HEPATITIS Flashcards
What is most common acute viral hepatitis?
HAV, it’s self limiting
What is hepatitis?
Inflammation of the liver characterized by presence of inflammatory cells.
Can be self limiting (heal on it’s own) or can progress to fibrosis and scarring.
What is most common chronic viral hepatitis?
HCV
Self limiting in only 15%
What virus is the most directly oncogenes causing HCC?
HBV, yet is still self-limiting in 85%
What are the causative microbes of acute viral hepatitis?
HEP ABCDE
EBV CMV
PARVOVIRUS B19, Human Herpes Virus 6 (little known)
What is the Pathophysiology of acute hepatitis?
Acute necroinflammation of liver
Damage is done by immune destruction not cytopathic
If potent immune reaction, fulminant hepatic failure may result
Presentation?
1) Non-specific prodrome
2) Pre-icterus phase
- vague RUQ pain
- nausea
- immune mediated symptoms: hives, rash, arthralgia
3) Icterus phase (not freq seen?)
- jaundice, dark urine, pale stool (dark urine noticed before jaundice)
- hepatosplenomegaly
+/- FULMINANT HEPATIC FAILURE may ensue at this point
4) post icterus/recovery phase may take up to 6 months.
What happens if there is disease 6 months after an acute episode?
Termed Chronic viral hepatitis
HAV
- incubation?
- transmission?
- RF?
- Ix?
- Rx?
Incubation 15-45 days Transmission - usually faecal-oral (ingestion of contaminated food or water) - can be via blood transfusion RF - travelling to developif country - children in child are or elderly in NH - homosexual men - IVDU Ix - anti-HAV IgM Rx - self-limiting, supportive treatment
HBV
- incubation
- transmission
- RF
Incubation 30-150days Transmission - sexual - vertical - percutaneous: blood, blood products, IVDU, tattooing RF - multiple sex partners - parents from endemic areas - immigrants - IVDU
Serological markers for HBV?
HBsAg (hepatitis B surface antigen): hallmark for current infection, acute or chronic
Anti-Hbs (hepatitis B surface antibodies) indicates immunity
Anti-Hbc (hepatitis B core antibodies): IgM (acute infection) and IgG (chronic infection or immunity)
HBeAg (hepatitis B e antigen) is a marker of HBV replication
- high viral load and infect ivory
- not necessary for diagnosis
Acute HBV = HBsAg + anti-HBc IgM
Management of HBV?
HBV just self-limited, but may progress to fulminant hepatitis
No evidence behind lamivudine (antiviral)
Although if fulminant, early antiviral may reduce need for transplant
HEV
- incubation
- transmission
- Ix
- Rx
15-60days
Faecal oral - contaminated food/water
Ix - anti-HEV IgM
Rx - HEV self limiting, though can become fulminant
S + S of chronic viral hepatitis?
Can be asymptomatic. Often picked up on LFTs Non-specific - fatigue - sleep disorders RUQ pain Sx of cirrhosis - liver insufficiency - portal HTN
What is chronic HBV infection rarely associated with?
Glomerulonephritis in children’s
Polyarteries nodusa in adults
Ix?
ALT > AST (opposite to alcoholic), ALP GGT mildly elevated Anti-HCV HCV viral load HCV genotype
Radiology Ix for chronic hepatitis?
Liver US to assess size and texture Fibroscan to assess liver stiffness Liver biopsy - balloon degeneration in periportal area - fibrosis in periportal areas
How do you stage and grade chronic hepatitis?
Liver biopsy, Scheur grading system
Grade - portal inflammation -> necrosis
Lobular activity - inflammation -> bridging necrosis
Stage - fibrosis
Pathology of chronic HCV?
Immune destruction of infected hepatocytes -> chronic inflammation -> fibrosis
RF for rapid progression chronic HCV?
Continuing IVDU ALCOHOL OBESITY CO-INFECTION OF HIV + HBV LOW CD4+ count
S + S of acute hepatitis C
Asymptomatic and undiagnosed lol
Rx of chronic HCV?
Non-pharm
- avoid IVDU
- avoid alcohol
- HAV vaccination
Antiviral depends on the genotype
- pegylated IFN-a
- ribavirin
- protease inhibitors: boceprevir, telaprevir
When would you delay treatment of Chronic hepatitis C?
Minimal inflammation or no fibrosis
Persistently normal ALT
Liver cirrhosis and signs of decompensation: low albumin, high INR, high bilirubin, ascites, jaundice -> LIVER TRANSPLANT NOT INTERFERON
What is sustained virological response?
Equivalent to cure 99% negative HCV RNA long term.
Absence of HCV RNA by PCR 6 months AFTER stopping treatment
SVR = reduction in mortality
