Hepatitis

Question 1

What is viral hepatitis?

Answer 1

Inflammation of liver as a result of viral replication within hepatocytes

Question 2

Acute?
Chronic?

Answer 2

<6 months onset
>6 months onset

Question 3

Pathology of hepatitis?

Answer 3

Virus invades hepatocytes, infects them and present abnormal proteins on CSM via MHC1
CD8+ cells recognise the, and undergo cytotoxic killing = INFLAMMATION + liver damage

Question 4

Sx of viral hepatitis?

Answer 4

Fever, malaise, nausea, hepatomegaly (liver inflammation), pain, jaundice

Question 5

Dx of viral hepatitis?

Answer 5

high transaminases (v High ALT and High AST)
High Bilirubin
Biopsy = interface necrosis

Atypical lymphocytes

Question 6

When there is damage to the hepatocytes and bile duct what happens to cause Sx?

Answer 6

Hepatocyte damage = transaminases leak into blood = High ALT (alanine aminotransferase) + AST (aspartate aminotransferase)

Bile duct = bilirubin leaks out = dark urine

Question 7

Hep A
notifiable disease?
Immunity after infection?
Acute or chronic?
RNA or DNA?

Answer 7

Notifiable disease to public health england

100% immunity after infection

acute (no chronic)

mild, ssRNA (single stranded)

Question 8

Hep A
Transmission?
Associated with?
RF?

Answer 8

Facal-oral spread, shellfish, picoRNAvirus

Associated with travel Hx, endemic to Africa

overcrowding, poor sanitation, shellfish, travel

Question 9

Hep A
Pathology?

Answer 9

2 week incubation
replicates in liver
excreted in bile
self limiting within 6 weeks

Question 10

Hep A
Sx and phases?

Answer 10

Proximal phase (1-2 weeks) = malaise, fever, N+V

Icteric phase (3 months) = jaundice, dark urine + pale stools, hepatosplenomegaly

Question 11

Hep A
Dx?

Answer 11

Bloods = high ESR + Leukopenia

LFT = High bilirubin in icteric

Serology HAV:
HAV IgM antibody = ACTIVE
HAV IgG antibody = recovery or vaccination

Question 12

Tx of Hep A
Rare comp?

Answer 12

Self limiting - treat Sx = painkillers, anti emetics

supportive = travellers vaccine available

rare comp = fulminant (rapid) liver failure

Question 13

Hep E
Acute or chronic?
RNA or DNA?
Common where?
transmission?

Answer 13

acute (not chronic)
ssRNA
Common in Indo-china
fecal-oral spread; water, dogs, undercooked pork, calcivirus

Question 14

Hep E
Self limiting?
What 2 diseases can it cause?

Answer 14

usually self limiting acute hepatitis
Can cause CHRONIC disease in immunosuppressed
Can cause FULMINANT LIVER FAILURE
-normal mortality = 1-2%
-pregnant ladies = 10-20%

Question 15

Hep E
Dx?

Answer 15

HEV Serology
HEV IgM = active (acute) infection
HEV IgG = Recovery

Question 16

Hep E
Tx?

Answer 16

Supportive - self limiting (vaccine only in china)
No vaccine but 1^ = 100% immunity

Question 17

Hep C
Acute or chronic?
RNA or DNA?
Transmission?

Answer 17

Acute AND chronic
ssRNA
Blood borne (childbirth + IV drug user!!!), Flavivirus
Limited vertical + sexual transmission

Question 18

Hep C
Sx?

Answer 18

Often acutely aSx
Few Px with influenza like Sx
Present later with chronic liver signs + hepatosplenomegaly

Question 19

Hep C
Dx?

Answer 19

Serology:

HCV RNA (Viral RNA in blood);
Low = recovery
same = chronic

HCV Ab;
Present within 4-6 weeks of infection

Question 20

Hep C
Tx?

Answer 20

Direct acting anti virals (DAA)
Oral rivabarin + NS5A-I / NS5B-I (Needed for viral replication)

Question 21

Hep B
acute or chronic?
RNA or DNA?
how is it acquired?

Answer 21

Acute + chronic (20%)
dsDNA
Blood borne
HepaDNA virus

Question 22

Hep B
Transmission?
Found in?
RF?

Answer 22

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

Question 23

Sx of Hep B?

Answer 23

similar to hep A - incubation for 1-6 months

Prodomal - 1-2 weeks
Deepening jaundice, dark urine + pale stools, hepatosplenomegaly

+urticaria + arthralgia

Question 24

Dx of Hep B?

Answer 24

HBsAg = surface Ag = 1-6 months of infection

HBcAg (core antigen) = marks viral replication = acute infection

HBeAg (‘e’ 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

Question 25

when is HBeAg raised?
What does HBeAB imply?

Answer 25

when Px ineffectively high (associated with high viral replication)
Implies acute stage of infection
HBeAB Implies low infectivity as HBeAg countered with Ab’s

Question 26

Hep B
Tx?

Answer 26

SC pegylated inferon alpha 2A

Question 27

Hep D
Acute or chronic?
RNA or DNA?
transmission?
What is it dependent on and why?

Answer 27

Acute and chronic
ssRNA
Blood borne
DEPENDENT on hep B virus
Incomplete - requires HBV for assembly

Question 28

Hep D
How does it manifest?
Tx, RF, Dx?

Answer 28

Manifests ars co infection (infect at same time - Hep B+D) - IgM HDV + HBV

Tx, RF, Dx = all same + dep on HBV