Hepatitis Flashcards
What is hepatitis?
Inflammation of the liver
What is the progression of liver disease?
Normal –> Inflammation (Hepatitis) –> Fibrosis –> Cirrhosis –> Liver failure/cancer
What are the types of hepatitis based on duration?
Acute (<6 months), Chronic (6 months +)
What are some causes of hepatitis?
- Infective: Hep A, B, C, D, E
- Drugs
- Alcoholic Hepatitis
- Autoimmune Hepatitis
- Ischaemic Hepatitis
What is unique about Hepatitis D?
Hep D is an incomplete RNA virus requiring Hep B surface antigen for transmission
Therefore pt. often has HepB and D at the same time!!!
What is the pathophysiology of viral hepatitis?
- Viral entry: virus enters body + targets hepatocytes
- Viral attachment and penetration: unique surface antigen interacts with hepatocyte surface
- Viral replication: viral replication
- Viral assembly + release: virons release to continue infection
- Cytopathic effect: hepatic cell death
- Immune response: natural immune response (cytotoxic T cells, NK + cytokines lead to hepatocellular injury)
What are common investigations for hepatitis?
- Serological testing
- Bloods: LFTs (ALT, AST, ALP, GGT, bilirubin, albumin, INR)
- Imaging: USS - identify signs CT/MRI
- Liver Biopsy (chronic disease HBV, HCV)
- Screen for Hepatocellular Carcinoma (HCC) - USS (every 6 months) + alpha-fetoprotein levels
What are the differential diagnoses for hepatitis?
- Alcoholic Hepatitis: rapid jaundice, AST:ALT - 2:1, INR >1.5, hepatomegaly + alcohol Hx
- AI Hepatitis: Serum autoantibodies: ANA, SMA, LKM, elevated IgG
- Drug-induced Liver Injury: drug exposure
What is the management for Hepatitis A?
Supportive
What treatments are available for Hepatitis B?
Supportive + Antiviral (e.g. pegylated interferon-alpha, tenofovir, entecavir, telbivudine)
What treatments are available for Hepatitis C?
Supportive + Protease inhibitors (Declatasvir + Sofobuvir + simeprevir +/- Ribavirin)
What is the management for Hepatitis D?
Supportive + Interferon treatment
What is the management for Hepatitis E?
Supportive
What vaccinations are available for hepatitis?
- Hep A
- Hep B
What is important for the prevention of hepatitis transmission?
Patient education
Risk factors for hepatitis transmission
- Contact with infected blood or body fluids
- Poor sanitation
- Unsafe medical practices
- Sharing needles
- Having unprotected sex.
What is a complication associated with Hepatitis C?
Charcot’s foot
What is the mortality rate associated with Hepatitis E in pregnancy?
20%
What is the primary serological marker for active Hepatitis B infection?
Hepatitis B surface antigen (HBsAg)
True or False: The presence of Anti-HBs indicates a resolved Hepatitis B infection.
True
Fill in the blank: The presence of __________ indicates ongoing viral replication in Hepatitis B.
Hepatitis B e antigen (HBeAg)
What does the presence of Anti-HBe indicate?
Seroconversion and lower levels of viral replication
In acute Hepatitis B infection, which serological marker is typically the first to appear?
Hepatitis B surface antigen (HBsAg)
Multiple Choice: Which of the following is NOT a marker of Hepatitis B infection? A) HBsAg B) Anti-HBs C) HCV RNA D) HBeAg
C) HCV RNA
