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Year 3 Gastro > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

What are the different types of hepatitis?

A 
Autoimmune
A
B
C
D
E
Alcoholic
Ischaemic
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2
Q

What is autoimmune hepatitis?

A

Condition of unknown aetiology
Commonly seen in young women
3 types
Concurrent autoimmnue disease are often present

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3
Q

What are the 3 types of autoimmune hepatitis?

A

Type I: ANA and/or anti-SMA
Adults and children
Most common 80%

Type II: Anti-liver/kidney microsomal type 1 antibodies
Only children

Type III - Soluble liver kidney antigen
Middle aged adults

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4
Q

What are the presenting features of autoimmune hepatitis?

A 
Acute - jaundice, fever
Amenorrhoea
Antibodies, raised IgG
Liver biopsy showing inflammation
Hepatomegaly and Splenomegaly
Stigmata of chronic liver disease
But patients can be asymptomatic
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5
Q

What is the management for autoimmune hepatitis?

A

steroids, other immunosuppressants e.g. azathioprine

liver transplantation

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6
Q

What is Hepatitis A?

A

Hepatitis A is typically a benign, self-limiting disease, with a serious outcome being very rare.

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7
Q

What causes Hepatitis A?

A

RNA picornavirus
transmission is by faecal-oral spread, often in institutions
2-4 week incubation

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8
Q

What are the presenting features of Hep A?

A 
flu-like prodrome
abdominal pain: typically right upper quadrant
tender hepatomegaly
jaundice
cholestatic liver function tests
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9
Q

Who should have a Hep A vaccine?

A

people travelling to areas of high prevalence

people with chronic liver disease

patients with haemophilia

men who have sex with men

injecting drug users

individuals at occupational risk: laboratory worker; staff of large residential institutions; sewage workers; people who work with primates

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10
Q

What causes Hep B?

A

double-stranded DNA hepadnavirus
spread through exposure to infected blood or body fluids + vertical transmission from mother to child
6-20 week incubation

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11
Q

What are the presenting features of Hep B?

A

Fever
Jaundice
Elevated liver transaminases

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12
Q

What are some complications of hepatitis B?

A

chronic hepatitis (5-10%). ‘Ground-glass’ hepatocytes may be seen on light microscopy

hepatocellular carcinoma

Usually stays acute

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13
Q

Who is vaccinated against Hep B?

A

Children born in the UK at 2,3,4 months

Healthcare workers

IV drug users

Sex workers

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14
Q

What is the management for Hep B?

A

Acute - supportive

Chronic - pegylated interferon-alpha used to be the only treatment available

Reduces viral replication in up to 30% of chronic carriers

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15
Q

What causes Hep C?

A

hepatitis C is a RNA flavivirus
incubation period: 6-9 weeks
80% cases chronic

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16
Q

How is Hep C transmitted?

A

Risk from needlestick = 2%

Risk from vertical mother to child = 6% (higher in HIV mothers)

Risk from sexual intercourse = <5%

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17
Q

What features are present in 30% of those exposed to the Hep C virus?

A

a transient rise in serum aminotransferases / jaundice
fatigue
arthralgia

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18
Q

What is the investigation for Hep C?

A

HCV RNA

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19
Q

What is the outcome post Hep C infection?

A

around 15-45% of patients will clear the virus after an acute infection

the majority (55-85%) will develop chronic hepatitis C

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20
Q

What are some potential complications of Hep C infection?

A

Arthralgia, arthrtis
Eye problems (Sjorgen’s)
Cirrhosis
Hepatocellular cancer

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21
Q

What is the management for chronic hep C infection?

A

combination of protease inhibitors (e.g. sofosbuvir + simeprevir) with or without ribavirin are used

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22
Q

What is the aim of Hep C treatment and how is it measured?

A

Sustained virological response (SVR), defined as undetectable serum HCV RNA six months after the end of therapy

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23
Q

What are the side effects of Ribavirin?

A

Haemolytic anaemia
Cough
Teratogenic

24
Q

What is Hep D?

A

single stranded RNA virus that is transmitted parenterally

Needs Hep B surface antigen to replicate

25
Q

What is superinfection?

A

A hepatitis B surface antigen positive patient subsequently develops a hepatitis D infection

26
Q

What is superinfection associated with?

A

high risk of fulminant hepatitis, chronic hepatitis status and cirrhosis

27
Q

How is Hep D diagnosed?

A

via reverse polymerase chain reaction of hepatitis D RNA

28
Q

Who is offered screening for Hep B?

A

All pregnant women

29
Q

What are the main features of Hep E?

A

RNA hepevirus
spread by the faecal-oral route
incubation period: 3-8 weeks
common in Central and South-East Asia, North and West Africa, and in Mexico

30
Q

What is ischaemic hepatitis?

A

Diffuse hepatic injury from acute hypoperfusion

Diagnosed with inciting event e.g. cardiac arrest

31
Q

What is the route of transmission for viral hepatitis (A+E)?

A

Faecal-oral route

Hep A- Shellfish

32
Q

How do Hepatitis viruses replicate?

A

RNA viruses bind to hepatocytes and kuffer cells

Enter cells via endocytosis

Release RNA into cell which binds to host ribosome

Translates polyprotein which is cut in to pieces before being released

33
Q

What causes pruritrus in viral hepatitis?

A

Bile salts in the blood

34
Q

What are the risks of Hep E?

A

Pregnancy -> Acute liver failure

Immunocompromised -> Chronic hepatitis

35
Q

What would bloods/serology look like in current viral hepatitis (A+E)?

A

Raised AST/ALT

HepA
Anti-HAV IgM = indicated acute infection (no seroconversion)
Anti-HAV IgG = past infection, persists for life

Hep E
Anti-HEV IgM = current infection
Anti-HEV IgG = past infection, persists for years

36
Q

Why does Hep A infection give life-long immunity?

A

Anti-HAV IgG antibodies persist for life

37
Q

Is there a Hep E vaccine?

A

No

38
Q

Why are Hep B and Hep D linked?

A

Need Hep B infection prev to get Hep D

Both DNA viruses

39
Q

How does viral Hep B replicate?

A

Enters hepatocyte via fusing with membrane

Releases capsid into cell which enters nucleus

Uses host cell organelles to replicate

40
Q

Is Hep B acute or chronic?

A

Chronic in 5-10% of cases

41
Q

What is a serious complication of Hep B?

A

Hepatocellular carcinoma in chronic cases

42
Q

Why do you get pale stool and dark urine in hepatitis?

A

Bilirubin released by hepatocytes are filtred by the kidneys and found in urine

No longer in stool

43
Q

What is the management for Hep B?

A

Acute - resolves

Antivirals
Immune system modulators e.g. interferon alpha

44
Q

How can Hep B be prevented?

A

Screening of donated blood
Avoid lifestyle risks
High risk pts vaccinated
If exposed pt can be give Hep B immune globulin

45
Q

What are the symptoms of Hep C?

A

Majority asymptomatic

Extra-hepatic manifestations e.g. skin rash, renal dysfunction

46
Q

How do you diagnose hepatitis C?

A

Raised AST/ALT
Anti-HCV antibodies
RT PCR if clinically suspected but viral serology -ve

Liver biopsy to assess degree of damage

47
Q

What would serolgy show in active acute HBV infection?

A

HBsAg - postitive surface antigen in current infection

Anti-HBc IgM - acute disease

48
Q

What would serolgy show in resolved acute HBV infection?

A

Anti-HBs seen in resolved infections

49
Q

What would serolgy show in chronic HBV infection?

A

Anti-HBc IgG
HBsAg

No Anti-HBs (infection has not cleared)

50
Q

What is ANA?

A

Anti-nuclear antibodies

51
Q

What is ASMA?

A

Anti-smooth muscle antibodies

52
Q

What are the investigative results in auto-immune hepatitis?

A

ALT>AST
Decreased serum albumin
Prolonged PT

53
Q

Why are there differences in AST and ALT levels?

A

AST is found in other tissues than liver

54
Q

What would Hep B serology show in someone who is vaccinated?

A

HBsAb

55
Q

What would Hep B serology show in someone with a past infection?

A

No antigen
HBsAb present
IgG HBcAb

Year 3 Gastro (39 decks)

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