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Semester 4 (NME) > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

Name 4 causes of hepatitis?

A

Viral
Autoimmune
Ethanol
Drug induced (paracetamol. rifampicin)

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2
Q

What are the types of acute hepatitis?

A

A and E

Normally resolve w/o long term problems

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3
Q

What are the types of chronic hepatitis?

A

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

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4
Q

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

A

Report it

It’s a notifiable disease

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5
Q

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

A

Hep C

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

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6
Q

What are the risk factors for Hepatitis?

A

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

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7
Q

What are the signs and symptoms of hepatitis?

A

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

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8
Q

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

A

Raised LFT’s

AST/ALT/ALP (+bilirubin later on)

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9
Q

What type of virus is hep A?

A

RNA- Picornavirus

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10
Q

What type of virus is hep B?

A

DNA- Hepadnavirus

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11
Q

What type of virus is hep C?

A

RNA- Dnavirade

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12
Q

What type of virus is hep D?

A

RNA

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13
Q

What type of virus is hep E?

A

RNA- Deltaviride

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14
Q

What type of hepatitis can be spread by pigs?

A

Hep E

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15
Q

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

A

B C D

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16
Q

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

A

A and E

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17
Q

What types of hepatitis have a carrier state?

A

B C D

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18
Q

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

A

B C D

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19
Q

What types of hepatitis can you be passively immune to?

A

A and B

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20
Q

What types of hepatitis can you vaccinate against?

A

A B E

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21
Q

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

A

Hep D only occurs when B also present

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22
Q

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

A

IgM for first 3 months

Replaced by IgG for long term immunity

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23
Q

Presence of IgM in the blood indicates what?

A

Recent infection

24
Q

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

A

90% fully recover

10% go on to develop chronic disease

25
Q

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

A

15% fully recover

85% go on to develop chronic disease

26
Q

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

A

90% fully recover (it’s always acute)

10% will have a re-occurrence

27
Q

What is the most prevalent type of hepatitis worldwide?

A

Hep B

350mil cases worldwide

28
Q

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

A

A, C, E = 2-9 weeks

B = 2-6months

29
Q

What is cholestasis?

A

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

30
Q

What is the pathophysiology of acute hepatitis?

A

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

31
Q

What is the pathophysiology of chronic hepatitis?

A

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

32
Q

What is the treatment for hep A?

A

NO TREATMENT

Rest, painkillers and anti-emetics

33
Q

What is the treatment for hep B or C?

A

Antiretrovirals (Interferon, tenofovir, entecavir)

Fluids, rest, avoid alcohol

34
Q

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

A

Stay cool
Loose clothes
No hot baths/ showers

35
Q

How does treatment change if patient is Hep Be Ag+

A 
Peg-interferon-alfa-2a (1st line)
Tenofovir disproxil (2nd line)
48 weeks
36
Q

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

A

Refer to gastroenterologist

37
Q

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

A

Hep Be Ag+ = On cell surface

Hep Bs Ag+= Extracelluar

38
Q

What is transient elastography?

A

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

39
Q

What is seroconversion?

A

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

40
Q

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

A 
Antigen= Current infection
IgM= Recent infection conquered by antibodies
IgG= Long term immunity
41
Q

What is the difference between attenuated and recombinant vaccines?

A 
Attenuated= Live microorganism with virulence removed 
Recombinant= Only antigen present, usually produced by bacteria or yeast and purified
42
Q

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

A

Hep E

43
Q

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

A

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

44
Q

What is the role of cholangiocyte cells?

A

They are the epithelial cells of the bile ducts

secrete bicarbonate and water into bile

45
Q

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

A

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

46
Q

What name two other names for perisinusoidal cells?

A

Hepatic stellate cells

Ito cells

47
Q

What is the name for the fetal precursor of hepatocytes?

A

Hepatoblasts

48
Q

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

A

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

49
Q

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

A

Cytomegalovirus

50
Q

What is Arthralgia?

A

Joint pain

51
Q

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

A

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

52
Q

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

A

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

53
Q

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

A

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

54
Q

What does the Hep Be antigen indicate?

A

+ve shows rapid virus replication

55
Q

What does the Hep Bs antigen indicate?

A

Presence of current infection

56
Q

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

A

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
57
Q

Where are human cytochrome p450 enzymes located?

A

Inner membrane of mitochondria

Semester 4 (NME) (24 decks)

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