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3RD YEAR - Infectious Diseases > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

How does blood get to the liver?

A 
Portal vein (80%)
Hepatic artery (20%)
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2
Q

Why do patients with chronic hepatitis get gynecomastia?

A

The scarred liver is unable to process hormones, in this case testosterone, so it is converted to oestrogen and builds up in breast tissue

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3
Q

Name some functions of the liver

A
  • Cleans blood
  • Regulates hormone
  • Controls blood glucose levels via glycogen storage
  • Produces bile
  • Helps with blood clotting
  • Produces important proteins
  • Processes toxins
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4
Q

For hepatitis to be acute, how many months has it occurred for?

A

Less than 6 months

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5
Q

What is fulminant hepatitis?

A

Severe impairment of hepatic function or severe necrosis of hepatocytes in absence of pre-existing liver disease

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6
Q

Which viruses can cause hepatitis?

A

Hep A,B,C,D,E, EBV, Yellow fever, HSV, CMV

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7
Q

Describe the route of transmission of hepatitis A-E

A

A,E - feco-oral

B,C,D - via blood and body fluids

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8
Q

Which viruses can lead to chronic hepatitis?

A

B,C,D (although D requires B)

C is the most common

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9
Q

What are the symptoms of acute hepatitis?

A 
Fever and chills
Headache
Fatigue and weakness
Nausea and vomiting
Dark urine and jaundice
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10
Q

Which of Hep A-E is very common in children?

A

Hepatitis A - as we get older we become immune to it so don’t contract the virus.

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11
Q

Which of Hep A-E is most commonly spread through unprotected sex?

A

Hepatitis B

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12
Q

Which of Hep A-E is most commonly spread through needles and blood-blood contact?

A

Hepatitis C

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13
Q

How can Hepatitis B be prevented?

A
  • Vaccination
  • Hep B immunoglobulin-exposed within 48h of incident (neonates)
  • Screening of blood donors
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14
Q

How is Hepatitis B treated?

A
  • Interferon Alpha
  • Lamivudine
  • Adefovir (Hepsera)
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15
Q

What is HBsAg?

A

Hepatitis B surface antigen:
A protein on the surface
of hepatitis B virus; it can be detected in high levels
in serum during acute or chronic hepatitis B virus infection. The presence of HBsAg indicates that the person has a CURRENT infection.

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16
Q

What is anti-HBs?

A

Hepatitis B surface antibody (anti-HBs):
The presence of anti-HBs is generally interpreted as indicating recovery and IMMUNITY from hepatitis B virus infection. Anti-HBs also develops in a person who has been successfully vaccinated against hepatitis B.

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17
Q

What is IgG anti-HBc? (also anti-HBe)

A

Total hepatitis B core antibody (anti-HBc): Appears at the onset
of symptoms in acute hepatitis B and persists
for life. The presence of anti-HBc indicates previous or ongoing infection with hepatitis B virus in an undefined time frame, and tells us they are `NON-INFECTIOUS.

NB - if you have had immunisation, you will not have anti-HBc, only anti-HBe.

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18
Q

What is IgM anti-HBc?

A

IgMantibodytohepatitisB core antigen (IgM anti-HBc): Positivity indicates recent infection with hepatitis B
virus (<6 mos). Its presence indicates acute infection.

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19
Q

What is HBeAg/HBcAg

A

These are both viral hepatitis proteins which are indicators of the virus being INFECTIOUS

20
Q

Which of Hep A-E is often asymptomatic?

A

Hepatitis C

21
Q

Which of Hep A-E have vaccinations?

A

A, B, D (NB B and D are the same)

22
Q

How is Hepatitis C treated?

A
  • Interferon

- Ribavarin

23
Q

What percentage of those encountering an HCV infection will develop acute hepatitis?

A

25%

The other 75% will have a subclinical course, which can then give rise to a persistent infection and eventually cirrhosis

24
Q

What are some potential extrahepatic problems associated with HCV?

A
  • Arthritis
  • Skin problems
  • Glomerulonephritis
  • Cryoglobulinemia (proteins in the blood)
25
Q

How can a person become infected with hepatitis D?

A

Co-infection: B and D transmitted together at the same time

Super-infection: In a person already harbouring HBV

26
Q

Which of Hep A-E is self-limiting?

A

Hepatitis E

27
Q

In which rare case can HEV become chronic?

A

Immunosuppressed patients

28
Q

In which case can HEV be severe?

A

Pregnant women - associated with fulminant hepatitic failure

29
Q

What are the symptoms of chronic hepatitis?

A

Malaise
Lethargy
Anorexia
Hepatosplenomegaly

30
Q

What are the signs of chronic hepatitis?

A 
Jaundice
Hepatic flap (asterexis) - due to build up of ammonia
Ascites
Spider Naevi
Scratch marks (from itching)
31
Q

LFTs: What does high ALT mean?

A

Viral hepatitis, cocaine use

(NB ALT is a more specific marker of liver inflammation, whereas AST can be raised in disease affecting other organs, such as skeletal or cardiac)

32
Q

LFTs: What does high AST mean?

A

Alcoholic liver disease, metabolic toxins, cirrhosis

33
Q

LFTs: What does high ALP mean?

A

Pathology affecting the cells lining the biliary ducts, bile canaliculi and bones

34
Q

LFTs: What does high GGT mean?

A

Injury to either hepatocytes or biliary epithelial cells (sensitive but lacks specificity)

35
Q

LFTs: What does low albumin mean?

A

If below 20, it is an indicator of chronic hepatitis, as its levels change slowly in response to damage to the synthetic function of the liver

36
Q

When performing a liver screen what tests are done?

A

AST, coeliac screen, hepatitis scree, alpha1antitrypsin, alphafetoprotein, ferritin, coagulation, CK, TFT, autoantibodies, immunoglobuilins, caeruloplasmin (copper carrying protein), EBV/CMV

37
Q

Where are varices commonly found?

A

NB Varices = abnormally dilated blood vessels with tortuous course, in this case due to portal hypertension

Found in stomach, oesophagus, rectum

38
Q

What is the structure of Hep A,C,D,E?

A

ssRNA

39
Q

What is the structure of Hep B?

A

dsDNA

40
Q

Which of Hep A-E have envelopes?

A

Hep B,C,D (those that have a chronic course)

41
Q

Which of Hep A-E have a carrier state?

A

Hepatits B, C

42
Q

Which virus can be caught from eating contaminated pork?

A

Hepatitis E

43
Q

Which virus can be caught from eating undercooked/unclean shellfish?

A

Hepatitis A

44
Q

Describe the typical presentations of a bacterial hepatitis and its pathogens

A

a) Usually formation of a pyogenic liver abscess, due to E.coli or Klebsiella
b) Acute hepatitis due to Neisseria
c) Chronic/granulomatous hepatitis due to mycobacteria

45
Q

What is Twinrix?

A

Twinrix is a vaccine that provides active immunity against both the hepatitis A and hepatitis B viruses. It is given in a series of 3 injections on the same schedule as the hepatitis B vaccine: an initial dose followed by doses at 1 month and 6 months.

This is not routine.

3RD YEAR - Infectious Diseases (16 decks)

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