Hepatitis Flashcards
What is a key symptom in all forms of hepatitis?
Jaundice with hepatic tenderness
What are the clinical features of hepatitis A? How long is the incubation?
Fever Malaise Anorexia Nausea Vomiting Upper abdo pain
28 day incubation
Jaundice may develop 3-10 days after other symptoms
- dark urine due to conjugated bilirubin
How does Hep A spread? When are patients infectious?
Faecal-oral
- food or water
- known in MSM and PWID
Most infectious around a week before onset of jaundice and for a few days after
How is Hep A diagnosed and treated? What is the prognosis?
Anti-HAV IgM antibodies - serology
No specific treatment - supportive
Recovery may be slow with prolonged fatigue, but death is rare
- no chronic liver damage
What are the clinical features of hepatitis B?
Anorexia Lethargy Nausea Fever Abdo discomfort Arthralgia Urticarial skin lesions All may precede jaundice and dark urine
How is hepatitis B spread? Who are the at-risk groups?
Vertical
Sexual, needlestick
PWID
Multiple sexual partners
Immigration from endemic regions
Patients with learning difficulties in residential care
Those on haemodialysis or with haemophilia
Sexual partner of anyone in the above groups
Babies of those at risk
Tattooing/piercing with non-sterile equipment
How is acute Hep B diagnosed?
Hep B surface Antigen detected in serum on presentation - but may have disappeared in later stages
- Anti HB core IgM antibodies should then be present - will be the only marker during ‘window period’ of surface antigen disappearing and surface antibodies appearing
After recovery, Anti HB surface antibodies will appear (weeks)
When is Hep B considered chronic? Who is at risk, and what are some long-term complications?
Persistence of HBsAg in the serum for more
than 6 months
Most infants
Some children
More in males
Immunodeficient
Chronic liver disease
Less commonly, membranous glomerulonephritis and
polyarteritis nodosa
Cirrhosis and hepatoma are long-term sequelae of chronic untreated liver disease
What is the prognosis for chronic hepatitis B?
Cirrhosis or hepatoma in 25% of those with chronic Hep B infection
How is Hep B treated? And who gets treated?
In acute, usually only supportive
- 95% will have seroconversion so can develop resistance to the virus
All those with cirrhosis, or with 2 of 3 of:
- HBV DNA high
- raised ALT
- significant liver inflammation or fibrosis
Should get antiviral therapy (nucleoside/nucleotide analogues) - inhibit viral replication e.g. entecavir
Transplant for advanced cirrhosis/hepatoma
How is Hep B infection prevented?
Immunisation - three doses at 0, 1 and 6 months
- passive immunity can also be given via HBIG, particularly for post-exposure protection
How does hepatitis C present?
Acute usually subclinical/mild Vague symptoms in 20% - malaise - anorexia - fatigue
What is the prognosis of hepatitis C?
Most develop chronic infection, with some of these people (20-50%) developing cirrhosis/hepatoma decades later
How is Hep C spread? Who is at risk?
Blood-borne flavivirus
Not spread efficiently via sexual contact
Vertical transmission also low
High incidence in PWID, people who received untreated blood products
How is Hep C diagnosed?
HCV antibody test - may not be detectable for months, or may have false positives/negatives
Detection of HCV antigen and RNA possible
How is Hep C managed?
Spontaneous clearance possible in acute infection
- not necessary to start therapy
Treat anyone with chronic infection
Alcohol abstention advised
What are the clinical features of hepatitis D?
Same as Hep B as it is never found without Hep B
- makes Hep B more severe
IVDU most common form of transmission
Co-infection if present from start of Hep B, otherwise ‘superinfection’
How is Hep D diagnosed and treated?
Presence of antibodies, RNA, antigen - serology
Higher level of anti Heb B core IgM in co-infection
Pegylated alpha-interferon - may need for several years
Liver transplant if severe
Can prevent Hep D if prevent Hep B
What are the clinical features of Hep E including incubation?
Incubation ~40 days
Clinically resembles Hep A, but usually worse than normal in pregnant women
Extra-hepatic features
- arthritis, anaemia, neurological manifestations
Where is Hep E found?
Endemic in developing AND developed countries
- possibly most common cause of acute viral hepatitis
Faecal-oral spread
- poorly cooked pork?
How is Hep E diagnosed and treated?
Serology for IgG/M and RNA
Mostly self-limiting - no specific treatment available
Passive HNIG immunisation has no benefit
