HEP B Flashcards
1
Q
what is Hep B?
A
Enveloped, hepatotropic, DNA virus
2
Q
how is hep B transmitted?
A
- Blood borne virus
- Sexually transmitted disease
3
Q
what happens if someone has a chronic infection of HEP B?
A
5-10% develop liver cancer
30% develop liver cirrhosis
decompensated / liver failure
4
Q
what are the risk factors for Hep B?
A
- Perinatal exposure
- Multiple sexual partners
- Men who have sex with men (MSM)
- Injection drug use
- Asian, eastern European, or African ancestry
- FHx of HBC, CLD, or HCC
- Household contact with HBV
- Male
- History of STDs
- Infected with HIV
- Infected with HCV
- Blood transfusion
- Health-care worker
- History of imprisonment
- Haemodialysis
5
Q
who is the Hep B vaccination given to?
A
- Vaccine to high risk
– Hyper-endemic areas
– IVDU
– Dialysis patients
– HIV patients
– Pregnant women
– Men who have sex with men
– Sexual and household contacts of HBV carriers who
are –ve for HBV serology
6
Q
when is the HEP b vaccine given?
A
- Vaccine given at 0,1 and 6 month intervals
7
Q
is there screening available for hep B?
A
- High risk patients
- Reduce incidence and offer early treatment
- Prevention of cirrhosis and hepatocellular Ca
- Transmission
– Permucosal
– Percutaneous
8
Q
what is the incubation period for hep B?
A
40 to 160 days
9
Q
what are the signs and symptoms of Hep B?
A
- Symptomatic – 10% of children and 30% of
adults - Symptoms
– Anorexia, Abdominal pain, nausea, vomiting, fever
– Dark urine & pale stools
– Acute HBV jaundice may be present
10
Q
What are the possible differential diagnosis of HEP b?
A
Chronic HCV, HEV, CMV, EBV, HSV, autoimmune hepatitis
11
Q
how do we test for hep b?
A
- LFTs
- FBC
- U & Es
- Coagulopathy
- Serum HBsAg, HBsAb, HBcAb (IgM), HBcAb (IgM
+ IgG), and HBeAg - HBV DNA
- Others: Serum HBeAb, HBV genotype, USS of
Liver, serum Ammonia, Liver biopsy, AFP
12
Q
what is the treatment for hep B?
A
- Acute HBV (<6months)
- Supportive Therapy
- Infants infected at birth – 90% will develop CHB
- Children < 5 – 25-30% will develop chronic CHB
- Older children and Adults – 95% of individuals
will sero-convert - Male more prone to develop CHB
13
Q
how would you treat complications in hep B?
A
- Development of complications
– Fulminant hepatitis or hepatic failure - Treatment
– Nucleoside analogue +/- liver transplant
– 1
st line – Lamivudine 100mg orally OD
14
Q
how do you treat chronic hep B?
A
- Chronic (>6 months)
- HBeAg positive
- HBeAg negative
- Flare of CHB state in 10-30% of patients
- Aim – to slow progression of liver disease
(cirrhosis or HCC) and reduce infections - 2oPrevention
– Hepatitis A vaccination
– Avoid heavy EtOH intake
15
Q
what are the complications of HEP B?
A
- Cirrhosis
– Immune reaction → inflammation, cell death
(necrosis) and scarring (fibrosis) within the Liver
– More likely in older patients, EtOH abuse and
infected with HBeAg – negative strain
– Only 14-28% of patients with decompensated
cirrhosis will survive beyond 5 years - HCC
– Usually occurs 25-30 years after acute infection
– Only 5-6% of patients survive beyond 5 years
