Hepatitis

Question 1

What is the global and local relevance of Hep B?

Answer 1

1/1000 people in the UK

5-8% of global population

Question 2

What is the global and local relevance of Hep C?

Answer 2

1/200 people in the UK most go whom don’t know
3% of global population
On the rise

Question 3

What is hepatitis?

Answer 3

Inflammation of the liver

Question 4

How can infection cause inflammation of the liver?

Answer 4

Systemic infections may cause co-latteral liver damage e.g. CMV, EBV and VZV
Hepatitis viruses replicate in hepatocytes and destroy them- a much more direct attack.

Question 5

Are Hep C and B chronic or acute?

Answer 5

Chronic

Question 6

How is hepatitis B spread?

Answer 6

Blood / sex/ vertical

Question 7

How is hepatitis C spread?

Answer 7

Blood / sex/ vertical

transfusions pre 1991
HIV increases risk of sexual transmission
>90% in UK are IV drug users

Question 8

Compare incubation periods fro Hep B and C.

Answer 8

Hep B 6 wks-6 months

Hep C 6-12 wks

Question 9

Outline the general structure of Hep B.

Answer 9

Enveloped double stranded DNA virus

Question 10

Is Hep C RNA or DNA and enveloped or not?

Answer 10

ssRNA enveloped

Question 11

Whats tested in LFTs?

Answer 11

Bilirubin 
ALT
AST 
ALP- raised in biliary tract damage (suggest jaundice is post hectic in cause)
Albumin 
Coagulation - PT

Question 12

What are symptoms of acute hep B?

Answer 12

Jaundice
Anorexia
Fatigue 
Arthralgia 
Nausea and Vomiting

Question 13

What percentage of children who catch Hep B retain chronic infection into adulthood?

Answer 13

10%

Question 14

Outline serology for Hep B.

Answer 14

HBsAg- surface antigen in 6/53

HBeAG- e antigen appears and suggests highly infectious

HBcAg- core antigen
HBcAb- core antibody IgM (first antibody to show)

HBeAb- decreases the e antigen so reduces infectivity

HBsAb- last antibody to appear but is vital for clearance.

HBcAb- IgG core antibody remains for life

Question 15

How do we define a Hep B case as being chronic?

What are these people at risk of?

Answer 15

Retained HBsAg at 6 months

Risk of hepatocarcinoma and cirrhosis.

Question 16

How do you treat chronic Hep B?

Answer 16

Life long anti viral to stop replication

Question 17

Why do some people have chronic hep B but not require treatment?

Answer 17

Inactive carriers have a low viral load, normal LFT and no signs of hepatic damage

Question 18

What is delivered in the Hep B vaccine?

Answer 18

HBsAg - 3 doses + a booster if needed

Patients develop HBsAb need >100 for long term protection.

Question 19

What percentage of Hep C go chronic?

Answer 19

80%

Question 20

Decompensated liver disease, hepatocellular carcinoma, death or needing liver transplantation are all side effects of what?

Answer 20

hep C chronic

Question 21

What percentage of people with Hep C get symptoms and if so what are they?

Answer 21

20% (hence a lot untested)

Fatigue, anorexia, nausea and abdo pain

Question 22

What serology test do we do if Hep C is suspected?

Answer 22

Anti- Hep C antibody (life long retention, but not protective)

Viral PCR- tells you if Hep C is current or chronic

Question 23

Which hepatitis can we treat?

Answer 23

Hep C

Question 24

How is Hep C treated?

Answer 24

8-12 week course of antivirals which works to cure in >90% of cases but is hugely expensive £20,000-£60,000 per course and is not protective in the future.

Question 25

On the ward a colleague gets a needle stick injury from a patient who is positive for HIV, Hep B and Hep C- list the risk of developing each individually.

Answer 25

1/300-HIV
1/30- Hep C
1/3- Hep B (thats why we vaccinate- greatly reduces this)

Question 26

What do you do if there is a needle stick injury?

Answer 26

First aid- bleed and wash out the wound. 
Ask px for blood to test.
Test HCW effected
Inform occupational health 
Check vaccination status of HCW
Assess risk and need for PEP for HIV