Hepatitis

Question 1

How is Hep A transmitted

Answer 1

Faecal-oral

Question 2

What is the incubation of Hep A

Answer 2

28 days

Most infective a week before symptoms appear till a few days after

Question 3

What are the symptoms of Hep A

Answer 3

Mild 
Fever
Malaise
Anorexia
N+V
Abdominal pain
Jaundice
Dark urine / pale stools
HSM

Question 4

Who is at risk of Hep A

Answer 4

MSM 
PWID
Sewage workers
Haemophiliacs 
Travel
Chronic liver disease

Question 5

How do you diagnose Hep A

Answer 5

IgM Anti-HAV
IgG reflects past exposure + immunity
Elevated liver enzymes

Question 6

What is the Rx of Hep A

Answer 6

No specific treatment
Human Ig prophylaxis
Vaccine (active if high risk)

Question 7

Complications of Hep A

Answer 7

No chronic damage

Prolonged fatigue / jaundice

Question 8

How is Hep B transmitted

Answer 8

Vertical - babies

Horizontal - blood / sexual / body fluids

Question 9

Who is high risk of Hep B and advised active immunisation?

Answer 9

PWID
MSM
Multiple partners
Immigration 
Haemodialysis / haemophiliac
Babies with risk mother
Close contacts
Health care personal 
Tattoos / piercings

Question 10

Explain hepatitis B virus virology?

Answer 10

HbsAg = surface antigen
HBcAg = core antigen which secretes E antigen detected in blood
Viral DNA

E antigen and viral DNA = highly infectious

Question 11

What is the incubation of Hep B

Answer 11

Weeks - 6 months

Question 12

What are the symptoms of Hep B

Answer 12

Fever
Lethargy
Anorexia
N+V
Abdominal pain
Arthralgia 
Skin lesion 
Dark urine
Jaundice

Question 13

What is the risk of chronic infection with Hep B?

Answer 13

Neonates = 90% chronic
In adults = 90% recovery

Fulminant Hepatic Necrosis <1%

• DIC
• Encephalpathy

Question 14

What is chronic Hep B

Answer 14

Presence of HBsAg > 6 months

More likely if immunocompromised

Question 15

Complications of chronic Hep B

Answer 15

Cirrhosis 
Hepatoma
Membranous GN
Polyarteritis Nodosa 
Cryroglobulinaemia 
Vasculitis rash

Question 16

EPP restrictions with Hep B

Answer 16

Can’t perform if
HBeAg / HBsAg +ve
Viral DNA >1000
Hep C

Question 17

How do you diagnose Hep B

Answer 17

Increased liver enzymes

Anti HbC IgM + IgG

Question 18

How do you treat Hep B

Answer 18

Anti-viral if

• cirrhosis
• HBV >2000
• increased ALT
• significant inflammation

Hb IG
Pegylated interferon
Liver transplant

Question 19

Prophylactic Rx of Hep B

Answer 19

Active immunisation (vaccine) given to babies
HBIG if no response to vaccine
HBIG and vaccine for PEP
Given if on chemo as risk of reactivation and family and sexual contacts

Question 20

How is Hep C transmitted

Answer 20

Blood borne

Very low risk of sexual

Question 21

RF for hep C transmission

Answer 21

PWID
HAemophiliac
Blood products / transfusion / dialysis
Tattoo / piercing

Question 22

Symptoms of Hep C

Answer 22

Mild 
Malaise
Anorexia
Fatique 
Jaundice

Question 23

Risk of chronic infection with hep C

Answer 23

Develops in most

Question 24

Complications of Chronic

Answer 24

Cirrhosis
Hepatoma
Can be asymptomatic for years

Question 25

What accelerates Hep C

Answer 25

Alcohol

Question 26

How do you diagnose Hep C

Answer 26

Increased liver enzymes No IgM IgG not detected for months HVC antigen detection

Question 27

How do you treat Hep C

Answer 27

Pegylated interferon RIbavarin No PEP or vaccine

Question 28

Response to Rx

Answer 28

Depends on age / gender / liver disease and amount of virus Non responder Viral breakthrough = respond initially Relapser = virus returns when Rx stopped Sustained viral response = undetectable virus

Question 29

How is Hep D transmitted

Answer 29

Parenteral - PWID Little vertical / sexual Need HBV

Question 30

Who is at risk of Hep D

Answer 30

PWID

Question 31

How do you diagnose Hep D

Answer 31

IgM and IgG

Question 32

Rx of Hep D

Answer 32

Pegylated interferon Liver transplant prevent Hep B

Question 33

What are the chronic complications of hep D

Answer 33

Chronic Hep B | Cirrhosis

Question 34

What are the symptoms of Hep D

Answer 34

More severe Hep B symptoms

Question 35

How is Hep E transmitted

Answer 35

Faecal-oral

Question 36

What is the incubation for Hep E

Answer 36

40 days

Question 37

What are the symptoms of Hep E

Answer 37

``` Resembles HVA High mortality in pregnant women Increased transaminase Arthritis Anaemia Neurological ```

Question 38

What are the complications of Hep E

Answer 38

Persistent infection in immunocompromised | Liver failure if chronic liver disease

Question 39

How do you diagnose Hep E

Answer 39

IgG and IgM | No specific test so under diagnosed

Question 40

How do you treat Hep E

Answer 40

Mostly self-limiting No licensed treatment Vaccine in China

Question 41

What infections are associated with Hepatitis

Answer 41

``` Rubella CMV / EBV HSV Enterovirus VZV Yellow fever Leptospirosis Q fever Psittacosis ```

Question 42

Transmission of Hep B

Answer 42

``` Blood borne Needles Sexual Vertical Horizontal ```

Question 43

What should a pregnant lady with Hep B have given to her baby?

Answer 43

Hep B specific antigen | Ig 1, 2, 3 and 12

Question 44

What is Hep B e a measure of?

Answer 44

Infectivity

Question 45

Is hepatitis a notifiable disease?

Answer 45

Yes

Question 46

Which hepatitis cannot be vaccinated against?

Answer 46

Hep C

Question 47

Complication of Hep C

Answer 47

Liver cirrhosis | HCC

Question 48

Which hepatitis may cause chronic disease?

Answer 48

Hep B

Question 49

What hepatitis infections cause HCC?

Answer 49

B | C

Question 50

What vaccine should be offered to patients with chronic hepatitis?

Answer 50

Pneumococcal

Question 51

How to monitor Hep C infection

Answer 51

Viral load