Hepatitis Flashcards
What is hepatitis?
Inflammation of the liver
Name 3 causes of hepatitis
- NAFLD
- AFLD
- Viral hepatitis
- Autoimmune hepatitis
- Drug induced hepatitis
Hepatitis may be asymptomatic or could present with non-specific symptoms - name 3 of these symptoms
- Abdominal pain
- Fatigue
- Pruritus
- Muscle and joint aches
- Nausea and vomiting
- Jaundice
- Fever (viral hepatitis)
The typical biochemical findings are that liver function tests become deranged - this is called the hepatic picture. What are the biochemical changes seen?
High transaminases (AST / ALT) with proportionally less of a rise in ALP
Hepatitis A
1) How is it transmitted?
2) Name 2 ways it can present/2 features of the disease
3) How is it managed?
4) Is it a DNA or RNA virus?
1) Faecal-oral route usually by contaminated water or food
2) Nausea, vomiting, fever, anorexia, jaundice, pale stools, dark urine, cholestasis, moderate hepatomegaly
3) Analgesia. Vaccine available
4) RNA virus
Hepatitis B (1)
1) Is HepB a DNA or RNA virus?
2) How is it transmitted?
3) Name 3 ways it can be transmitted
4) Name 2 complications of chronic HepB
1) DNA
2) Direct contact with blood or bodily fluids
3) Sexual intercourse, sharing IV needles, sharing household objects i.e. toothbrushes, contact between minor cuts or abrasions, vertical transmission in pregnancy
4) Liver cirrhosis, failure and hepatocellular carcinoma
Hepatitis B (2)
1) What does the surface antigen/HBsAg indicate?
2) What is the E antigen/HBeAg a marker of, and what does a high value imply?
3) What do core antibodies/Anti HBc/ HBcAb indicate?
4) What can Anti HBc IgM and IgG help to differentiate?
5) What does the surface antibody/Anti HBs/HBsAb indicate?
6) What does the Hepatitis B virus DNA (HBV DNA) indicate?
7) Which 2 makers are looked for in the HepB screen?
8) Vaccinated patients are checked for what marker to check response to the vaccine?
1) Active infection
2) Marker of viral replication and a high value implies high infectivity
3) Past or current infection
4) Anti HBc IgM = acute infection. Anti HBc IgG = chronic infection (active or carrier) or immunity following acute infection
5) Immunity from infection or immunisation
6) Direct count of the viral load
7) HBsAg (active infection) and HBcAb (past or current infection)
8) HBsAb
Hepatitis B (3)
1) Name 3 aspects of the management of HepB
- Screen for other blood borne viruses and sexually transmitted diseases
- 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 medication can be used to slow the progression of the disease and reduce infectivity
- Liver transplantation for end-stage liver disease
Hepatitis C
1) Is HepC a DNA or RNA virus?
2) How does it transmit?
3) Around what percentage of people with HepC develop chronic infections?
4) What is the screening test?
5) What test is done to confirm diagnosis?
6) How is HepC treated?
1) RNA
2) Blood and body fluids
3) 75%
4) Hepatitis C antibody
5) Hepatitis C RNA
6) Direct acting antivirals
Hepatitis D
1) Is it a DNA or RNA virus?
2) What does HepD require to survive?
3) What effect does HepD infection have on HepB infection?
1) RNA
2) It attaches itself to the HBsAg protein of HepB virus to survive
3) Increases complications and severity
Hepatitis E
1) Is it a DNA or RNA virus?
2) How does it transmit?
1) RNA
2) Faecal oral route
Name 2 other infective causes of hepatitis
- EBV
- CMV
- Q fever
- Yellow fever
- Malaria
What is autoimmune hepatitis?
Inflammatory liver disease of unknown cause that’s characterised by abnormal T cell functions and autoantibodies directed against hepatocyte surface antigens
1) Which type of autoimmune hepatitis (I or II) is associated with adults, and which is associated with children?
2) What is the typical patient of type I autoimmune hepatitis?
3) Name 1 way this patient may present
4) What is the typical patient of type II autoimmune hepatitis and how would they present?
5) Name 2 things that would be seen in a blood test of someone with autoimmune hepatitis
1) Type I = adults and type II = children
2) Woman in her late forties or fifties
3) Fatigue and features of liver disease on examination
4) Young females which present with acute hepatitis, amenorrhoea with high transaminases and jaundice
5) Raised transaminases (ALT and AST), IgG levels and many autoantibodies (anti-nuclear antibodies and/or anti-smooth muscle antibodies in type I autoimmune hepatitis, and anti kidney/liver microsomal type 1 antibodies in type II autoimmune hepatitis)
How is autoimmune hepatitis treated, and name the 2 main drugs of this drug group that are used
High dose of steroids - prednisolone and azathioprine
