Hepatitis Flashcards
How does blood get to the liver?
Portal vein (80%) Hepatic artery (20%)
Why do patients with chronic hepatitis get gynecomastia?
The scarred liver is unable to process hormones, in this case testosterone, so it is converted to oestrogen and builds up in breast tissue
Name some functions of the liver
- Cleans blood
- Regulates hormone
- Controls blood glucose levels via glycogen storage
- Produces bile
- Helps with blood clotting
- Produces important proteins
- Processes toxins
For hepatitis to be acute, how many months has it occurred for?
Less than 6 months
What is fulminant hepatitis?
Severe impairment of hepatic function or severe necrosis of hepatocytes in absence of pre-existing liver disease
Which viruses can cause hepatitis?
Hep A,B,C,D,E, EBV, Yellow fever, HSV, CMV
Describe the route of transmission of hepatitis A-E
A,E - feco-oral
B,C,D - via blood and body fluids
Which viruses can lead to chronic hepatitis?
B,C,D (although D requires B)
C is the most common
What are the symptoms of acute hepatitis?
Fever and chills Headache Fatigue and weakness Nausea and vomiting Dark urine and jaundice
Which of Hep A-E is very common in children?
Hepatitis A - as we get older we become immune to it so don’t contract the virus.
Which of Hep A-E is most commonly spread through unprotected sex?
Hepatitis B
Which of Hep A-E is most commonly spread through needles and blood-blood contact?
Hepatitis C
How can Hepatitis B be prevented?
- Vaccination
- Hep B immunoglobulin-exposed within 48h of incident (neonates)
- Screening of blood donors
How is Hepatitis B treated?
- Interferon Alpha
- Lamivudine
- Adefovir (Hepsera)
What is HBsAg?
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.
What is anti-HBs?
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.
What is IgG anti-HBc? (also anti-HBe)
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.
What is IgM anti-HBc?
IgMantibodytohepatitisB core antigen (IgM anti-HBc): Positivity indicates recent infection with hepatitis B
virus (<6 mos). Its presence indicates acute infection.
What is HBeAg/HBcAg
These are both viral hepatitis proteins which are indicators of the virus being INFECTIOUS
Which of Hep A-E is often asymptomatic?
Hepatitis C
Which of Hep A-E have vaccinations?
A, B, D (NB B and D are the same)
How is Hepatitis C treated?
- Interferon
- Ribavarin
What percentage of those encountering an HCV infection will develop acute hepatitis?
25%
The other 75% will have a subclinical course, which can then give rise to a persistent infection and eventually cirrhosis
What are some potential extrahepatic problems associated with HCV?
- Arthritis
- Skin problems
- Glomerulonephritis
- Cryoglobulinemia (proteins in the blood)
How can a person become infected with hepatitis D?
Co-infection: B and D transmitted together at the same time
Super-infection: In a person already harbouring HBV
Which of Hep A-E is self-limiting?
Hepatitis E
In which rare case can HEV become chronic?
Immunosuppressed patients
In which case can HEV be severe?
Pregnant women - associated with fulminant hepatitic failure
What are the symptoms of chronic hepatitis?
Malaise
Lethargy
Anorexia
Hepatosplenomegaly
What are the signs of chronic hepatitis?
Jaundice Hepatic flap (asterexis) - due to build up of ammonia Ascites Spider Naevi Scratch marks (from itching)
LFTs: What does high ALT mean?
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)
LFTs: What does high AST mean?
Alcoholic liver disease, metabolic toxins, cirrhosis
LFTs: What does high ALP mean?
Pathology affecting the cells lining the biliary ducts, bile canaliculi and bones
LFTs: What does high GGT mean?
Injury to either hepatocytes or biliary epithelial cells (sensitive but lacks specificity)
LFTs: What does low albumin mean?
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
When performing a liver screen what tests are done?
AST, coeliac screen, hepatitis scree, alpha1antitrypsin, alphafetoprotein, ferritin, coagulation, CK, TFT, autoantibodies, immunoglobuilins, caeruloplasmin (copper carrying protein), EBV/CMV
Where are varices commonly found?
NB Varices = abnormally dilated blood vessels with tortuous course, in this case due to portal hypertension
Found in stomach, oesophagus, rectum
What is the structure of Hep A,C,D,E?
ssRNA
What is the structure of Hep B?
dsDNA
Which of Hep A-E have envelopes?
Hep B,C,D (those that have a chronic course)
Which of Hep A-E have a carrier state?
Hepatits B, C
Which virus can be caught from eating contaminated pork?
Hepatitis E
Which virus can be caught from eating undercooked/unclean shellfish?
Hepatitis A
Describe the typical presentations of a bacterial hepatitis and its pathogens
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
What is Twinrix?
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.
