg
Highly infectious
Core antibodies HBcAb
Previous or current infection
Surface antibodies HBsAb
Vaccination, previous or current infection
Hepatitis B virus DNA HBV DNA
Direct count of viral load
What does screening for Hepatitis B involve?
HBcAb - previous infection
HBsAg
If positive further testing for
HBeAg and HBV DNA
How can you distinguish acute, chronic and past infection using HBcAb?
Measure IgM and IgG versions of HB
IgM
Active infection
High titre with acute infection
Low titre with chronic infection
IgG
Previous infection where HBsAg is negative
What does HBeAg correlate to?
Infectivity
What does the presence of HBeAg mean?
Patient is in the acute phase where virus is actively replicating
High HBeAg- highly infectious
Negative HBeAg and positive HBeAb implies virus was replicating but has stopped and now less infectious
What does vaccination involve?
Injecting HBsAG
Patients then tested for HBsAb to confirm vaccine response
Vaccine requires 3 doses at different intervals
Part of UK 6-in-1 vaccine
How is Hepatitis B managed?
Low threshold for screening patients at risk
Screen other viral infections
Referral to gastro, hepatology or ID for specialist management
Avoid alcohol
Education about reducing transmission
Contact tracing
Test for complications
Antiviral medication to slow disease
Liver transplantation (fulminant hepatitis)
What type of virus is Hepatitis C?
RNA virus
How is Hepatitis C spread?
Coming into contact with infected blood and bodily fluids
Is there a vaccine for Hepatitis C?
No but there is a cure
How is Hepatitis C cured?
Direct-acting antivirals
Sofosbuvir
Must be tailored to specific viral genotype
Cures 90%, taking 8-12 weeks
What is the prognosis in untreated patients?
1/4 make full recovery
3/4 develop chronic hepatitis C
What are the complications of Hepatitis C?
Liver cirrhosis
Hepatocellular carcinoma
What testing is used for Hepatitis c?
Hepatitis C antibody
Hepatitis C RNA testing to confirm diagnosis, calculate viral load and identify genotype
How is Hepatitis C managed?
Low threshold for screening patients at risk
Screen other viral infections
Referral to gastro, hepatology or ID for specialist management
Avoid alcohol
Education about reducing transmission
Contact tracing
Test for complications
Antiviral medication to slow disease
Liver transplantation (fulminant hepatitis)
What type of virus is Hepatitis D?
RNA virus
Who is affected by Hepatitis D?
Can only survive in patients who also have Hepatitis B infection
Why can you not get Hepatitis D without Hepatitis B?
Hepatitis D attaches itself to HBsAg and cannot survive without it
How many people are affected by Hepatitis D?
Very few
What does Hepatitis D cause in Hepatitis B patients?
Increased complications
Increased disease severity
How is Hepatitis D treated?
Pegylated interferon alpha
Over 48 hours
Not very effective and significant side effects
What type of virus is Hepatitis E?
RNA virus
How is Hepatitis E transmitted?
Faecal-oral route
Contaminated food or water
Very rare in the UK
How does Hepatitis E present?
Mild illness
Virus is cleared within a month
No treatment required
Is there a vaccination for Hepatitis E?
No
What are some rare complications of Hepatitis E?
Progression to chronic hepatitis
Liver failure
Usually in immunocompromised patients
