Hepatitis Flashcards
Causes
Alcoholic hepatitis
NAFLD
Viral hepatitis
Drug induced
Presentation
Abdo pain
Fatigue
Pruritis
Muscle and joint aches
Nausea and vomiting
Jaundice
Fever
LFTs
High transaminases with proportionally less rise in ALP
Bilirubin may also rise
Hepatitis A
Most common viral cause (rare in UK)
RNA virus transmitted faecal-oral route
Nausea, vomiting, anorexia and jaundice
Can cause cholestasis with dark urine and pale stools
Resolves without treatment in 1-3 months
Vaccination is available
Hepatitis B
Transmitted by direct blood/ bodily fluid contact and vertical transmission
DNA virus
Most recover within 2 months but 10% chronic carriers
Hep B serology
HBsAg is first marker to appear and causes production of anti-HBs
HBsAg normally implies acute disease
If HBsAg >6months then chronic disease
Anti-HBs implies immunity (it is negative in chronic disease)
Anti-HBc implies previous (or current) infection
- IgM during acute and present around 6 months
- IgG persists
HbeAg results from breakdown of core antigen from infected liver cells (implies high infectivity)
Hep B vaccination
Injecting hepatitis B surface antigen
Needs 3 doses
Management of hep B
Screen for other blood born viruses
Refer to gastro/ hepatology/ ID for specialist input
Notify Public Health
Stop smoking and alcohol
Test for complications
Antiviral medications
Liver transplant in end-stage liver disease
Hepatitis C
RNA virus
Spread by bloods and body fluids
No vaccines available
Curable wit direct acting antiviral medications
Hep C testing
Hep C antibody is screening test
Hep C RNA is used to confirm diagnosis, calculate viral load and assess for individual genotype
Hep C management
Screen for other blood born viruses
Refer to gastro/ hepatology/ ID for specialist input
Notify Public Health
Stop smoking and alcohol
Test for complications
Direct acting antivirals tailored to specific genotype for 8-12 weeks
Liver transplant in end-stage liver disease
Hepatitis D
RNA virus
Can only survive in patients who also have hep B
Attaches to HBsAg to survive
Increases complications and severity of hep B
Notifiable disease
Hepatitis E
RNA virus
Transmitted by faecal oral route
Normally produces mild illness and cleared within a month
No vaccination
Notify Public Health
Autoimmune hepatitis
Type 1 typically affects women in late 40/50s and presents with fatigue and features of liver disease
Type 2 typically teenage/ early 20s with acute hepatitis, high transaminases and jaundice
Type 1 autoantibodies
Anti-nuclear antibodies
Anti-smooth muscle antibodies
Anti-soluble liver antigen
