Hepatitis Flashcards
Causes of hepatitis
Alcoholic hepatitis Non alcoholic fatty liver disease Viral hepatitis Autoimmune hepatitis Drug induced hepatitis (e.g. paracetamol overdose)
Presentation of hepatitis
Abdominal pain Fatigue Pruritis (itching) Muscle and joint aches Nausea and vomiting Jaundice Fever (viral hepatitis)
Typical LFT findings in hepatitis
Hepatitic picturre
AST and ALT proportionally higher than ALP
Bilirubin may also be high - due to inflammation of the liver cells. High bilirubin causes jaundice.
How are the different viral hepatitis spread?
Hep A and E - faecal-oral route
Hep B and C - Contact with blood or bodily fluids e.g. IVDU, sex
Hep D - only occurs as a co-infection in Hep B
What is Hep B?
A double stranded DNA virus spread often through blood borne route
Can also be spread by vertical transmission
Hep B serology
HbsAg - Hep B surface antigen:
- Positive in active infection (acute or chronic)
Anti-HBc (HBcAb) (antibody against Hep B core antigen)
- Implies past or current infection
- Not positive after vaccination
- Can be used to distinguish between acute and chronic infection
- IgM in acute, IgG in chronic
Anti-HBs (HBsAb) (antibody to Hep B surface antigen)
- Positive in both past infection and vaccination
HBeAg:
- Determines infectivity
- If this is negative and anti-HBe is positive - implies they have been through phase where virus was replicating and are less infectious
- If this is positive = higher infectivity
Management of Hep B
Screen for other blood born viruses e.g. Hep C, HIV and other STIs
Refer to gastroenterology, hepatology or infectious diseases for specialist management
Notify public health England
Advice on reducing transmission
- Avoid unprotected sex (including oral sex)
- Avoid sharing needles
- Avoid sharing toothbrushes
Testing for complications - FibroScan for cirrhosis and ultrasound for hepatocellular carcinoma
Stop smoking and alcohol
Interferon-alpha for chronic hepatitis B (an antiviral)
- Tenofovir is second line
HbsAg negative
Anti-HBs - positive
Anti-HBc - negative
Vaccinated against Hep B
HbsAg negative
Anti-HBs - positive
Anti-HBc - positive
Previous hepatitis B infection
HbsAg - positive
Anti-HBs - negative
Anti-HBc - negative or positive IgM
Acute Hep B
Anti-HBc is positive for IgM in later infection
HbsAg - positive
Anti-HBs - negative
Anti-HBc - positive IgG
HBe-Ag - negative
Anti-HBe - positive
Chronic Hep B with low infectivity
HbsAg - positive
Anti-HBs - negative
Anti-HBc - positive IgG
HBe-Ag - positive
Anti-HBe - positive
Chronic Hep B with high infectivity
What is Hepatitis C?
An RNA virus spread through blood borne route
What is the disease prognosis and possible complications of Hep C?
1/4 make full recovery
3/4 get chronic Hep C
Complications are liver cirrhosis and its associated complications and hepatocellular carcinoma
Hepatitis C serology
HCV RNA - positive in active infection
Anti-HCV - positive in previous infection and chronic infection usually
Hepatitis C management
Screen for other blood born viruses (hepatitis A and B and HIV) and other STIs
Refer to gastroenterology, hepatology or infectious diseases for specialist management
Notify Public Health (it is a notifiable disease)
Stop smoking and alcohol
Education about reducing transmission and informing potential at risk contacts
Testing for complications: FibroScan for cirrhosis and ultrasound for hepatocellular carcinoma
Antiviral treatment with direct acting antivirals (DAAs) is tailored to the specific viral genotype. They successfully cure the infection in over 90% of patients. They are typically taken for 8 to 12 weeks
Liver transplantation for end-stage liver disease
Who needs to be informed in viral hepatitis cases?
Public Health
A notifiable disease
What is autoimmune hepatitis?
May be due to environmental factors such as a viral infection that causes a T cell-mediated response against the liver cells
Two types:
- Type 1 - adults
- Type 2 - children (more acute course)
What are the autoantibodies seen in autoimmune hepatitis?
Type 1 Autoantibodies:
- Anti-nuclear antibodies (ANA)
- Anti-smooth muscle antibodies (anti-actin)
- Anti-soluble liver antigen (anti-SLA/LP)
Type 2 Autoantibodies:
- Anti-liver kidney microsomes-1 (anti-LKM1)
- Anti-liver cytosol antigen type 1 (anti-LC1)
Investigations in suspected autoimmune hepatitis?
LFTs - raised ALT and AST
Autoantibody screen
Clotting/INR - liver function
Liver biopsy to confirm diagnosis
Treatment of autoimmune hepatitis?
Treatment is with high dose steroids (prednisolone) that are tapered over time as other immunosuppressants, particularly azathioprine are started
Treatment usually needed lifelong
Liver transplant may be needed in end-stage liver disease
