Hepatitis Flashcards
What is viral hepatitis?
Inflammation of liver as a result of viral replication within hepatocytes
Acute?
Chronic?
<6 months onset
>6 months onset
Pathology of hepatitis?
Virus invades hepatocytes, infects them and present abnormal proteins on CSM via MHC1
CD8+ cells recognise the, and undergo cytotoxic killing = INFLAMMATION + liver damage
Sx of viral hepatitis?
Fever, malaise, nausea, hepatomegaly (liver inflammation), pain, jaundice
Dx of viral hepatitis?
high transaminases (v High ALT and High AST)
High Bilirubin
Biopsy = interface necrosis
Atypical lymphocytes
When there is damage to the hepatocytes and bile duct what happens to cause Sx?
Hepatocyte damage = transaminases leak into blood = High ALT (alanine aminotransferase) + AST (aspartate aminotransferase)
Bile duct = bilirubin leaks out = dark urine
Hep A
notifiable disease?
Immunity after infection?
Acute or chronic?
RNA or DNA?
Notifiable disease to public health england
100% immunity after infection
acute (no chronic)
mild, ssRNA (single stranded)
Hep A
Transmission?
Associated with?
RF?
Facal-oral spread, shellfish, picoRNAvirus
Associated with travel Hx, endemic to Africa
overcrowding, poor sanitation, shellfish, travel
Hep A
Pathology?
2 week incubation
replicates in liver
excreted in bile
self limiting within 6 weeks
Hep A
Sx and phases?
Proximal phase (1-2 weeks) = malaise, fever, N+V
Icteric phase (3 months) = jaundice, dark urine + pale stools, hepatosplenomegaly
Hep A
Dx?
Bloods = high ESR + Leukopenia
LFT = High bilirubin in icteric
Serology HAV:
HAV IgM antibody = ACTIVE
HAV IgG antibody = recovery or vaccination
Tx of Hep A
Rare comp?
Self limiting - treat Sx = painkillers, anti emetics
supportive = travellers vaccine available
rare comp = fulminant (rapid) liver failure
Hep E
Acute or chronic?
RNA or DNA?
Common where?
transmission?
acute (not chronic)
ssRNA
Common in Indo-china
fecal-oral spread; water, dogs, undercooked pork, calcivirus
Hep E
Self limiting?
What 2 diseases can it cause?
usually self limiting acute hepatitis
Can cause CHRONIC disease in immunosuppressed
Can cause FULMINANT LIVER FAILURE
-normal mortality = 1-2%
-pregnant ladies = 10-20%
Hep E
Dx?
HEV Serology
HEV IgM = active (acute) infection
HEV IgG = Recovery
Hep E
Tx?
Supportive - self limiting (vaccine only in china)
No vaccine but 1^ = 100% immunity
Hep C
Acute or chronic?
RNA or DNA?
Transmission?
Acute AND chronic
ssRNA
Blood borne (childbirth + IV drug user!!!), Flavivirus
Limited vertical + sexual transmission
Hep C
Sx?
Often acutely aSx
Few Px with influenza like Sx
Present later with chronic liver signs + hepatosplenomegaly
Hep C
Dx?
Serology:
HCV RNA (Viral RNA in blood);
Low = recovery
same = chronic
HCV Ab;
Present within 4-6 weeks of infection
Hep C
Tx?
Direct acting anti virals (DAA)
Oral rivabarin + NS5A-I / NS5B-I (Needed for viral replication)
Hep B
acute or chronic?
RNA or DNA?
how is it acquired?
Acute + chronic (20%)
dsDNA
Blood borne
HepaDNA virus
Hep B
Transmission?
Found in?
RF?
Needles (needle stick injury, IV drug user)
Sexual
Vertical (mother to child)
Horizontal (between children)
HBV found in semen + saliva
IV Drug use, MSM, dialysis Px, healthcare workers
Sx of Hep B?
similar to hep A - incubation for 1-6 months
Prodomal - 1-2 weeks
Deepening jaundice, dark urine + pale stools, hepatosplenomegaly
+urticaria + arthralgia
Dx of Hep B?
HBsAg = surface Ag = 1-6 months of infection
HBcAg (core antigen) = marks viral replication = acute infection
HBeAg (āeā antigen secreted by infected cells) - high viral infection = infectious
HBcIgM = acute infection
HBcIgG = chronic/infection/carrier
HBsAB = present after 6 moths of infection (denotes immunity - natural or imm)
HBV DNA = direct count of viral load
