Hepatitis Flashcards
What is the cause of Hepatitis B?
Hepatitis B virus, Hepadnavirus - partially double-stranded virus
What is the incubation period of Hepatitis B?
1-6 months
Define chronic Hepatitis B
Chronic Hepatitis B infection is the persistence of serum HBsAg for more than 6 months
How long does acute Hepatitis B generally lasts for?
1-3 months
What type of virus causes Hepatitis C?
Hepacivirus, ssRNA flaviviridae
How is Hepatitis B transmitted?
Hepatitis B is transmitted via blood or body fluids, such as through the sharing of needles, receiving of infected blood products during blood transfusions, tattoos and body piercings or acupuncture, sexual intercourse or mother-to-baby transmission.
Not transmitted by social contact such as kissing or through sharing towels. There is a small risk of infection from sharing of toothbrushes and razors.
What is a complication of Acute Hepatitis B infection?
Fulminant Hepatitis, which can progress rapidly into life-threatening liver failure with coagulopathy, encephalopathy and cerebral oedema.
What are the Extra-hepatic manifestations?
Glomerulonephritis, Vasculitis or Polyarteritis
Who are those at high risk of HepB infection?
People who are more likely to be exposed to the virus, such as IV drug users and sex workers, or immigrants from places with high prevalence.
Those who are sexually assaulted, have sustained a needle-stick injury, or are HIV positive.
What are the prodromal symptoms of Hepatitis B? Around how many weeks before jaundice will these symptoms present itself?
Prodromal symptoms: Fever, arthralgia and/or rash
These symptoms can occur 2 weeks before the onset of jaundice.
Are there any changes to the following in a Liver Function Test?
- ALT
- AST
- Alkaline phosphatase
- bilirubin and albumin levels
- Prothrombin time
ALT and AST will increase (~1000-2000IU/L in acute hepatitis, or mildly in chronic hepatitis)
ALT usually more than AST
Alkaline phosphatase, bilirubin and albumin levels, and prothrombin time will not change unless liver disease is severe or advanced.
How is Hepatitis B tested?
Serological testing involves detecting hepatitis B surface antigen (HBsAg) or antibody to hepatitis B core antigen (anti-HBc)
What is the normal vaccination schedule against Hepatitis B infection?
Vaccination for Hepatitis B is given at 0, 1, and 6 months in three doses
What is the rapid immunization schedule? What is the very rapid schedule? When will these schedules be necessary?
0, 1, and 2 months. or within 21 days if very rapid protection is needed.
Usually very rapid protection is needed if there is a needlestick injury or imminent travel to highly endemic areas.
rapid immunisation is needed in babies born to infected mothers.
What is done at the same time as Hepatitis B immunisation for those who are at high risk of being infected?
Serology testing for immunity to Hepatitis B and immunoglobulin prophylaxis is given at the same time as vaccination
When is the preferred/recommended time for immunoglobulin prophylaxis against Hepatitis B given for those at high risk of infection?
Hepatitis B immunoglobulin prophylaxis is preferably given intramuscularly within 48 hours of exposure, and at the same time as the first dose of vaccination.
What does it indicate if an individual is positive for both HBsAg and HBeAg?
Individual is currently infected with Hepatitis B and is highly infectious.
What does it indicate if an individual’s serum tested positive for HBsAg, and positive for anti-HBeAg?
Individual is currently infected with Hepatitis B and is infectious, but have lower infectivity than someone with HBeAg positivity as well.
How long is HBeAg positive for? What does it’s presence indicate?
HBeAg is present for 1.5 to 3 months after acute illness, and often implies high infectivity
What does presence of anti-HBsAg, anti-HBcAg and +/- anti-HBeAg indicate on serology testing?
Indicates immunity from previous infection
What is the incubation period of Hepatitis C and B?
Hepatitis C: 2-6 weeks
Hepatitis B: 1-6 months
What is also suspected if a patient with Hepatitis has jaundice, pale stools and dark urine?
Cholestasis
What are the 3 criteria that confirmed the diagnosis of Hepatitis A?
Confirmed Hepatitis A infection is defined by:
- An acute illness with a discrete onset of symptoms, and
- Jaundice or elevated serum aminotransferase levels, and
- Laboratory-confirmed IgM antibodies to Hepatitis A
What is the incubation period of Hepatitis A?
2-4 weeks, up to 6 weeks
How long does Hepatitis A usually lasts for?
Less than 2 months. It is self-limiting
What are the symptoms of Hepatitis A in the prodromal phase?
Flu-like symptoms such as myalgia, headache, fever, cough, and GI symptoms such as N&V, abdominal pain (or RUQ discomfort), anorexia.
What are the changes in the LFT and blood test results when patient is infected with Hepatitis A?
Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels will be elevated, usually higher than 1000IU/L.
Bilirubin levels may also be elevated, up to 500micromols/L.
Prothrombin time may be prolonged (>5secs).
How many doses are there for monovalent Hepatitis A vaccination? What is the schedule?
monovalent Hepatitis A vaccine is given in 2 doses, at 0 and 6-12 months
How long does the Hepatitis A vaccine provide immunity for?
Hepatitis A vaccine provides life-long protection.
What is done before Hepatitis A vaccination is given to those at high risk of infection?
Hepatitis A serology testing for HepA Immunoglobulin G (HAV-IgG) is first tested to check for existing immunity.
What are the most common causes of HAV, HBV, HCV, HDV and HEV?
HAV - uncooked shellfish HBV - unprotected sex HCV - injections/IV drug users HDV - co-infection with HBV HEV - undercooked pork
