Hepatitis Flashcards
What does hepatitis describe?
Inflammation to the liver
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
Muscle and join aches
Nausea and vomiting
Jaundice
Fever (viral hepatitis)
Typical LFT findings in hepatitis?
High AST/ALT with proportionally less rise in ALP
How is Hepatitis A transmitted?
Faecal-oral route
How long does it take for Hep A to resolve?
1-3 months
What type of virus is Hep A?
RNA
What type of virus is Hep B?
DNA
How is Hep B transmitted?
Direct contact with blood/bodily fluids
What percentage of people with Hep B go on to become chronic carriers?
10%
What antibodies indicate active infection?
HBsAg = surface antigen
What antibodies indicate previous infection?
HBcAb = core antibodies
If HBsAg and HBcAb are positive then what else should you test for?
HBeAg = E antigen - marker of viral replication and implies high infectivity
Viral load
What immunoglobulin implies active infection?
Active infection
What immunoglobulin implies past infection?
IgG where HBsAg is neg
What type of virus is Hepatitis C?
RNA
How is Hep C spread?
Blood/body fluids
Disease course of hep C?
1/4 fights infection and makes full recovery
3/4 becomes chronic
Complications of Hep C?
Liver cirrhosis and hepatocellular carcinoma
Treatment of Hep C?
Direct acting antivirals (DAAs) - successful cure in over 90% of patients. Typically taken for 8-12 weeks.
Liver transplant in end-stage disease
What type of virus is Hep D?
RNA
What infection does Hep D require its host to already be infected with in order to survive?
Hep B
What type of virus is Hep E?
RNA
How is Hep E transmitted?
Faecal-oral route
Is Hep E serious?
Often only a mild illness, cleared within a month, no treatment required.
What are the 2 types of autoimmune hepatitis?
Type 1 - adults
Type 2 - children
Typical patient with Type 1 autoimmune hepatitis?
Women in late 40s/50s, presenting around/after the menopause with fatigue and features of liver disease on examination
Typical patient with Type 2 autoimmune hepatitis?
Teens/early 20s with acute hepatitis with high transaminases and jaundice.
Autoantibodies associated with Type 1 autoimmune hepatitis?
Anti-nuclear antibodies (ANA)
Anti-smooth muscle antibodies (anti-actin)
Anti-soluble liver antigen (anti-SLA/LP)
Autoantibodies associated with Type 2 autoimmune hepatitis?
Anti-liver kidney microsomes-1 (anti-LKM1)
Anti-liver cytosol antigen type 1 (anti-LC1)
How is autoimmune liver disease confirmed?
Liver biopsy
Treatment of autoimmune liver disease?
Prednisolone
Azathioprine
Transplant in end-stage liver disease
However autoimmune hep can recur in transplanted livers
