Hepatitis

Question 1

What does hepatitis describe?

Answer 1

Inflammation to the liver

Question 2

Causes of hepatitis?

Answer 2

Alcoholic hepatitis
Non alcoholic fatty liver disease
Viral hepatitis
Autoimmune hepatitis
Drug-induced hepatitis (e.g. paracetamol overdose)

Question 3

Presentation of hepatitis?

Answer 3

Abdominal pain
Fatigue
Pruritis
Muscle and join aches
Nausea and vomiting
Jaundice
Fever (viral hepatitis)

Question 4

Typical LFT findings in hepatitis?

Answer 4

High AST/ALT with proportionally less rise in ALP

Question 5

How is Hepatitis A transmitted?

Answer 5

Faecal-oral route

Question 6

How long does it take for Hep A to resolve?

Answer 6

1-3 months

Question 7

What type of virus is Hep A?

Answer 7

RNA

Question 8

What type of virus is Hep B?

Answer 8

DNA

Question 9

How is Hep B transmitted?

Answer 9

Direct contact with blood/bodily fluids

Question 10

What percentage of people with Hep B go on to become chronic carriers?

Answer 10

10%

Question 11

What antibodies indicate active infection?

Answer 11

HBsAg = surface antigen

Question 12

What antibodies indicate previous infection?

Answer 12

HBcAb = core antibodies

Question 13

If HBsAg and HBcAb are positive then what else should you test for?

Answer 13

HBeAg = E antigen - marker of viral replication and implies high infectivity

Viral load

Question 14

What immunoglobulin implies active infection?

Answer 14

Active infection

Question 15

What immunoglobulin implies past infection?

Answer 15

IgG where HBsAg is neg

Question 16

What type of virus is Hepatitis C?

Answer 16

RNA

Question 17

How is Hep C spread?

Answer 17

Blood/body fluids

Question 18

Disease course of hep C?

Answer 18

1/4 fights infection and makes full recovery
3/4 becomes chronic

Question 19

Complications of Hep C?

Answer 19

Liver cirrhosis and hepatocellular carcinoma

Question 20

Treatment of Hep C?

Answer 20

Direct acting antivirals (DAAs) - successful cure in over 90% of patients. Typically taken for 8-12 weeks.
Liver transplant in end-stage disease

Question 21

What type of virus is Hep D?

Answer 21

RNA

Question 22

What infection does Hep D require its host to already be infected with in order to survive?

Answer 22

Hep B

Question 23

What type of virus is Hep E?

Answer 23

RNA

Question 24

How is Hep E transmitted?

Answer 24

Faecal-oral route

Question 25

Is Hep E serious?

Answer 25

Often only a mild illness, cleared within a month, no treatment required.

Question 26

What are the 2 types of autoimmune hepatitis?

Answer 26

Type 1 - adults
Type 2 - children

Question 27

Typical patient with Type 1 autoimmune hepatitis?

Answer 27

Women in late 40s/50s, presenting around/after the menopause with fatigue and features of liver disease on examination

Question 28

Typical patient with Type 2 autoimmune hepatitis?

Answer 28

Teens/early 20s with acute hepatitis with high transaminases and jaundice.

Question 29

Autoantibodies associated with Type 1 autoimmune hepatitis?

Answer 29

Anti-nuclear antibodies (ANA)
Anti-smooth muscle antibodies (anti-actin)
Anti-soluble liver antigen (anti-SLA/LP)

Question 30

Autoantibodies associated with Type 2 autoimmune hepatitis?

Answer 30

Anti-liver kidney microsomes-1 (anti-LKM1)
Anti-liver cytosol antigen type 1 (anti-LC1)

Question 31

How is autoimmune liver disease confirmed?

Answer 31

Liver biopsy

Question 32

Treatment of autoimmune liver disease?

Answer 32

Prednisolone
Azathioprine
Transplant in end-stage liver disease
However autoimmune hep can recur in transplanted livers