Hepatitis

Question 1

Name 4 causes of hepatitis?

Answer 1

Viral
Autoimmune
Ethanol
Drug induced (paracetamol. rifampicin)

Question 2

What are the types of acute hepatitis?

Answer 2

A and E

Normally resolve w/o long term problems

Question 3

What are the types of chronic hepatitis?

Answer 3

Infection >6mnths with sequelae (occurrence and complication)
- Type B and C

Question 4

What are you legally obliged to do by law when you discover a case of hepatitis?

Answer 4

Report it

It’s a notifiable disease

Question 5

What is the most common type of hepatitis in the UK?

Answer 5

Hep C

Followed by A, then B, then E, then D, then other

Question 6

What are the risk factors for Hepatitis?

Answer 6

Sharing drug equipment
Vaginal/ anal/ oral sex
Increased alcohol intake
Travel (epecially w/o vaccine)

Question 7

What are the signs and symptoms of hepatitis?

Answer 7

RUQ pain, fatigue, malaise, anorexia, N+V
Jaundice (icterus), itching, dark urine
Rash and joint pain

Question 8

What would appear on a blood test in a patient with hepatitis?

Answer 8

Raised LFT’s

AST/ALT/ALP (+bilirubin later on)

Question 9

What type of virus is hep A?

Answer 9

RNA- Picornavirus

Question 10

What type of virus is hep B?

Answer 10

DNA- Hepadnavirus

Question 11

What type of virus is hep C?

Answer 11

RNA- Dnavirade

Question 12

What type of virus is hep D?

Answer 12

RNA

Question 13

What type of virus is hep E?

Answer 13

RNA- Deltaviride

Question 14

What type of hepatitis can be spread by pigs?

Answer 14

Hep E

Question 15

What types of hepatitis are spread by blood and body fluids?

Answer 15

B C D

Question 16

What types of hepatitis are spread by faecal/ oral transmission?

Answer 16

A and E

Question 17

What types of hepatitis have a carrier state?

Answer 17

B C D

Question 18

What types of hepatitis carry an increased risk of developing liver cancer?

Answer 18

B C D

Question 19

What types of hepatitis can you be passively immune to?

Answer 19

A and B

Question 20

What types of hepatitis can you vaccinate against?

Answer 20

A B E

Question 21

What type of hepatitis only occurs when another type is present?

Answer 21

Hep D only occurs when B also present

Question 22

Which antibody is seen in the first three months of infection, what is it then replaced by?

Answer 22

IgM for first 3 months

Replaced by IgG for long term immunity

Question 23

Presence of IgM in the blood indicates what?

Answer 23

Recent infection

Question 24

What are the long term outcomes for patients with Hep B?

Answer 24

90% fully recover

10% go on to develop chronic disease

Question 25

What are the long term outcomes for patients with Hep C?

Answer 25

15% fully recover | 85% go on to develop chronic disease

Question 26

What are the long term outcomes for patients with Hep A?

Answer 26

90% fully recover (it's always acute) | 10% will have a re-occurrence

Question 27

What is the most prevalent type of hepatitis worldwide?

Answer 27

Hep B | 350mil cases worldwide

Question 28

What are the incubation times for the different types of hepatitis?

Answer 28

A, C, E = 2-9 weeks | B = 2-6months

Question 29

What is cholestasis?

Answer 29

Where bile can't flow (so fatty change occurs) Mainly occurs in zone 3 Mainly in alcohol/ drug related hepatitis

Question 30

What is the pathophysiology of acute hepatitis?

Answer 30

Inflammation causes hepatocyte damage and necrosis (maximal in zone 3) Veins can join up/ lobules become inflitrated with lymphocytes

Question 31

What is the pathophysiology of chronic hepatitis?

Answer 31

Lymphocytes/ plasma cells and lymphoid follicles all present in portal tracts Damage due to apoptosis not necrosis Accompanied by fibrosis (mild) cirrhosis (severe)

Question 32

What is the treatment for hep A?

Answer 32

NO TREATMENT | Rest, painkillers and anti-emetics

Question 33

What is the treatment for hep B or C?

Answer 33

Antiretrovirals (Interferon, tenofovir, entecavir) | Fluids, rest, avoid alcohol

Question 34

What are some recommended lifestyle changes for Px with excessive itching?

Answer 34

Stay cool Loose clothes No hot baths/ showers

Question 35

How does treatment change if patient is Hep Be Ag+

Answer 35

``` Peg-interferon-alfa-2a (1st line) Tenofovir disproxil (2nd line) 48 weeks ```

Question 36

What must you do with patients who are Hep Bs Ag+

Answer 36

Refer to gastroenterologist

Question 37

Where would you find Hep Be Ag+/ Hep Bs Ag+ antigens?

Answer 37

Hep Be Ag+ = On cell surface | Hep Bs Ag+= Extracelluar

Question 38

What is transient elastography?

Answer 38

Quantitative (1D) image of tissue stiffness Vibrates skin to create tissue distortion (shear wave) Stiffness is given as a youngs modulus

Question 39

What is seroconversion?

Answer 39

Where antibody becomes detectable in the blood and the corresponding antigen becomes undetectable

Question 40

What does the presence of an antigen/ IgM antibody/ IgG antibody each suggest?

Answer 40

``` Antigen= Current infection IgM= Recent infection conquered by antibodies IgG= Long term immunity ```

Question 41

What is the difference between attenuated and recombinant vaccines?

Answer 41

``` Attenuated= Live microorganism with virulence removed Recombinant= Only antigen present, usually produced by bacteria or yeast and purified ```

Question 42

Which of the following viruses is transmitted by the faecal-oral route and associated with an approximately 20% mortality rate in pregnant women?

Answer 42

Hep E

Question 43

What is the role of oval cells (aka ovalocytes)?

Answer 43

Bi-potential stem cells (into either hepatocytes or cholangiocytes). Activated when liver proliferation is impaired

Question 44

What is the role of cholangiocyte cells?

Answer 44

They are the epithelial cells of the bile ducts | secrete bicarbonate and water into bile

Question 45

What is the role of Hepatic stellate cells (aka Ito cells or perisinusoidal cells)?

Answer 45

Pericytes (wrap all the way round) found in space of Disse - they normally store vitamin A When liver is damaged they become activated and secrete collagen scar tissue

Question 46

What name two other names for perisinusoidal cells?

Answer 46

Hepatic stellate cells | Ito cells

Question 47

What is the name for the fetal precursor of hepatocytes?

Answer 47

Hepatoblasts

Question 48

Which is the major cell type involved in liver fibrosis and cirrhosis?

Answer 48

Ito cells (aka perisinusoidal cells) (aka Hepatic stellate cells)

Question 49

Which virus that can affect the liver is especially fond of immunocompromised people?

Answer 49

Cytomegalovirus

Question 50

What is Arthralgia?

Answer 50

Joint pain

Question 51

When doing serological tests, how do you distinguish between Px's who have had an active HepB infection and those who have been vaccinated?

Answer 51

anti-HBc +ve (Only postive for HBc when had actual infection) - Those who are vaccinated will be HBs +ve BUT HBc -ve

Question 52

What serum test helps show the difference between Px who are acutely or chronically infected with HepB?

Answer 52

IgM anti-HBc (+ve in those who are acute) (-ve in those who are chronic)

Question 53

What serum test allows one to differentiate between Px with active or no longer active (immune) Hep B disease?

Answer 53

HBsAg (ANTIGEN) (+ve in those with active infection) (-ve in those who are immune/ unexposed)

Question 54

What does the Hep Be antigen indicate?

Answer 54

+ve shows rapid virus replication

Question 55

What does the Hep Bs antigen indicate?

Answer 55

Presence of current infection

Question 56

What is cytochrome p450 and what is it's function?

Answer 56

It's a haemoprotein enzyme - usually final bit of oxidation in ETC's - Involved in hormone synthesis/ toxin breakdown and 75% of all drug metabolism

Question 57

Where are human cytochrome p450 enzymes located?

Answer 57

Inner membrane of mitochondria