Hepatitis Flashcards
What type of viruses are hepatotropic viruses?
All RNA viruses except Hepatitis B, which is a DNA virus
Which types of viral hepatitis are transmitted via the faecal-oral route?
Hepatitis A and E
Which type of viral hepatitis are blood-borne?
Hepatitis B, C and D
What is the most common type of hepatitis in the UK?
Hepatitis A
How is hepatitis A transmitted and what risk factor is it associated with?
Faecal-oral route
Poor personal hygiene (and shellfish)
Where is hepatitis A endemic? What is the incubation period? In whom should it be suspected?
Africa, South America and India
Incubation period of 2-4 weeks
So suspect in travellers who presented with symptoms 2-4 weeks after returning home
Is hepatitis A acute or chronic?
Acute
Symptoms resolve and don’t progress to chronic disease
Name and describe the 2 phases of hepatitis A presentation
Prodromal phase; Acute, Flu-like Sx, GI symptoms (abdo pain, nausea, vomiting)
Icteric phase; Jaundice, Pruritis, Dark Urine, Hepatosplenomegaly
Name 2 investigations used to diagnose Hepatitis A
LFTs - Raised ALT/AST
IgM and IgG anti-hepatitis A
(IgM detectible after 5 days, IgG after 10 days)
Who should be vaccinated for Hepatitis A? (5)
Travelling to high risk area
Chronic liver disease
Haemophillia
Men who have sex with men
IV drug users
What is the most common hepatitis worldwide?
Hepatitis B
Name 3 ways Hepatitis B can be transmitted
Parenteral (IV drugs, needle-stick injury)
Sexual
Vertical (mother to child)
What happens in 95% of Hep B cases?
Adults experience symptoms with jaundice lasting 1-3 months, followed by spontaneous resolution
What happens in 5% of hepatitis B patients?
Develop chronic hepatitis.
Can lead to Cirrhosis and increased risk of hepatocellular carcinoma
How is hepatitis B diagnosed?
Hepatitis Serology
What 3 biochemical markers are used in Hepatitis B serology?
HbsAg (surface antigen) (Indicates Acute infection 1-6 months)
Anti-HBs (Indicates Immunity - exposure or immunisation)
Anti-HBc (Indicates infection - current or previous)
What serology results would be seen in a patient with previous immunisation to Hepatitis B?
Anti-HBs Positive
Anti-HBc + HbsAg negative
What serology results would be seen in a patient who previously had hepatitis B >6 months ago and is NOT a carrier?
Positive anti-HBc
Negative HBsAg
What serology results would be seen in a patient who previously had hepatitis B ago and IS a carrier?
Anti-HBc positive
HBs-Ag positive
What biochemical marker can be used to quantify viral load in a patient with hepatitis B? What are high levels associated with?
HBV DNA
High levels are associated with a greater risk of progression to cirrhosis and hepatocellular carcinoma.
What medications can be offered to manage hepatitis B? (2)
Pegylated interferon alpha
Entecavir or Tenofovir (suppress viral replication)
How does Hepatitis C tend to progress and manifest?
Progresses very slowly and manifests as chronic hepatitis (rather than acute)
How does hepatitis C tend to present?
Most infections are asymptomatic.
But hepatic inflammation is present (silent chronic infection) and can lead to progressive hepatic fibrosis (cirrhosis)
How is hepatitis C investigated? (3)
Anti-HCV RNA (PCR) - Confirms current infection
Anti-HCV antibodies (enzyme immunoassay) - Confirms exposure
LFTs and Biopsy - Determines extent of fibrosis
What biochemical test results would suggest active Hepatitis C infection?
Positive Anti-HCV antibodies + Anti-HCV RNA
Give 4 potential complications of chronic hepatitis C
Cirrhosis
Hepatocellular Carcinoma
Cryoglobulinemia (type II)
Sjogren’s syndrome (eye problems)
How is hepatitis C managed?
Goal is to prevent chronic disease
Combination therapy - Sofosuvir + Peginterferon alfa + Ribavirin
Is there a vaccine for hepatitis C?
No
What does Hepatitis D require for infection?
Concurrent Hepatitis B infection
What vaccine helps prevent against Hepatitis D? And why?
Hepatitis B vaccine
As Hep D requires Hep B (HBsAg) to replicate
Babies born to mothers with chronic hepatitis B or who have acute hepatitis B during pregnancy should receive what?
Hep B vaccination + Hep B immunoglobulin
Can Hepatitis B be transmitted via breastfeeding?
No. It is safe to breastfeed wit hepatitis B.
