hepatitis Flashcards
what are the pathological features of Hepatitis?
Liver cell necrosis and cell inflammation
What is the prognosis for acute hepatitis?
Normally self limiting with a return to normal structure and function.
What are the clinical presentations of Hepatitis?
- Jaudice
- Enlarged and tender liver
- Laboratory evidence of hepatocellular damage
- Raised serum aminotransferase lvls
What is the definition of chronic hepatitis?
> 6 months duration
What are the viral causes of chronic hepatitis?
- Hepatitis B +/- D
* Hepatitis C
Name 4 drugs that can cause Chronic Hepatitis?
- Methyldopa
- Nitrofurantoin
- Isoniazid
- Ketoconazole
Name a hereditary cause of chronic hepatitis?
Wilson’s disease
What is the most common cause of chronic hepatitis in the UK.
Alcohol
what is a condition of the Gut associated with chronic hepatitis?
Inflammatory bowel disease
What is the transmission route of Hep A (HAV)?
- Faecal/oral
* saliva
What is the transmission route of Hep B (HBV)?
- Blood/Blood product
- sexual
- Vertical
- Saliva
What is the transmission route of Hep C (HCV)?
•Blood/ Blood products
What is the transmission route of Hep D (HDV)?
- Blood/blood products
* Saliva
What is the transmission route of Hep E (HEV)?
• Faecal/oral
What is the incubation period for Hep A?
2-6 weeks
What is the incubation period for Hep B?
1-5 months
What is the incubation period for Hep C?
2-6 months
What is the incubation period for Hep D?
1-3 months
What is the incubation period for Hep E?
3-8 weeks
Which Hepatitis viruses cause Chronic liver disease?
- Hep B +/- D
* Hep C
Which hepatitis viruses cause Liver cancer?
- Hep B
- Hep C
- Hep D (rare)
When is Hep E really dangerous?
in pregnant women ( mortality 10 -20%)
What are the symptoms for Hep A?
- Initially Fever, Malaise, Anorexia, Nausea, Arthralgia
* Followed by Jaundice (rare in children), Hepatosplenomegaly, adenopathy
What are the symptoms for Hep B?
- Initially Fever, Malaise, Anorexia, Nausea, Arthralgia + Uticaria
- Followed by Jaundice (rare in children), Hepatosplenomegaly, adenopathy
What is a good indicator that an individual might have Hep A?
- Seafood (faecal/oral route)
* incubation period of 2-6 weeks
What is a good indicator that an individual might have Hep B?
- Recent foreign travel to an endemic area
* Incubation period of 1-5 months
What is a good indicator that an individual might have Hep C?
- Young intravenous drug user
* Chronic infection
What are the tests for Hep B?
- The first and most important test is HBsAg ( Hep B surface antigen). this is the first serum marker seen in acute infection.
- HBeAg Appears during the first 1 1/2 - 3 months and can also be used as an acute marker of infection.
- HBcAg (Hep B core antibody) is initially IgM and if detected indicates Acute infection.
- HBcAg IgG replaces Igm. If this is detected without a HBsAg then it indicates the individual fought off a past infection
- Anti-bodies to Hep B surface antigen alone imply vaccination
What are the tests for Hep C?
- Anti-HCV Antibodies confirm exposure.
- HCV-PCR confirms on going infection/chronicity
- Liver biopsy if HCV-PCR +ve to assess Liver damage and need for treatment
What is a good indicator that an individual might have Hep E?
- Middle aged patient
* Chronic infection - Jaundice, malaise
What is the treatment for Hep B?
The aim is to clear Hep B and avoid cirhoss, HCC.
- Old method is to Treat with Pegelated interferon.
- Lamivudine
- entecavir
- Adefovir
- tenofovir
What is interesting about chronic infections of Hep B?
They will have been contracted as a baby (Vertical, blood products/saliva) and will have an incredibly high HBsAg
What is the treatment for Hep C?
- Genotype 1 → DAAs
- sofosbuvir + ledipasvir +/- ribavirin
- paretaprevir/r + ombitasvir + dasabuvir +/- ribavirin
- Genotype 3 → Encouraging results with newer agents
