Hepatitis Flashcards
What are 5 non-viral causes of hepatitis?
- Alcoholic hepatitis
- Non-alcoholic steatohepatitis
- Autoimmune hepatitis
- Drug induced hepatitis
- Bacterial hepatitis
Give 8 general symptoms of hepatitis:
- Abdominal pain
- Jaundice
- Flu-like symptoms
- Nausea and vomiting
- Pruritis
- Fatigue
- Muscle and joint aches
- Light stool and dark urine
What is acute hepatitis?
Inflammation of the liver leading to cell injury and necrosis lasting<6 months
Describe the LFT results that would constitute as a ‘hepatitis picture’: (4)
1) very high alanine transaminase
2) very high aspartate transaminase
3) high alkaline phosphate (proportionally less of a rise in this)
4) raised bilirubin
What is the most common viral hepatitis worldwide?
Hep A
Is hepatitis A a DNA or RNA virus?
RNA
Is hepatitis B a DNA or RNA virus?
DNA
Are hep C,D and E RNA viruses or DNA?
RNA
How is Hep A transmitted?
Faecal oral route (Usually contaminated water)
What is a common gall bladder manifestation of hepatitis A?
Cholestasis (slow moving of bile flow through biliary system)
How long is the incubation period for Hep A?
2-6 weeks
What are the clinical features of Hep A?
- Fever
- Malaise
- Anorexia
- Nausea
- Arthralgia (joint pain)
Then Jaundice (rare in children), hepatosplenomegaly, and adenopathy
Mostly in children, they are asymptomatic
What are the test results expected in those with Hep A?
AST and ALT rise 22-40d after exposure (ALT may be >1000IU/L), returning to normal over 5-20wks.
*IgM rises from day 25 and means recent infection.
*IgG is detectable for life
How is hepatitis A diagnosed?
IgM antibody serology (raised)
What is the treatment for Hep A?
- Supportive
- Avoid alcohol
- Rarely, interferon alfa for fulminant hep
What vaccinations can you receive for Hep A?
Active immunisation with inactivated viral protein
1 IM dose gives immunity for 1yr (20yrs if further boost is given at 6-12 months)
What is the prognosis for Hep A?
- Typically, self-limited acute hepatitis
- May rarely lead to fulminant hepatic failure and subsequent death
Can relapse (rarely), but never becomes chronic
What is fulminant hepatitis?
liver failure with massive liver necrosis
Can hep A be sexually transmitted?
Yes
What are the complications of Hep A?
- Extra-hepatic complications are very rare, but include arthritis, myocarditis and renal failure.
- Acute fulminant liver failure (0.1-0.4%)
- Some patients may feel ill for months after the disease - Post hepatitis syndrome
How is hepatitis B transmitted?
1) blood (sharing needles, sharing razors, direct contact with open cuts)
2) bodily fluids (sexual intercourse)
3) vertical transmission
How long does it typically take to recover from hepatitis B?
1-3 months
What does it mean to be a hepatitis B carrier?
the viral DNA has integrated into the cell nucleus allowing cells to continue to produce viral proteins
What is the epidemiology of Hep B?
Extremely high transmission rate.
Deaths:1 million/yr.
Endemic in: Far East, Africa, Mediterranean
Name 5 antigens and antibodies used in the monitoring of hepatitis B:
1) surface antigen
2) E antigen
3) core antibodies
4) surface antibody
5) hepatitis B virus DNA
What do Hep B surface antibodies in the blood indicate?
vaccination, past or current infection
What is given in the Hep. B vaccination?
hepatitis B surface antigens
What is the pathology of Hep B?
- Incubation: 1-6 months
- Spread: Bodily fluid, blood products, IV drug abusers, sexual, direct contact
What are at risk of Hep B?
- IV drug users and their sexual partners/carers
- Health workers
- Haemophiliacs; Haemodialysis (and chronic renal failure)
- Homosexual men
- Sexually promiscuous
- Foster carers
- Close family members of a carrier or case
- Babies of HBsAg +ve mothers; adopted child from endemic area
What do Hep B core antibodies in the blood indicate?
past or current infection
Describe how Hep B core antibodies can help distinguish acute, chronic and past infections:
1) high IgM core antibodies implies active infection
2) high IgM titre is seen in acute cases and a lower titre in chronic cases
3) high IgG implies past infection
What can the levels of Hep B E antigen tell us?
the infectivity of the virus (high levels correlate with the virus actively dividing) and so when E antigen is high, the patient is highly infectious to others
What are the symptoms of Hep B?
Yellow colouring of the skin and the whites of the eyes (jaundice)
Dark urine
Pale colored stools
Pale coloured stools
Pain in the area of liver or abdominal Pain
Joint Pain
Fever
Itching all over the body
Nausea and vomiting
Loss of appetite
Extreme fatigue and weakness
What are the clinical features of Hep B?
- Resembles Hep A but arthralgia and urticaria are common
- May be asymptomatic, but may present as a viral prodrome and/or jaundice
- HBV and HCV may feature a mild acute phase or none at all
How long is HBsAg present for after exposure to Hep B?
1-6 months after exposure
HBsAg persisting for longer than 6 months defines carrier status and occurs in 5-10% of infections
Give 7 types of management for hepatitis B:
1) screen for any other viral infections such as HIV and the other Heps
2) refer to specialist management
3) avoid alcohol
4) inform the UK Health Security Agency
5) test for complications e.g. cirrhosis (fibroscanner) and ultrasound (hepatocellular carcinoma)
6) antiviral medication
7) liver transplantation
What are the complications for Hep B?
- Fulminant hepatic failure: requires antivirals or liver transplant in severe cases
- Hepatocellular Carcinoma
- Other: cholangiocarcinoma, cryoglobulinaemia, membranous nephropathy, polyarteritis nodosa
What is the prognosis for Hep B?
- <10%of infections in adults become chronic, while most vertically transmitted become chronic.
- Without treatment, 8-20% of those with ongoing immunoreactive chronic hepatitiscan develop cirrhosis within 5 year
- Those in the immune tolerant phase(with extremely high HBV-DNA levels) are at minimal risk for liver fibrosis as they do not have immune-mediated liver injury
How is hepatitis C transmitted? (2)
- Blood
- Body fluid
What are the risk factors for Hep C?
- Injection drug use
- Blood transfusion received before 1992
- Tattoos
- Intranasal cocaine use
What are the symptoms of Hep C?
Usually asymptomatic
Bleeding easily.
Bruising easily.
Fatigue.
Not wanting to eat.
Yellowing of the skin, called jaundice. This might show up more in white people. Also, yellowing of the whites of the eyes in white, Black and brown people.
Dark-colored urine.
Itchy skin.
Fluid buildup in the stomach area, called ascites.
Swelling in the legs.
Weight loss.
Confusion, drowsiness and slurred speech, called hepatic encephalopathy.
Spiderlike blood vessels on the skin, called spider angiomas.
Give two examples of direct antiviral drugs that can act to cure hepatitis C:
1) sofasbubir
2) declatasvir
What % of untreated cases of hepatitis C go on to become chronic hepatitis (with very high risk of cirrhosis and thus hepatocellular carcinoma)?
75%
Give two investigations used to diagnose hepatitis C:
1) hepatitis C antibody test
2) hepatitis C RNA testing (also used to calculate viral load and identify the genotype to guide antivirals)
What are the complications of Hep C?
- 85% of HCV develop silent chronic infection
- 25% of these get cirrhosis in 20 years
- around 4 percent get hepatocellular carcinoma
- Very rarely leads to acute liver failure
- Glomerulonephritis, lymphoma cryoglobulinaemia etc
What are the risk factors for progression of Hep C?
- Male
- Age
- Higher viral load
- Use of alcohol
- HIV
- HBV
Describe the transmission of hepatitis D:
It is only infectious to patients who also have a Hep B infection
Why is it that Hep D can only infect in patients with Hep B?
the Hep D virus attaches itself to the surface antigen of Hep B and cannot survive without it
What is used to treat hepatitis D?
pegylated interferon alpha
How is hepatitis E transmitted?
faecal oral route
Describe the nature and severity of hepatitis E infection:
typically only a mild illness which is cleared within a month with no treatment required
Give 3 other causes of viral hepatitis (other than the hepatides):
1) Epstein-barr virus (infectiou smononucleosis)
2) cytomegalovirus
3) acute HIV infection
Give two bacteria associated with causing bacterial hepatitis:
1) Coxiella burnetii
2) Leptospirosis
What % of autoimmune hepatitis cases are seen in females?
90%
What LFT marker is significantly raised in autoimmune hepatitis?
aminotransferase
Give 3 autoantibodies associated with autoimmune hepatitis:
1) antinuclear antibodies
2) smooth muscle antibodies
3) peri nuclear anti-neutrophil cytoplasmic autoantibodies
Describe the pathophysiology of paracetamol overdose: (4)
1) around 5% of paracetamol is metabolised using cytochrome P450 enzymes to NAPQI which is toxic
2) NAPQI then binds to glutathione to become non-toxic so it can be excreted in the urine
3) in overdose, toxic NAPQI can exceed the body’s detoxification capacity due to the finite amount of glutathione available
4) toxic NAPQI XS can cause mitochondrial injury and hepatocyte cell death
What drug is used to treat paracetamol overdose?
N-acetylcystine
Give 4 additional clinical features seen in paracetamol overdose on top of the general hepatitis symptoms:
1) AKI
2) metabolic acidosis
3) coma
4) systemic haemorrhage (in extreme cases - due to coagulopathy)
For intentional paracetamol overdose, what vital discharge referral should be made?
specialist mental health professional referral
What is non-alcoholic steatohepatitis?
build up of fat in the liver that causes inflammation and damage
