Hepatitis Flashcards
What is hepatitis?
Inflammation of the liver
What are the different types of hepatitis?
Viral hepatitis
Alcoholic hepatitis
Non-alcoholic Steatohepatitis (NASH)
Autoimmune hepatitis
Drug induced hepatitis
What are the 5 types of viral hepatitis?
Hepatitis A-E
What are the 2 hepatitis viruses that are transmitted via faecal-oral route?
Hepatitis A
Hepatitis E
What are the hepatitis viruses that cause acute disease?
Hepatitis A
Hepatitis E
Hepatitis B can be acute or can be chronic
Which hepatitis virus cant you catch unless you have another hepatitis virus?
What are these viruses?
You cant catch hepatitis D unless you have hepatitis B
Cant get D without B
Which hepatitis virus is a DNA virus and what type of virus are the rest of the hepatitis viruses?
Hepatitis B = DNA virus
Hepatitis A, C, D,E =2.718 RNA viruses
What are the hepatitis viruses that have an available vaccine?
Hepatitis A
Hepatitis B
How is hepatitis B transmitted?
Blood
Bodily fluids (sex)
How is hepatitis C transmitted?
Who is most commonly affected?
Blood
IVDU
Who needs to be notified about viral hepatitis cases?
UK Health Security Agency
How does a patient with viral hepatitis present?
Asymptomatic
Abdo pain
Fatigue
Flu like illness
Pruritus
Jaundice
Muscle and. Joint aches
N+V
Hepatomegaly
What investigations would be done on a patient who might have hepatitis?
FBC
LFTs (WILL BE ABNORMAL)
Serum amylase (pancreatic issue?)
VIRAL SCREEN
AUTOIMMUNE SCREEN
EBV and CMV screen
What might help you suspect hepatitis A over hepatitis B from. The patients history?
Hepatitis A is transmitted via the faecal oral route so from contaminated food or water
Hepatitis B is normally transmitted through direct contact with blood or bodily fluids like through sex or sharing needles. Hepatitis B can also be passed in pregancy to child via VERTICAL TRANSMISSION
What is the management for hepatitis A?
Supportive management (fluids and analgesia)
How is a diagnosis of Hepatitis A made?
Viral serology
IgM antibodies to hepatitis A
What is a complication of Hepatitis A?
Acute liver failure = Fulminant Hepatitis
What is a potential complication of the hepatitis A vaccine?
Can cause cholestasis leading to pruritus, jaundice, dark urine and pale stools.
What are the viral serological markers that need to be requested if you think a patietn might have Hepatitis B?
HBsAg
HBcAb IgM
HBeAg
HBeAb
HBV DNA PCR
What is the significance of HBsAg?
If it’s positive it indicates that there is currently an active infection of Hepatitis B
What is the significance of HBcAb IgM?
If it is positive then indicates theres an acute Hepatitis B infection (since IgM is the acute phase antibody rather than IgG)
If its negative indicates theres either a chronic hepatitis B infection or NO hepatitis B infection (Look to see whether the HBsAg is positive, if it is then its a chronic hepatitis B infection)
What is the significance of HBeAg?
It what the virus makes when it replicates rapidly
So if its positive it indicates rapid viral replication occurring
What is the significance of HBeAb?
Produced by the immune system
If its positive it indicates that the immune system is responding to the hepatitis B infection
What is the significance of HBV DNA PCR?
Less than 2000 is considered a low viral load
How is hepatitis B managed?
Screen for other viral infections (HIV, Hep A,C and D)
Refer to gastroenterology, hepatology or infectious disease
Avoid alcohol
Education in reducing transmission
Contact tracing
Testing for complications
Antivirals sometimes
Liver transplant if have fulminant hepatitis
What is the management for a low risk carrier of hepatitis B?
Nothing
What imaging should be done and why if a patient has chronic hepatitis B?
Fibroscan to check for liver cirrhosis
Ultrasounds
Why does a patient receive regular ultrasound scans if they have chronic hepatitis B?
To screen for hepatocellular carcinoma
How frequently are patients with chronic hepatitis B screened with an ultrasound for hepatocellular carcinoma?
What other investigation screen is done?
Every 6months
AFP levels
How is an acute hepatitis B infection managed where there is a good immune response (Positive HBeAb)?
Supportive should resolve
Re-measure HBsAg in 3 months time (if still elevated try antivirals)
What is the management for a patient with a chronic. Hepatitis B infection with a high viral load and poor immune repsonse?
Antivirals
Or
Pegylated interferon
What are some antivirals that can be given to treat a Hepatitis B infection?
Tenofovir
Entecavir
How does pegylated interferon help treat hepatitis B?
Helps boost the immune response against viral infection
How is hepatitis C diagnosed?
Hepatitis C antibody
Hepatitis C RNA testing
What are the complications of Hepatitis C infection?
Liver cirrhosis (complications of liver cirrhosis)
Hepatocellular carcinoma
How is hepatitis C managed?
Direct acting antivirals 8-12 weeks
What antivirals are given to treat hepatitis C?
Sofosbuvir
Daclatasvir
How is hepatitis D managed?
Pegylated interferon
(Not very effective)
How is hepatitis E managed?
Supportive
Normally only a mild illness
When should antivirals be given to a patient if she is trying to have a baby but she has hepatitis B?
In the last 3 months of pregnancy
What are some common patient inflicted causes of hepatitis that aren’t viral causes?
Excess alcohol
What is the overall management strategy for hepatitis C infection?
Give antivirals
Fibroscran to see if fibrosis
If fibrosis do liver US and AFP every 6 months to screen for hepatocellular carcinoma
What are the 2 types of autoimmune hepatitis?
Type1
Type 2
What is a Type 1 autoimmune hepatitis?
Women late 40s or 50s after menopause
Fatigue and features of liver disease on exam
What is a type 2 autoimmune hepatitis?
An acute hepatitis affecting children or young people most commonly girls
High ALT and jaundice
What investigations are done if you suspect an autoimmune hepatitis?
FBC
Viral serology
Serum amylase
Urine dip
LFTs
Raised IgG levels
ANA
What autoantibodies should be tested for in Type 1 autoimmune hepatitis?
ANA
Anti-actin
Anti-soluble liver antigen
What diagnostic investigation is done to diagnose autoimmune hepatitis?
Liver biopsy showing interface hepatitis and plasma cell infiltration
How is autoimmune hepatitis managed?
High dose steroids (prednisolone or budesanide)
+
Azathioprine (immunosuppressive DMARD)
Liver transplant if end stage liver disease
What makes budesanide a good corticosteroid for treating autoimmune hepatitis?
Really only metabolised by liver and gut so fewer systemic side effects.
Its used in non cirrhotic patients
