Hepatitis

Question 1

Hepatitis

Answer 1

Inflammation of the liver, with resultant liver dysfunction.
* Viral subtypes: A, B, C, D, E, G
* Autoimmune
* Alcoholic

• Pre-icteric phase: Fatigue, malaise, anorexia, N/V, HA, aversion to smoking and drinking
• Icteric phase: Weight loss, jaundice, pruritus, RUQ pain, clay colored stool, dark urine, low grade fever may be present, hepatosplenomegaly may be present.

Lab/diagnostics:
WBC-low to normal
Urinalysis- proteinuria, bilirubinemia
Elevated AST and ALT (500-2000)
LDH, bilirubin, alkaline phosphatase and PT normal or slightly elevated.

Management: Generally supportive care, rest during active phase.
Increase fluids from 3L-4L/day
Avoid alcohol or other drugs processed by the liver.
No/low protein diet due to potential increase of ammonia.
Oxazeam if sedation is necessary
Vit K for prolonged PT >15 sec
Lactulose 30mL orally or rectally for elevated ammonioa/hepatic encephalopathy.
Antiviral drugs

Question 2

Hepatitis A

Answer 2

An enteral virus transmitted via the fecal-oral route and rarely parenterally.
Common source outbreaks result from contaminated water and food, as well as intimate sexual contact.
Blood and stool are infectious during the 2-6 week incubation period.
The mortality is very low and fulimant hepatitis is rare.

Serology test:
Anti-HAV tells us we are dealing with Hep
A.
IgM=immediate
IgG=gone

Active Hep A: Anti-HAV IgM, peak during first week of clinical illness and disappear in 3-6 months.
Recovered Hep A: Anti-HAV, IgG implies previous exposure and confers immunity.
Presence of IgG alone is not diagnostic of acute HAV infection, it indicates previous exposure, noninfectivity, and immunity to recurring HAV infection

Question 3

Hepatits B

Answer 3

A blood borne DNA virus present in serum, saliva, semen and vaginal secretions.
“B is all Body fluids.”
Transmitted via blood and blood products, sexual activity and mother-fetus.

Serology:
HBsAG: The B surface antigen, tells us we are dealing with Hep B. Will remain positive in aysymptomatic carriers and chronic Hep B.
Anti-HBc: Will appear in all 3 serologies.
HBeAg: Signifies increase viral load
Anti-HBe: Often appears after HBeAG dissapears. Signifies diminished viral load.
Anti-HBs: Indicates recovery and immunity from HBV infection or successful vaccination.
IgM=Immediate
IgG=Gone

• Active Hep B: HBsAG, Anti-HBc, HBeAg, IgM
• Chronic Hep B: HBsAG, Anti-HBc, Anti-HBe, IgM, IgG
• Recovered Hep B: Anti-HBc, Anti-HBs

Question 4

Hepatitis C

Answer 4

A blood borne RNA virus in which the source of infection is often uncertain.
Traditionally associated with blood transfusion.
50% of cases are related to IV drug use.

Serology:
Acute Hep C: Anti-HCV, HCV RNA
Chronic Hep C: Anti-HCV, HCV RNA

Since serologies are identical for both diseases, use PCR to differentiate exposure from current viremia, yes/no answer.