Hepatitis Flashcards
What is the incubation time for hepatitis A?
2-6 weeks, average of 28 days
Through what route does hepatitis A spread?
faeco-oral route and arises from the ingestion of contaminated food or water (e.g. shellfish)
How long do hepatitis A symptoms last for?
Symptoms usually last less than 2 months, although some people can be ill for as long as 6 months
What are classic symptoms for hepatitis A?
- Fatigue
- Fever
- Nausea
- Appetite loss
- Jaundice
- Dark urine
- Diarrhea
- Light or clay-colored faeces (acholic faeces)
- Abdominal discomfort
How does hepatitis A relate to smoking and cigarette appetite?
Distate for cigarettes after infection
How is hepatitis A diagnosed?
HAV-specific IgM antibodies in the blood
What would LFTs show for a hepatitis A patient?
Raised ALT
What do IgM antibodies represent?
Acute infection
Low-titre –> chronic hep B
What do IgA antibodies represent?
Past infection, current immunity
How is hepatitis B transmitted?
- Vertical transmission
2. Horizontal transmission: children playing with same toy, IV drugs, male-male intercourse
In what body fluids can hepatitis B be found?
Saliva and semen
What causes the liver damage in hepatitis B infections?
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
What would LFTs show for a hepatitis B patient?
Raised ALT
What are symptoms of acute infection with Hep B?
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
What is the incubation time for hepatitis B?
30-180 days
What can chronic hep B lead to?
Cirrhosis
What oncological risk does hep B infection carry?
hepatocellular carcinoma
Across Europe, hepatitis B and C cause approximately 50% of hepatocellular carcinomas
How is Hep B diagnosed?
Based on markers of hepatitis B infection:
- Antigens of Hep B
- Antibodies against Hep B
How would you manage acute hep B infection?
Symptomatic control
How would you manage a chronic hep B infection?
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
What is HBsAg?
Antigen for Hepatitis B: acute of chronic
What is HBwAg?
Acute hepatitis B
What would LFTs show for a CHRONIC hepatitis B patient?
LFT show moderate rise in aminotransferase and ALP
What are indications for Hep B antiviral therapy?
Three criteria are used:
- serum HBV DNA levels
- serum ALT levels
- histological grade and stage
What histology is related to Hep B?
Histologically, there is a full spectrum of changes from near normal with only a few lymphocytes and interface hepatitis to a full-blown cirrhosis
What does anti-HBe indicate?
Seroconversion from Hep B pos to Hep B neg
What percentage of people develops chronic Hep B?
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.
How is hepatitis C transmitted?
blood and blood products
High-risk groups: men who have sex with men, IV drugs, sex workers and attendees at STI clinics
How does hep C present?
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.
What is the presentation of chronic hep C?
Fatigue is the commonest symptom with sometimes nausea, anorexia and weight loss, which do not correlate with disease activity.
How do you treat chronic Hep C?
Pegylated interferon alpha
What percentage of people with hep C develop chronic liver disease?
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
What is the incubation time for Hepatitis C?
2 weeks to 6 months
In hep C infections, what percentage of people is symptomatic?
20%
What is the incubation time for Hepatitis D?
3-7 weeks
What does hepatitis D need to infect someone?
A pre-existing Hep B infection, cannot exist without this
How would you treat hep D?
Pegylated interferon alpha
How is hepatitis D transmitted?
through broken skin (via injection, tattooing etc.) or through contact with infected blood or blood products
What are the two types of hep D infections?
- Co-infection of HBV (clinically indistinguishable from an acute icteric HBV infection)
- Superinfection (results in an acute flare-up of previously quiescent chronic HBV infection)
