Hepatitis Flashcards
What is hepatitis
inflammation of the liver
Difference between acute and chronic
acute- less than 6 months of onset
chronic- more than 6 months
presentation of acute hepatitis
general malaise
myalgia
gi upset
abdo pain
with or without cholestatic jaundice
causes of acute hepatitis
Infective
Viral = Hep A , Hep E , EBV
Non - viral
- leptospirosis
Chronic hepatitis presents as
- +/- signs of chronic liver disease:
- Clubbing
- Palmar erythema
- Dupuytren’s contracture (one or more fingers bending into palm of hand)
- Spider naevi
- LFTs e.g. AST and ALT can be normal
- Compensated liver function can be maintained with cirrhosis
Define Hep A
The Hepatitis A virus is a non-enveloped single-stranded RNA virus.
How does Hep a spread
- faeco - oral route
- uncommon in uk
- common in africa and south america
Is hep a acute or chronic
acute only
What do adults experience with Hep A
- ## mild self - limiting manifesting with flu like symptoms
risk factors of Hep a
travel
sexually risky
haematological disorders
iv drug user
Pathophysiology of hep a
- picornavirus
- Replicates in the liver, is excreted in bile and then excreted in the faeces for about 2 weeks before the onset of clinical illness and for up to 7 days after
when is hep a most infectious
just before onset of jaundice
is there immunity after infection with hep a
yes 100%
describe the phases of Hep a
- Incubation:**Hepatitis A has a relatively long incubation period that may last from 2 - 6 weeks (mean 28-30 days).
- Prodromal: Early part of the disease, characterised by fever, joint pain and rash. Flu-like symptoms may be present
- Icteric:**In addition to jaundice, the icteric phase is characterised by anorexia, abdominal pain and change in bowel habit.
- Convalescent:**Recovery phase as the body returns to normal and symptoms subside. Symptoms like malaise may last months.
key presentation of hep a
mild illness with flu like symptoms and gi upset
hep a signs
- Jaundice
- RUQ tenderness
- Hepatomegaly (85%)
- Splenomegaly (15%)
- Lymphadenopathy (5%)
symptoms in hep a
- Abdominal discomfort
- Nausea
- Arthralgia
- Anorexia
- Diarrhoea
- Flu-like illness
- Pruritus
- Dark urine, pale stool
- Rash
1st line investigation in hep a
- serology , HAV- igM positive soon after symptoms
Management of Hep a
- supportive
- oral hydration
- nausea- metoclopramide
Define Hep b
It is an enveloped DNA virus that belongs to the Hepadnaviridae family and can cause acute or chronic hepatitis:
HBV genotype
- It is a DNA virus that contains a nucleocapsid and outer envelope.
- Its small DNA genome is contained within the nucleocapsid.
Pathophysiology of HBV
- HBV enters hepatocytes
- viral particle removes its outer envelope and forms covalenty closed circular dna
- template for HBV protein
- NORMAL VIRAL REPLICATION PROCECC
How does acute HBV present
- Subclinical - no symptoms
-
Anicteric - non specific illness and no jaundice
- Malaise, anorexia, nausea, fever, right upper quadrant pain, vomiting, arthralgia, urticarial rash
- Icteric - presents same as anicteric, with jaundice
- Fulminant hepatitis failure - rare, presents with jaundice, confusion and coagulopathy
how does chronic hbv present
- Asymptomatic carrier state
- Chronic hepatitis - wide range of symptoms depending on the severity of hepatitis and underlying liver impairment. May mimic acute hepatitis B symptoms.
- Cirrhosis - hepatomegaly, splenomegaly, portal hypertension
- Decompensated cirrhosis - ascites, encephalopathy, jaundice, coagulopathy and GI bleeding.
- Extra-hepatic manifestations - polyarteritis nodosa (PAN), glomerulonephritis, mixed cryoglobulinaemia, papular acrodermatitis
1st line investigation for HBV
Serology - antigens, antibodies and HBV DNA levels
Management of acute infection
- supportive
-oral rehydration - education
HBV chronic management
- avoid alcohol
- antiviral therapy
- nucleotide analogies
- pegylated interferon
Define Hep c
Hepatitis C virus (HCV) is an infectious, hepatotropic virus belonging to the Flavivirus family. Infection may be acute and chronic.
how is hep c spread
- blood transfusions
- iv drug userss
- Mother-to-child
- Sexual (MSM)
- Tattoos, piercings, etc
risk factors for hep c
- Male
- Older
- Use of alcohol
- HIV
- HBV
what type of virus IS HCV
RNA FLAVIVIRUS
Acute HBC presentation
- Most patients are asymptomatic
- 10% have mild influenza-like illness with jaundice and a rise in serum aminotransferases (ALT and AST)
chronic infection with hep c presents as
Signs of cirrhosis, liver failure and hepatocellular carcinoma
1st line investigation for hep c
Serology - HCV antibody, HCV RNA (indicates current active infection, decreasing levels indicate recovery)
management of hep c
- Stop alcohol consumption
- Acute HCV
- If viral load is falling then no treatment may be required
- combo of protease inhibitors with or without ribavirin is the treatment of choice
- Monitor patient to confirm viral clearance
- oral rivabarin + NS5A inhibitors + NS5B inhibitors
complications with hep c
- Glomerulonephritis
- Cryoglobulinaemia - abnormal proteins in blood
- Thyroiditis
- Autoimmune hepatitis
- Polyarteritis nodosa (PAN) - systemic necrotising inflammation of blood vessels
- Polymyositis - inflammatory disease that causes muscle weakness affecting both sides of the body
- Porphyria cutanea tarda - porphyrin build up in skin
Define Hep D
Hepatitis D is caused by the defective hepatitis D RNA virus (delta virus) that needs hepatitis B for replication.
Link between Hep B and Hep d
Hepatitis D virus (HDV) is a unique RNA virus that can only establish infection in the human liver with the help of Hepatitis Bvirus (HBV). HDV has an outer envelope that contains the HBV surface antigen (HBsAg). Therefore, it can only establish infection in HBsAg-positive patients.
There are two key terms to recognise with HDV infection:….?
- Coinfection: acute hepatitis D infection acquired at the same time of hepatitis B infection. Typically indistinguishable from acute hepatitis B alone.
- Superinfection: development of acute hepatitis D infection in a patient with pre-existing hepatitis B infection. Usually more severe illness and higher risk of chronic infection (>90% of cases).
how is hdv spread
- sex
- household contact
- infected with hep b
Hep d presents as
- nausea
- Vomiting
- Anorexia
- Malaise
- Right upper quadrant pain
- Fever
- Jaundice
- Cirrhosis
Hep d investigations ?
Serology - hepatitis D and B serological markers and viral levels are important to distinguish between both acute and chronic infection, as well as coinfection and superinfection.
WHAT IS THE MANAGEMENT FOR HEPATITIS
SUPPORTIVE
Define Hep e
Hepatitis E is a small, non-enveloped RNA virus that can lead to acute and chronic hepatitis.
most common cause of acute viral hep
Hep e
how is hep e spread
faeco- oral
what hepatitis is spread through the faeco oral route
a e
what are the genotypes for hep e
HEV1
HEV2
HEV2
HEV4
HOW IS hev 1-4 spread
HEV 1 AND 2= FAECO ORAL
HEV 3 AND 4 = zoonotic infections
Acute hepatitis e manifestation
- Jaundice
- Fatigue
- Nausea & vomiting
- Abdominal pain
- Pruritus
- Flu-like illness
- Hepatomegaly
chronic hep e presentation
- ommonly asymptomatic
- Fatigue
- Rarely jaundiced
investigations for hep e
- Serology - IgM shows active infection; IgG shows recovery
- Presence of HEV RNA - detected using PCR. Due to viraemic window, this may be negative but a negative result doesn’t exclude HEV.
- LFTs - elevated AST and ALT
Management for hep e
- supportive management
