Hepatitis

Question 1

Aetiology/risk factors/epidemiology/specific features of viral hepatitis A

Answer 1

RNA virus (single-stranded)
Trasmission via faecal-oral route (hence contaminated food)
3-6 week incubation

RF: Travelling (Africa/Asia) | Contaminated food/water

Acute presentation

Question 2

Aetiology/risk factors/epidemiology/specific features of viral hepatitis B

Answer 2

DNA virus
Transmission: parenteral, sexual, vertical
Incubation 4-12 weeks

RF: Bodily fluids | contaminated blood e.g. IVDU | healthworkers

Most common worldwide

Acute presentation

Question 3

Aetiology/risk factors/epidemiology/specific features of viral hepatitis C

Answer 3

RNA virus
Transmission is mainly parenteral
Incubation: 2 wks - 6 months

RF: contaminated blood | IVDU

Most common in Europe

Usually asymptomatic and chronic (60-80%)

Question 4

Aetiology/risk factors/epidemiology/specific features of viral hepatitis D

Answer 4

RNA virus
Transmission: Parenteral and sexual

RF: bodily fluids, contaminated blood

ONLY co-infects with Hep B

Question 5

Aetiology/risk factors/epidemiology/specific features of viral hepatitis E

Answer 5

RNA virus
Transmission: Faecal-oral
Incubation: 3-6 weeks

RF: contaminated food/water

High mortality with pregnant women

Question 6

Symptoms of Viral Hepatitis

Answer 6

Generic triad:

1. Fever
2. Jaundice
3. Raised AST/ALT

Reduced appetite -> anorexia
Nausea and vomiting
Abdominal pain
Jaundice and Pruritus
Dark urine + pale stools
Skin rash
Joint pain

80% of hep C is asymptomatic

Question 7

Signs of Viral Hepatitis on exam

Answer 7

Pyrexia
Jaundice
Tender hepatomegaly
Splenomegaly (20%)

Absence of CLD stigmata, may see Spider naevi

Question 8

Investigations for Viral Hepatitis

Answer 8

Urinalysis: +ve for bilirubin and raised urobilinogen

Viral Serology: positive
LFTs: ALT/AST raised. bilirubin raised, Alk phos raised, albumin reduced
Clotting: ?liver function
FBC: Platelets raised
ESR/CRP: raised
Nucleic acid amplification test: indicates viral load

Fibroscan - measure of fibrosis
biopsy + microscopy: Ground-glass hepatocytes can be seen on light microscopy as hepatocytes with flat, hazy and uniformly dull appearing cytoplasms

Question 9

How is viral serology for Viral hepatitis interpreted (hep B)

Answer 9

Early acute infection:
HbsAg +ve

Acute infection:
Anti-HBc IgM +ve
HbsAg +ve

Chronic infection:
Anti-Hbc IgG +ve
HbsAg +ve

Resolved acute HBC infection:
Anti-Hbc IgG +ve
Anti-HBs +ve

Prior vaccination
Anti-HBs +ve

Question 10

Management of Viral Hepatitis

Answer 10

A/E - supportive care (bed rest + antipyretics + antiemetics) | cholestyramine for severe pruritus

B/D
Supportive care (acute)
Antivirals (Oral antivirals e.g. entecavir, tenofovir) + peginterferon (chronic)
- HBsAg +ve
- Compensated liver disease
- Pregnant
- young age

C
Curative treatment: Sofosbuvir + ribavirin

Severe: liver transplant

Immunisation for those travelling to endemic areas + high-risk individuals

Question 11

Complications of Viral Hepatitis

Answer 11

Liver failure
Cholestatic hepatitis + prolonged jaundice
Post-hepatic syndrome: continued malaise for weeks to months
Chronic liver disease
Scaring → cirrhosis → HCC

Question 12

Prognosis for Viral Hepatitis

Answer 12

A/E: nearly all resolve by 6 months, may have the occasional relapse, no chronic sequelae

High mortality in failure and chronic hep C
> 90% of people with HCV can be CURED

Question 13

Management for HIV + and Hep +

Answer 13

a combination of Tenofovir and Emtricitabine (known as Truvada) is used as it is effective against both