Hepatitis

Question 1

What is the most simple description of Hepatitis?

Answer 1

Inflammation of the Liver

Question 2

What are the causes of Hepatitis?

Answer 2

Microbes (most are viral), Drugs (hepatotoxic drugs), Autoimmunity (less than 10%).

Question 3

What are the 3 main types of Viral Hepatitis?

Answer 3

Hep A, B, C.

Question 4

What factors differenciate the various types of hepatitis?

Answer 4

The virus, transmission, incubation period, and severity.

Question 5

What is the cause, mode of transmission, incubation period of Hep A?

Answer 5

Cause: Hep A virus (HAV). MOT: Fecal-oral route, poor sanitation, person-to-person contact. Incubation: 15-50 days, average 30.

Question 6

What is the cause, mode of transmission, incubation period of Hep B?

Answer 6

Cause: Hep B virus (HBV). MOT: parenterally, sexual and oral-oral contact, mother to infant. Incubation: 28-160 days, average 70-80 days.

Question 7

What is the cause, mode of transmission, incubation period of Hep C?

Answer 7

Cause: Hep C virus (HCV). MOT: Transfusion of blood and products, contaminated blood through equipment/drug paraphernalia, sexual contact. Incubation: 15-160 days, average 50 days. Second attack may indicate weak immunity or infecton with another agent.

Question 8

What is the severity of Hep A, Hep B, and Hep C?

Answer 8

Hep A: mild severity, acute form (self-limiting).
Hep B: more severe, 10-15% of cases are chronic.
Hep C: 80% of cases are chronic, characterised by remissions and exacerbations (carrier state), often leads to cirrhosis.”

Question 9

What are hepatocytes?

Answer 9

Hepatocytes are the functioning cells of the liver.

Question 10

What is the pathophysiology of Hepatitis?

Answer 10

Regardless of the type of hepatitis, there are two mechanisims of injury. 1) Immune response causing inflammation and necrosis. 2) Viral injury causing necrosis. Hepatocyte necrosis decreases the function of the liver. Vasculature and ducts are damaged from inflammation. Healing occurs in approximately 4 months.

Question 11

What is prodromal?

Answer 11

Prodromal is the period between the appearance of initial symptoms and the full development of an illness.

Question 12

What are the manifestations of Hepatitis?

Answer 12

Manifestations occur in 3 phases. Prodromal phase: lethargy, myalgia, fever, abdominal pain, anorexia, nausea, and vomiting. Clinical phase (5-10 days later): manifestations worsen, jaundince, pruritis, enlarged and tender liver. Recovery phase: acute manifestations subside (3 wks). Full recovery will occur within 16 weeks.

Question 13

What is an enlarged liver called?

Answer 13

Hepatomegaly

Question 14

What is the treatment for Hepatitis?

Answer 14

Rest (decreases energy required), Diet (small meals, high calorie meals), No alcohol or other hepatotoxic drugs, Relief from pruritis, Post exposure prophylaxis.

Question 15

What treatments are specific to Hepatitis A/B?

Answer 15

Immunoglobulins, Vaccine (Twinrex)

Question 16

What treatments are specific to Hepatitis C?

Answer 16

No vaccine so treatment will involve Antiviral drugs.

Question 17

What is the cause of Autoimmune Hepatitis?

Answer 17

Autoimmune is a complex trait disease that has defective HLA genes on Chromosome 6. Chromosome 6 might have a defect, but in combination with an environmental trigger it is enough to cause an autoimmunity.

Question 18

What are the characteristics of Type 1 Autoimmune hepatitis?

Answer 18

Most common type. 30% in females younger than 40. Anti-nuclear Antibodies and anti-smooth muscle antibodies.

Question 19

What are the characteristics of Type 2 Autoimmune hepatitis?

Answer 19

Most commonly occurs in 2-14 year olds. Antibodies against cytosol and microsomes

Question 20

What is cytosol?

Answer 20

Cytosol is the aqueous component of the cytoplasm of a cell, within which various organelles and particles are suspended.

Question 21

What are microsomes?

Answer 21

Microsomes are fragments of endoplasmic reticulum and attached ribosomes obtained by the centrifugation of homgenized cells.

Question 22

In Type 2 Autoimmune hepatitis what is targeted by antibodies?

Answer 22

The Cytosol and Microsomes

Question 23

What are the manifestations of Autoimmune Hepatitis?

Answer 23

They range from asymptomatic to manifestations of Liver Failure.

Question 24

How is Autoimmune Hepatitis diagnosed?

Answer 24

Diagnosis is made through exclusion of viral hepatitis and other liver diseases like cirrosis. Diagnosis is also made throught increased levels of gammaglobulins

Question 25

What is the treatment for Autoimmune Hepatitis?

Answer 25

Immunosuppressant drugs. Liver transplant may be required in non-responsive to immunosuppressants.