Hepatitis

Question 1

What is the incubation time for hepatitis A?

Answer 1

2-6 weeks, average of 28 days

Question 2

Through what route does hepatitis A spread?

Answer 2

faeco-oral route and arises from the ingestion of contaminated food or water (e.g. shellfish)

Question 3

How long do hepatitis A symptoms last for?

Answer 3

Symptoms usually last less than 2 months, although some people can be ill for as long as 6 months

Question 4

What are classic symptoms for hepatitis A?

Answer 4

• Fatigue
• Fever
• Nausea
• Appetite loss
• Jaundice
• Dark urine
• Diarrhea
• Light or clay-colored faeces (acholic faeces)
• Abdominal discomfort

Question 5

How does hepatitis A relate to smoking and cigarette appetite?

Answer 5

Distate for cigarettes after infection

Question 6

How is hepatitis A diagnosed?

Answer 6

HAV-specific IgM antibodies in the blood

Question 7

What would LFTs show for a hepatitis A patient?

Answer 7

Raised ALT

Question 8

What do IgM antibodies represent?

Answer 8

Acute infection

Low-titre –> chronic hep B

Question 9

What do IgA antibodies represent?

Answer 9

Past infection, current immunity

Question 10

How is hepatitis B transmitted?

Answer 10

1. Vertical transmission

2. Horizontal transmission: children playing with same toy, IV drugs, male-male intercourse

Question 11

In what body fluids can hepatitis B be found?

Answer 11

Saliva and semen

Question 12

What causes the liver damage in hepatitis B infections?

Answer 12

The HBV is not directly cytopathic and liver damage is produced by the host cellular immune response

HBV-specific cytotoxic CD8 T cells recognise the viral antigen via HLA class I molecules on the infected hepatocytes

Question 13

What would LFTs show for a hepatitis B patient?

Answer 13

Raised ALT

Question 14

What are symptoms of acute infection with Hep B?

Answer 14

Malaise, loss of appetite, nausea, vomiting, body aches, mild fever, and dark urine, and then progresses to development of jaundice

The illness lasts for a few weeks and then gradually improves in most affected people

The infection may be entirely asymptomatic and may go unrecognised

Question 15

What is the incubation time for hepatitis B?

Answer 15

30-180 days

Question 16

What can chronic hep B lead to?

Answer 16

Cirrhosis

Question 17

What oncological risk does hep B infection carry?

Answer 17

hepatocellular carcinoma

Across Europe, hepatitis B and C cause approximately 50% of hepatocellular carcinomas

Question 18

How is Hep B diagnosed?

Answer 18

Based on markers of hepatitis B infection:

1. Antigens of Hep B
2. Antibodies against Hep B

Question 19

How would you manage acute hep B infection?

Answer 19

Symptomatic control

Question 20

How would you manage a chronic hep B infection?

Answer 20

Treatment with antiviral agents → Interferon, entecavir and tenofovir

Side-effects of treatment are many, with an acute flu-like illness occurring 6–8h after the first injection

Question 21

What is HBsAg?

Answer 21

Antigen for Hepatitis B: acute of chronic

Question 22

What is HBwAg?

Answer 22

Acute hepatitis B

Question 23

What would LFTs show for a CHRONIC hepatitis B patient?

Answer 23

LFT show moderate rise in aminotransferase and ALP

Question 24

What are indications for Hep B antiviral therapy?

Answer 24

Three criteria are used:

1. serum HBV DNA levels
2. serum ALT levels
3. histological grade and stage

Question 25

What histology is related to Hep B?

Answer 25

Histologically, there is a full spectrum of changes from near normal with only a few lymphocytes and interface hepatitis to a full-blown cirrhosis

Question 26

What does anti-HBe indicate?

Answer 26

Seroconversion from Hep B pos to Hep B neg

Question 27

What percentage of people develops chronic Hep B?

Answer 27

Following an acute HBV infection, which may be subclinical, approximately 1–10% of patients will not clear the virus and will develop a chronic HBV infection.

Question 28

How is hepatitis C transmitted?

Answer 28

blood and blood products High-risk groups: men who have sex with men, IV drugs, sex workers and attendees at STI clinics

Question 29

How does hep C present?

Answer 29

Most acute infections are asymptomatic, with about 10% of patients having a mild flu-like illness with jaundice and a rise in serum aminotransferas. Most patients will not be diagnosed until they present, years later, with evidence of abnormal transaminase values at health checks or with chronic liver disease.

Question 30

What is the presentation of chronic hep C?

Answer 30

Fatigue is the commonest symptom with sometimes nausea, anorexia and weight loss, which do not correlate with disease activity.

Question 31

How do you treat chronic Hep C?

Answer 31

Pegylated interferon alpha

Question 32

What percentage of people with hep C develop chronic liver disease?

Answer 32

Some 85–90% of asymptomatic patients develop chronic liver disease. A higher percentage of symptomatic patients ‘clear’ the virus with only 48–75% going on to chronic liver disease

Question 33

What is the incubation time for Hepatitis C?

Answer 33

2 weeks to 6 months

Question 34

In hep C infections, what percentage of people is symptomatic?

Answer 34

20%

Question 35

What is the incubation time for Hepatitis D?

Answer 35

3-7 weeks

Question 36

What does hepatitis D need to infect someone?

Answer 36

A pre-existing Hep B infection, cannot exist without this

Question 37

How would you treat hep D?

Answer 37

Pegylated interferon alpha

Question 38

How is hepatitis D transmitted?

Answer 38

through broken skin (via injection, tattooing etc.) or through contact with infected blood or blood products

Question 39

What are the two types of hep D infections?

Answer 39

1. Co-infection of HBV (clinically indistinguishable from an acute icteric HBV infection) 2. Superinfection (results in an acute flare-up of previously quiescent chronic HBV infection)