Hepatitis

Question 1

Causes of hepatitis

Answer 1

Alcoholic hepatitis, NAFLD, viral, autoimmune, drug induced

Question 2

Presentation of hepatitis

Answer 2

Abdominal pain, fatigue, pruritis, muscle and joint aches, nausea and vomiting, jaundice, fever

Question 3

How is hep A transmitted

Answer 3

Faecal-oral route usually by contaminated water or food

Question 4

Presentation of hep A

Answer 4

Nausea, vomiting, anorexia, jaundice, cholestasis, dark urine, pale stools, hepatomegaly

Question 5

Management of hep A

Answer 5

Usually resolves in 1-3 months so analgesia only

Question 6

What type of virus is hep A

Answer 6

RNA virus

Question 7

What type of virus is hep B

Answer 7

DNA virus

Question 8

How is hep B transmitted

Answer 8

Direct contact with blood or bodily fluids

Question 9

Prognosis of hep B

Answer 9

Most recover in 2 months, but 10% go on to be chronic hep B carrier

Question 10

What does HBsAg imply

Answer 10

Surface antigen - active infection

Question 11

What does HBeAg imply

Answer 11

E antigen - marker of viral replication and implies high infectivity

Question 12

What does HBcAb imply

Answer 12

Core antibodies - past or current infection

Question 13

What does HBsAb imply

Answer 13

Surface antibody - implies vaccination, past or current infection

Question 14

What does the HBV DNA imply

Answer 14

Hepatitis B virus DNa which is a direct count of the viral load

Question 15

Management of hep B

Answer 15

Screen for other blood born viruses, refer for specialist management, stop smoking and alcohol, test for complications, antivirals, informing contacts

Question 16

Complications of Hep B

Answer 16

Cirrhosis and hepatocellular carcinoma

Question 17

What type of virus is hep C

Answer 17

RNA virus

Question 18

How is hep C transmitted

Answer 18

Blood and bodily fluids

Question 19

How can hep C be treated

Answer 19

Direct acting antivirals tailored to the specific genotype, successful in 90%

Question 20

What type of virus is hep D and E

Answer 20

RNA virus

Question 21

Which viral hepatitis’ need to be notified to public health

Answer 21

All of them

Question 22

How is hep D spread

Answer 22

It can only survive in patients who also have hepatitis B

Question 23

Effect of hep D

Answer 23

Increases complications and disease severity of hep B and there is no specific treatment

Question 24

How is hep E spread

Answer 24

Faecal-oral route

Question 25

Presentation of Hep E

Answer 25

Very rare in UK, producing mild illness, which clears in a month and often no treatment requiredm rarely progresses to chronic hep and liver failure

Question 26

What are the types of autoimmune hepatitis and who do they occur in

Answer 26

Type 1 - adults
Type 2 - children

Question 27

Features of type 1 autoimmune hepatitis

Answer 27

typically affects women in their late 40s or 50s, around or after menopause with fatigure and features of liver disease

Question 28

Feature of type 2 autoimmune hepatitis

Answer 28

Teenagers or young 20s presening with acute hepatitis

Question 29

Autoantibodies in type 1

Answer 29

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

Question 30

Autoantibodies in type 2

Answer 30

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

Question 31

How can autoimmune hep be confirmed

Answer 31

Liver biopsy

Question 32

Treatment of autoimmune hepatitis

Answer 32

High dose prednisolone that are tapered over time as other immunosuppressants (azathioprine) and introduced