Hepatitis Flashcards
How are the types of viral hepatitis transmitted?
A - Faecal-oral
B - blood/bodily fluids
C - blood
D - with hepatitis B
E - faecal-oral route
What are the other causes of hepatitis?
Alcoholic hepatitis
Non-alcoholic hepatitis
Autoimmune hepatitis
Drug induced hepatitis
What are the clinical features of acute viral hepatitis?
Flu-like symptoms
Jaundice
Anorexia
Nausea and vomiting
Abdominal pain
What are the clinical signs of acute viral hepatitis?
Fever
Hepatomegaly
Splenomegaly
Ascites
What LFT results would be seen in viral hepatitis?
High ALT and AST
Raised ALP (but proportionally less of a rise compared to AST and ALT)
Raised transaminases
Raised bilirubin
What investigation is diagnostic of acute viral hepatitis A?
IgM antibodies to hepatitis A
What is the management of hepatitis A?
Supportive management
- IV fluids
- Analgesia
Vaccination
What are the complications of hepatitis A?
Fulminant hepatitis (acute liver failure)
Relapsing hepatitis
What are the risk factors for hepatitis B?
Unprotected sex
Sharing needles
Healthcare work
What does hepatitis B surface antigen (HBsAg) indicate?
Indicates current infection
- If it has been present for more than 6 months - suggests chronic infection
What does hepatitis B e antigen (HBeAg) indicate?
Indicates high viral load
Predictive of progression to chronic hepatitis
What do antibodies to hepatitis B core antigen (anti-HBc) indicate?
Indicated current or previous hepatitis B infection
- IgM - infection within last 6 months
- IgG - infection more than 6 months ago
What do antibodies to hepatitis B surface antigen (anti-HBs) indicate?
Indicates immunity to hepatitis B (may be due to vaccination or previous infection)
What is the management of hepatitis B?
Supportive management (IV fluids, analgesia)
Vaccination
Anti-virals - tenofovir or entecavir
Pegylated interferon
What are the complications of chronic hepatitis B?
Chronic liver disease
Liver cirrhosis
Hepatocellular carcinoma
What are the risk factors for hepatitis C?
Sharing needles
Healthcare work
Unprotected sex (less common than hepatitis B)
What investigations are used to diagnose hepatitis C?
Hepatitis C antibody - screening
Hepatitis C RNA testing - diagnostic
What is the management of hepatitis C?
Antivirals (8 to 12 weeks)
- Telaprevir plus ribavarin
- Sofosbuvir plus ribavirin
- Simeprevir plus ribavarin
What are the complications of hepatitis C?
Chronic hepatitis
Cirrhosis
Hepatocellular carcinoma
What investigations are used in the diagnosis of hepatitis E?
LFTs - elevated ALT/AST, bilirubin, ALP and gamma-GT
Hepatitis E IgM antibodies
Viral PCR
What is the management of hepatitis E?
Supportive management
- IV fluids
- Analgesia
What antibodies are associated with autoimmune hepatitis?
ANA
Anti-smooth muscle antibody (ASMA)
Anti-SLA/LP (anti-soluble liver antigen/liver-pancrease antibody)
Anti-LC1 (anti-liver cytosol 1 antibody)
What are the types of autoimmune hepatitis?
Type 1 - typically affects women in 40s/50s, presents after menopause and is less acute.
Type 2 - usually affects young people, more commonly girls. Presents with acute hepatitis
What antibodies are associated with type 1 AIH?
ANA
ASMA
Anti-SLA/LP
What antibodies are associated with type 2 AIH?
Anti-LKM1
Anti-LC1
What HLA genotypes are associated with type 1 AIH?
DR3 and DR4
What HLA genotypes are associated with type 2 AIH?
DQB1 and DRB1
What are the symptoms of autoimmune hepatitis?
Fatigue
Arthralgia
Weight loss
Nausea
Amenhorrhoea
What are the clinical signs of autoimmune hepatitis?
Jaundice
Gynaecomastia
Splenomegaly
Ascites
Variceal bleed
Encephalopathy
Spider telangiectasia
What investigations are used to diagnose autoimmune hepatitis?
LFTs
- Raised ALT and AST
- Minimal change in ALP
Raised IgG
Liver biopsy - interface hepatitis seen
Viral screen - exclude viral hepatitis
Autoimmune screen
What is the management of autoimmune hepatitis?
First line - prednisolone and azathioprine
Hepatitis A and B vaccines
Second line - transplantation
What are the complications of autoimmune hepatitis?
Cirrhosis
Osteoporosis
Cushing’s syndrome
Hepatocellular carcinoma
