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Human Diseases > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

What is Hepatitis?

A

Inflammation of the liver

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2
Q

11 types

What are the different types of viral hepatitis?

A

Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E
Hepatitis F
Hepatitis G
Hepatitis X (does not exist as yet to encounter)
Cytomegalovirus (CMV)
Epstein-Barr virus (EBV; glandular fever virus)
Herpex Simplex

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3
Q

3 types

Which viral hepatitis transmit parentally (via bloodstream, transfusions, IV injections, sexual transmission)?

A

Hepatitis B
Hepatitis C
Hepatitis D

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4
Q

2 types

Which viral hepatitis transmit enterally (begins with the mouth/oral cavity)?

A

Hepatitis A
Hepatitis E

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5
Q

What does ACUTE viral hepatitis mean?

A

Infection of the hepatocytes with direct killing by effector lymphocytes (damage to the liver cells comes from the immune response to the virus, not from the virus itself)
Self-limiting liver inflammation

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6
Q

What does CHRONIC viral hepatitis mean?

A

Low-level long-term (longer than 6 months) immune damage with additional direct cytopathic effects as well as fibrosis and cirrhosis

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7
Q

What do the hepatitis A and E viruses cause?

A

Acute self-limited hepatitis

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8
Q

How to prevent hepatitis A?

A

Vaccination

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9
Q

Which food group is hepatitis A often found in?

A

Seafood

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10
Q

What is hepatitis E infection most commonly caused by?

A

Consumption of undercooked pork products

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11
Q

What may happen in immunosuppressed patients when infected with the hepatitis E virus?

A

Unable to clear the infection leading to chronic hepatitis

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12
Q

How can hepatitis E be prevented?

A

Food hygiene (cook pig meat well)

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13
Q

How can hepatitis B be prevented?

A

Vaccination

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14
Q

Why is there relatively little evolution of the hepatitis B virus compared to hepatitis C?

A

Hepatitis B is a DNA virus whereas hepatitis C is an RNA virus

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15
Q

Why does infection of the hepatitis B virus give rise to significantly different outcomes in different patients?

A

Hep B virus integrates into the human genome and then reappears as viral particles, which can result in different host response, hence the differing outcome seen

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16
Q

What promotes the longevity of the hepatitis B virus with an incubation period of 2-6 months?

A

Virus integrating into human genome and then reappearing as viral particles

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17
Q

The majority of adults clear the hepatitis B virus following the acute infection, but __ to __% of immunocompetent adults go on to develop chronic infection. This occurs in over 90% of those infected perinatally.

A

1 to 5%

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18
Q

What can chronic hepatitis B viral infection lead to?

A

Liver cirrhosis
Liver failure
Hepatocellular cancer

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19
Q

Some patients are carriers of hepatitis B. What does this mean?

A

The virus infects the liver cells but does not damage them so the liver function is normal
There is no immune response at all to the virus so there is a lot of virus around
Hence, cancer risk ++ remains

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20
Q

How might some people develop as carriers of hepatitis B?

A

Vertical transmission (mother to child), where people contract the virus either in utero or at delivery

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21
Q

How to diagnose chronic hepatitis B?

A

Surface antigen test (sAg) positive
DNA positive
Ongoing liver damage
Abnormal LFTs

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22
Q

When infected by Hepatitis B virus in adult life, __% of people will clear the virus normally. __% will fail to clear the virus and develop ______ hepatitis. ___% will develop ______ liver failure (reason in clarifier) which only treatment is liver transplant.

Acute clearance of the virus is so effective it kills all hepatocytes

A

95, 5, chronic, 0.1, fulminant

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23
Q

What are the risk factors of hepatitis B infection in adults?

A

Sexual transmission
IV drug abuse
Blood transfusion
‘Soft’ blood contact
Professional exposure

Soft blood contact = helping a bleeding stranger who is a hep B carrier

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24
Q

How long is the incubation period for hepatitis B?

A

Up to 6 weeks

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25
Q

After the incubation period, how long would the ‘flu-like’ symptoms of hepatitis B last?

A

1-2 weeks

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26
Q

How long does it take for jaundice or other symptoms to resolve after presenting flu-like symptoms from hepatitis B infection?

A

2-4 weeks

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27
Q

There is no way of knowing, during the acute illness, who will go on to develop chronic hepatitis B. Disease is defined as chronic at __ months. Patients with chronic hepatitis are at risk of developing ______ and _______-_______ ________.

A

6, cirrhosis, hepato-cellular carcinoma

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28
Q

What are the clinical features of acute hepatitis B?

A

Lethargy
Jaundice & dark urine
Liver pain/discomfort

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29
Q

What are the clinical features of chronic liver disease where cirrhosis has developed?

A

Skin thinning
Weight loss
Variceal bleeding (due to portal hypertension)
Can be totally asymptomatic

Varices are enlarged veins often on the lining of the oesophagus

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30
Q

What does liver function test measure?

A

Alanine transaminase (ALT)
Alkaline phosphatase (Alk Phos)
Bilirubin
Albumin
Prothrombin Time (PT)

31
Q

What results from LFTs would confirm the diagnosis of hepatitis B?

A

Increase in ALT
Increase in Alk Phos
Increase in Bilirubin

32
Q

What results from LFTs would indicate the severity of the liver disease? (What are indicators/features of liver injury?)

A

Decrease in albumin
Increase in prothrombin time

33
Q

What is HepBsAg (surface antigen of hepatitis B) a marker of?

A

Marker of viral presence present in acute and chronic disease and carrier state

34
Q

What is HepBeAg (e antigen of hepatitis B) a marker of?

A

Marker of degree of viral load in chronic disease and carrier state

35
Q

What test is used to screen hepatitis B?

A

HepBsAg (presence indicates hep B; absence to 99% indicates not hepatitis B)

36
Q

What is HepB DNA, which measures nucleic acid, a marker of?

A

Marker of degree of viral replication

37
Q

What is HepBsAb (surface antibody of hepatitis B virus) marker of?

A

Marker of immunity

38
Q

What are HepBeAb (e antibody of hep B virus) and HepBcAb (core antibody) markers of?

A

Markers of low risk in chronic hepatitis patients

39
Q

What is the most common reason for someone to present HepBsAb (surface antibody) positive?

A

Vaccinated

40
Q

If someone is HepBsAb positive, do they have hepatitis B?

A

No, because surface antibody positive indicates immunity to hepatitis B (can be vaccination or resolution of disease) and the virus has been cleared

41
Q

You either have HepBeAg positive or HepBeAb positive. If you are HepBeAg positive you usually have high _______ states. HepBeAb positive indicates a _______ level of viral infection but can give more in the way of chronic injury.

A

Replication, lower

42
Q

HepBcAb is usually tested alongside HepBsAg. If HepBsAg is negative but HepBcAb is positive, what does it indicate?

A

It indicates that the person is infected with a mutated hepatitis B (surface antigen is mutant)

43
Q

All patients with acute HepB will be ____ and _____ positive. They will then develop ______ and _____, at which point the disease has resolved. They are now _______.

A

sAg, eAg. sAb, eAb. Immune.

44
Q

After 6 months, when patients are defined as having chronic hepatitis they will remain sAg ___ and sAb ____ with one important exception of cAb +ve

A

positive, negative

45
Q

Screen patients suspected to have hepatitis B by measuring ____ and _____. If negative, they do not have hepatitis B. If positive, do full markers to assess risk status.

A

sAg, cAb

46
Q

Apart from adult infection, what is another type of hepatitis B infection?

A

Perinatal infection

47
Q

What does perinatal infection mean?

A

These people are infected before birth, at birth or shortly afterwards

48
Q

How many percent of children born by vaginal delivery will be infected and become chronic carriers?

A

50%

49
Q

Why won’t the children who were delivered through the vagina and then became chronic carriers develop liver disease?

A

They have no immune response to the virus

50
Q

The perinatally infected children will be very ______ and might be at risk of ______ _______.

A

Infectious, liver cancer

51
Q

The aim of therapy is to clear the hepatitis B virus in patients with chronic hepatitis thereby reducing the risk of ________ and _________ ________.

A

Cirrhosis, hepatocellular cancer

52
Q

What are examples of drugs included in antiviral therapy?

A

Interferon
Lamivudine
Adefovir

53
Q

What drug is used in immuno-stimulatory therapy?

A

Interferon

54
Q

What is the limitation of hepatitis B therapy?

A

Therapy can only control hep B virus, which permits and cannot be cleared/eliminated due to viral resistance

55
Q

Transplantation is effective but it has a high __________ risk in people with chronic hepatitis B because the virus is present to the time of the transplant.

A

Reinfection

56
Q

The best way of preventing hepatitis B is ____________

A

Vaccination

57
Q

What is hepatitis C?

A

It is an RNA virus that does not integrate into the human genome. Its infection gives rise to a single clinical pattern which is chronic disease.

58
Q

_________ host response does not occur in hepatitis C, so we don’t see a form of liver failure. Under-response is seen rather than anything else.

A

Excessive

59
Q

What is the normal host response to hepatitis C infection?

A

Viral clearance with clinical resolution occurs in less than 20% of infected individuals

60
Q

What does inadequate host response to hepatitis C virus lead to?

A

Chronic hepatitis with people being viraemic

61
Q

What are the 3 risk groups of hepatitis C infection?

A

1) IV drug abusers
2) Receivers of blood products
3) ? (People who have never been IV drug abusers and have never received both products)

62
Q

What do most people with hepatitis C present with?

A

Abnormal liver function tests
Clinical features of liver disease seen in hep B not typically present

63
Q

When are hepatitis C usually found?

A

Screening of IV drug abusers as part of their detox programme
Blood donors screening for viral risk factors
Screening of recipients of blood products for studies

64
Q

What types of investigations are carried out to diagnose hepatitis C?

A

ALT 50-100
ELISA
PCR
Biopsy (allows us to see the degree of liver injury)

65
Q

How to prevent hepatitis C?

A

Risk modulation (no vaccine available)

66
Q

What was the original treatment of hepatitis C?

A

Pegylated-interferon 180mg weekly + Ribavirin (results: 30-50% viral clearance rate)

67
Q

What is the novel treatment of hepatitis C?

A

Protease and polymerase inhibitors (results: 90% control and clearance of the virus)

68
Q

What type of therapy is given to avoid the development of viral resistance?

A

Combination therapy

69
Q

What are the 3 pros of hepatitis C treatment?

A

Potential cure
Reduced progression to cirrhosis even if virus not cleared
Reduced risk of hepatocellular cancer even if virus not cleared

70
Q

What are the cons (largely historical) of hepatitis C treatment?

A

Sustained response rate less than 50% until recently
Length and nature of old treatment (makes it not conducive to compliance)
Side effects of old treatment
Costs (+++ in case of new generation therapies)

71
Q

If encountering a patient with chronic liver disease who starts bleeding during dental surgery, what can be done?

A

Apply pressure on the bleeding site

72
Q

How do we as dental professionals prevent ourselves from hepatitis A and B infection by an infected patient?

A

Vaccination

73
Q

In terms of hepatitis C and E which cannot be prevented by vaccination, what can we do if we get in contact?

A

Get onto therapy at a time that therapy will be highly effective

Human Diseases (24 decks)

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