Hepatitis (2) Flashcards
What is it most commonly due to?
→ What are its other causes?
How does it present?
What will LFTs show?
→ What indicates if its acute or chronic?
➊ Hep A, B, C, and Alcohol
→ Hep D, E, Autoimmune, CMV, EBV
➋ • Malaise and fatigue
• RUQ pain
• Jaundice
• Diarrhoea
• N+V
• Hepato/splenomegaly
• Liver failure - characterised by hepatic encephalopathy, jaundice, ascites, and abnormal clotting
➌ • Raised AST and ALT
→ • Mildly raised ALP = Acute
• Normal ALP = Chronic
N.B. All infectious hepatitis cases are notifiable diseases
Hepatitis A Virus:
What type of nuclear material does it contain?
How is it transmitted?
How does it present?
How is it managed?
➊ RNA
➋ Faecal-Oral (usually contaminated food/water)
➌ • Flu-like symptoms followed by jaundice, pale stools (in some), dark urine and abdominal pain
• Complete recovery can take up to 6 months
➍ Supportively
Hepatitis B Virus:
What type of nuclear material does it contain?
How is it transmitted?
How does it present?
→ What do some go on to develop?
→ What are they then at risk of developing?
Serology:
What is HBsAg and what does it indicate?
What does HBsAb (Anti-HBs) indicate?
What does HBcAb (Anti-HBc) indicate?
→ How does it differ with active and past infection?
What is HBeAg?
→ What does it indicate?
N.B. Most common cause globally
➊ dsDNA
➋ Infected blood or body fluids (vertically from pregnant woman, unprotected sex, transfusion, IVDU)
➌ Jaundice, fever, malaise
→ Chronic disease
→ Liver fibrosis and Hepatocellular carcinoma
➍ Surface antigen indicating active infection (given in vaccine)
➎ Previous vaccination
➏ Previous infection
→ • IgM indicates active infection
• IgG indicates past infection
➐ E antigen released during viral replication
→ Infectivity (higher the level, the more infectious)
Which investigations may be done?
What drug can be given to suitable pts?
➊ FibroScan, and USS for its complications
➋ Peginterferon alfa-2a
Hepatitis C Virus:
What type of nuclear material does it contain?
How is it transmitted?
How does it present?
→ What do some go on to develop?
→ What are they then at risk of developing?
How is it investigated?
How is it managed?
➊ RNA
➋ Exchange of blood and bodily fluids (unprotected sex, transfusion, IVDU)
➌ Most are asymptomatic and only 15-25% clear the virus
→ Chronic disease
→ Liver fibrosis and Hepatocellular carcinoma
➍ • Anti-HepC
• FibroScan, and USS for its complications
➎ Direct Acting Antivirals, which cures it
Hepatitis D Virus:
In who does it affect?
How is it managed?
Hepatitis E Virus:
What can it lead to?
➊ Only those with Hep B as it needs to attach to HBsAg to survive
➋ No specifics, but Hep B vaccine can protect against it
➌ Chronic disease, Liver fibrosis, and Hepatocellular carcinoma
Autoimmune Hepatitis:
What are the 3 types and who does it typically affect?
What will LFTs show?
How is it managed?
➊ * Type 1 - most common, and present from menopause - is +ve for anti-smooth muscle antibodies
* Type 2 - less common but more severe - is +ve for anti-liver/kidney microsomal antibodies
* Type 3 - less common
➋ Raised ALT and bilirubin with normal/mildly raised ALP
➌ Steroid (pred) induction therapy followed by maintenance therapy with azathioprine
Alcoholic Hepatitis:
What do most pts with this develop?
What are the LFTs expected in these pts?
How is it managed?
➊ Liver fibrosis, and Hepatocellular carcinoma
➋ AST > 2x ALT, and a raised GGT
➌ Stop drinking to allow the liver time to recover
