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Case 3 > Global Perspectives of Viral Liver Disease > Flashcards

Global Perspectives of Viral Liver Disease Flashcards

1
Q

What do all hepatitis viruses cause

A

Transamintis

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2
Q

What is hepatitis A

A

RNA virus (HAV)

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3
Q

How is hepatitis A spread

A

Food and water borne (sexual)

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4
Q

Why is Hep A not as common anymore

A

Effective vaccine

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5
Q

How long is the Hep A incubation period

A

3 weeks

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6
Q

Describe Hepatitis B

A

DNA virus (HBV)

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7
Q

How is Hepatitis B spread

A

Blood and body fluids (BBV)

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8
Q

What is the most common transmission of Hepatitis B

A

Vertical transmission

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9
Q

Explain how clearing of Hepatitis B is age dependent

A

Newborns= 5% chance of clearing disease. In adult life most clear the virus (95%) (never really cleared just locked inside liver cells

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10
Q

What is the incubation period of Hepatitis B

A

6 months, therefore delayed onset of symptoms

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11
Q

How much of the population is infected with Hepatitis B

A

4%

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12
Q

What is Hepatitis C

A

RNA virus

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13
Q

How is Hepatitis C spread

A

Blood and bodily fluids borne

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14
Q

What is Hepatitis C more due to

A

Less sexual transmission, more used of IV drugs

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15
Q

What percentange of drug users and Hepatitis C positive

A

50%

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16
Q

What is the incubation period of Hepatitis C

A

3 weeks

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17
Q

How many people clear a Hepatitis C infection

A

30%

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18
Q

What percentage of the population is infected with Hepatitis C

A

2-3%

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19
Q

What is Hepatitis D

A

RNA virus

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20
Q

Who gets Hepatitis D

A

Only people with Hepatitis B

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21
Q

What is Hepatitis E

A

RNA virus

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22
Q

How is Hepatitis E spread

A

Food and water borne

23
Q

Which is more common, Hepatitis A or Hepatitis E

A

Hepatitis E

24
Q

What is the risk of transmission on contact with infected blood

A

Rule of thirds: Hep B = 33%, Hep C = 3%, HIV = 0.3%. Other viruses: Cytomegalovirus, Epstein-Barr virus

25
Q

Describe acute hepatitis

A

Spontaneous viral clearance by immune system, usually within weeks-months, Hep A, Hep E, Hep B (unless acquired during infancy)

26
Q

Describe chronic hepatitis

A

Immune system fails to clear virus, viral persistence for > 6 months, usually long-term (unless treated), Hep B, Hep C (80% of cases)

27
Q

Describe what cholestatic is

A

Blockage (LFTs = ↑ alk phos and ↑gamma)

28
Q

Describe transaminitis

A

Something toxic to cells (LFTs = ↑ ALT, ↑ AST)

29
Q

Describe the transmission/ groups at risk of Hep A and Hep E

A

FOOD AND WATER, Endemic in countries with poor sanitation, Travellers, Person-to-person, Gay men (due to faecal contact), Animal contact (Hep E) - European pig meat, Pregnant women have specific serotype, this or transplant leads to immunosuppression, where acute infection can become chronic

30
Q

Describe the transmission/ groups at risk of Hep B and Hep C

A

BBV, Blood transfusion: Haemophiliacs, IV drug use/sharing, Sexual: HBV = 30% risk, HCV = Rare, Vertical: HBV = 5-90% risk, HCV =

31
Q

Describe the clinical features of acute hepatitis

A

Symptoms: Fever, malaise, nausea, vomiting, jaundice, dark urine, diarrhoea.Signs: Jaundice, tender, enlarged liver. Investigations: Deranged LFTs: ↑ bilirubin, ↑ transaminases, liver ultrasound and viral serology.

32
Q

What are the complications of chronic viral hepatitis

A

Liver fibrosis/cirrhosis - variable progession over years. End stage liver disease- portal hypertension/ascites (backflow leads to leaking, as well as decreased albumin production, which is meant to hold fluid within the blood system), bleeding (oesophageal varices) and liver failure. Hepatocellular carcinoma

33
Q

Describe the course and diagnosis of Hepatitis A

A

Incubation period = 2-6 weeks. Serological diagnosis: Detection of specific antibodies. Anti-HAV IgM = Recent infection. Anti-HAV IgG = Past infection or immunisation

34
Q

Describe the course and diagnosis of Acute Hep B

A

Incubation period = 6 weeks - 6 months. Detection of viral surface antigen (HBsAg) in serum indicates infection (acute and chronic). Surface antibody (anti-HBs)- indicates viral clearance, post vaccination

35
Q

Describe chronic Hep B

A

Risk of developing chronic infection depends on age at time of infection. Persistent HBsAg. Presence of HBeAg (part of viral core)- high infectivity, high risk of liver damage, viral DNA detectable in plasma (PCR)

36
Q

Describe the clearance and course of Hep C

A

Usually asymptomatic during acute stage. Most patients develop chronic infection. ‘Silent killer’ - end stage liver disease often decades after infection. Effective treatment available - curative

37
Q

Describe the prevention of hepatitis A & E

A

Food water and hygiene, hand washing, vaccination (HAV)

38
Q

Who is the HAV vaccination recommended for

A

Travelers to endemic areas, Patients with chronic liver disease, MSM, HIV, Sewage workers, Staff in residential institutions

39
Q

Describe active component of the Hep A immunisation

A

Prepared from inactivated whole Hep A virus, single dose by IM injection, booster dose at 6 months gives life long immunity, live attenuated vaccine available but rarely used

40
Q

Describe passive component of the Hep A immunisation

A

Human normal immunoglobulin (HNIG) can be used for port-exposure protection of contacts (together with active vaccine)

41
Q

Describe the prevention of Hep C & B

A

Screen/viral inactivation of blood products for transfusion, safe sex, avoid needle/syringe sharing

42
Q

Who is the Hep B vaccine recommended for

A

Healthcare workers, Injecting drug users, MSM, HIV, Chronic liver disease, chronic kidney disease, Travelers to high prevalence areas, Post-exposure

43
Q

Describe active component of the Hep B immunisation

A

HBsAg prepared in yeast cells by recombinant DNA technology (sub-unit of vaccine, doses in 3 IM injections, response to vaccine can be checked by measuring levels of HBs antibody (>100 IU/ml protective)

44
Q

Describe passive component of the Hep B immunisation

A

Specific Hep B immunoglobulin (HBIG) can be used for post-exposure protection of contacts (together with active vaccine) - Prepared from plasma of immunised donors.

45
Q

How do you prevent mother-to-child transmission of Hep B

A

Babies born to mothers with chroic BV. Vaccination of infant: 3 dose schedule starting at birth. Passive immunisation of mother eAg + High viral load - Single dose of HBIG. Anti-viral drug therapy to mother during pregnancy - reduces viral load at time of delivery

46
Q

What is innate immunity

A

Non-specific, general, immediate response, no immunological memory

47
Q

What are the two aspects of the innate response

A

Humoral and cellular

48
Q

Describe the humoral aspect of innate immunity

A

Pattern receptors, complement, enzymes, cytokines

49
Q

Describe the cellular aspect of innate immunity

A

Phagocytes, natural killer cells

50
Q

Describe adaptive immunity

A

Specific to antigen, lag time from exposure to response, immunological memory after exposure

51
Q

What are the twp aspects of adaptive immunity

A

Humoral and cellular

52
Q

Describe the humoral aspect of adaptive immunity

A

Antibodies and cytokines

53
Q

Describe the cellular aspect of adaptive immunity

A

T cells and B cells

54
Q

What are vaccine types

A

Preventative vs therapeutic. Active vs passive

Case 3 (9 decks)

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