Hepatitis Flashcards
What is hepatitis?
Inflammation of the liver
What is the difference between acute and chronic hepatitis?
Acute: less than 6 months, usually self limiting and liver returns to normal
Chronic: over 6 months, repeated attacks on liver takes a toll on it.
How does acute hepatitis present?
Can be asymptomatic
Malaise GI upset Myalgia Abdominal pain Jaundice Dark urine + pale stools Tender hepatomegaly
Causes of acute hepatitis?
Infection:
- viral
- bacterial
- parasitic
Alcohol Drugs Toxins Pregnancy Autoimmune Genetic conditions
Which viruses can cause acute hepatitis?
Hepatitis A-E
Herpes viruses
- Epstein Barr virus
- Cytomegalovirus
- Varicella Zoster virus
Which bacteria can cause acute hepatitis?
Leptospirosis
Coxiella
Which parasite(s) can cause acute hepatitis?
Toxoplasmosis
How does chronic hepatitis present?
Asymptomatic
Jaundice
Ascites
Low albumin
Coagulopathy
Signs of chronic liver disease:
- Clubbing
- Palmar erythema
- Spider naevi
- Dupuytren’s contracture
What is coagulopathy?
Impaired ability to clot blood, because the liver isn’t producing enough of the proteins in the coagulation cascade
What is palmar erythema?
Red palms
What are spider naevi?
On the skin
A central red spot and reddish extensions which radiate outwards like a spider’s web.
They are caused by swollen blood vessels
What is Dupuytren’s contracture?
Fixed forward curvature of finger(s) caused by the development of fibrous tissue between finger tendons and on the skin of the palm
What happens in chronic hepatitis that means liver function is maintained?
Compensation
The body compensates for the problems, meaning chronic hepatitis can sometimes be asymptomatic
What are some complications of chronic hepatitis?
Chronic liver disease - fibrosis, cirrhosis
Hepatocellular carcinoma
Portal hypertension
Gastro-oesophageal varices
GI bleed
What causes chronic hepatitis?
Hepatitis B-D
Autoimmune hepatitis
Drugs
Alcohol
Genetic conditions
Describe the effect on acute hepatitis on the liver?
Damage to cells
Influx of neutrophils causes necrosis
Death of cells due to necrosis or apoptosis
Describe the effect of chronic hepatitis on the liver?
Damage and destruction of hepatocytes and other cells
The liver regenerates not in an orderly fashion
Damaged cells are replaced with scar tissue
Over time, there are only a few islands of hepatocytes left amongst the scar tissue
How would you distinguish autoimmune hepatitis from other types?
Blood tests:
Increased IgG levels
Antibodies against liver proteins
Biopsy: mononuclear infiltrate, you would see white blood cells in the liver
What causes autoimmune hepatitis?
Genetics
Sometimes viral infections (viral hepatitis or EBV)
How do patients with autoimmune hepatitis present?
Acute initially, but they will eventually become chronic
Fatigue Anorexia Weight loss Amenorrhoea Abdominal pain
Coagulopathy Jaundice Hepatomegaly Ascites Signs: Palmar erythema, spider naevi
How would you manage autoimmune hepatitis?
Immunosuppressants
- prednisolone
- non-steroids
Liver transplant
Name the hepatitis viruses.
A B C D E
How is hepatitis A spread?
Faecal-oral route
What type of virus is hepatitis A?
RNA virus
What food is hepatitis A commonly found in?
Shellfish
Does hepatitis A cause an acute or chronic illness?
Acute, it never progresses to chronic
It is a self-limiting infection
Do you acquire immunity to hepatitis A after an infection with it?
Yes
100% immunity
How long does a hep A infection usually last?
3-6 weeks
Management of hep A infection.
Supportive care
Monitor liver
Check close contacts and give them prophylaxis
What can you do to prevent hep A infection?
Vaccinate
HNIG - human normal immunoglobulin - provide someone with donor hep A antibodies
Summarise hep A!
A is Acquired by mouth for Anus, is Always cleared Acutely and only ever Appears once
How is hep E spread?
Faecal-oral route
Water or food-borne
What type of virus is hep E?
A small RNA virus
There are different genotypes of hep E, one of these is found in an animal, which animal?
Pigs
Virus can be found in some British sausages
Does hep E cause an acute or chronic infection?
Usually self-limiting acute infection
It can become chronic in the immunocompromised
Which people do you need to be extra concerned about if they get hep E?
Pregnant women: mortality is as high as 10-20%
Immunocompromised: can progress to chronic hepatitis
Summarise hep E!
E is Even in England and can be Eaten, if not always beaten
What is the link between hep B and D?
You can’t be infected with D without having B too
What type of virus is hep B?
DNA virus
How is hep B spread?
Blood-borne
- needle stick
- tattoos
- sexual
- vertical
Is hep B an acute or chronic infection?
Acute
But can become chronic if the immune system can’t right it off
Management of hep B?
Supportive care
Monitor liver function
Treat with drugs
Contacts: post-exposure prophylaxis, vaccination
What is a serious complication that can occur from hep B?
Fulminant liver failure
What 2 drug treatment options are there to treat hep B?
Describe them briefly
Pegasys
- stimulates the immune system to fight off infection better
- weekly subcut injection
- nasty side effects
Nucleoside analogues
- inhibit viral replication
- one tablet per day
- fewer side effects
- lifelong
What is fulminant liver failure?
Acute liver failure that results in encephalopathy within 8 weeks
What is encephalopathy?
Neurological symptoms: confusion, coma, can lead to death
What is the delta virus?
Hepatitis D
Why is it that hep D cannot infect without hep B?
The virus is a bit defective
It needs the hep B surface antigens to survive
Is it best to have hep B and D together or to have just hep B?
Best to have just hep B
Hep B and D together cause a faster rate of fibrosis of the liver
In an infection of hep B and D, which virus is dominant?
Hep D
Does hep D cause a chronic or acute infection?
Acute leading to chronic
Where is hep B virus found?
All over the place
Summarise hep B?
B is Blood-Borne and if not Beaten can be Bad
Summarise hep B and D?
B and D are DastarDly
What type of virus is hep C?
A flavivirus - RNA
How is hep C spread?
Blood-borne
Sexually transmitted
Mother to baby
What are the complications of a hep C infection?
Chronic hep C can lead to cirrhosis
Which can lead to Hepatocellular carcinoma
Is hep C a chronic or acute infection?
Acute that becomes chronic
Management of hep C?
Drug treatment: Pegasys + Ribvirin
Contacts: screen
How do you prevent hep C?
No vaccine
Take precautions: needle exchanges, condoms
Summarise hep C?
C is usually Chronic but Can be Cured at a Cost
How does hep A present?
Nausea Anorexia Jaundice Dark urine + pale stools Hepatomegaly Skin rash Lymphadenopathy
How does hep B present?
Skin rash
Arthralgia
Nausea Anorexia Jaundice Dark urine + pale stools Hepatomegaly Lymphadenopathy
How does hep C present?
Mild symptoms, occasionally jaundice
Not usually picked up until infection is chronic
How does hep E present?
Nausea Anorexia Jaundice Dark urine + pale stools Hepatomegaly Skin rash Lymphadenopathy
Signs of chronic liver disease
