Hepatitis Flashcards
How is Hep A transmitted
Faecal-oral
What is the incubation of Hep A
28 days
Most infective a week before symptoms appear till a few days after
What are the symptoms of Hep A
Mild Fever Malaise Anorexia N+V Abdominal pain Jaundice Dark urine / pale stools HSM
Who is at risk of Hep A
MSM PWID Sewage workers Haemophiliacs Travel Chronic liver disease
How do you diagnose Hep A
IgM Anti-HAV
IgG reflects past exposure + immunity
Elevated liver enzymes
What is the Rx of Hep A
No specific treatment
Human Ig prophylaxis
Vaccine (active if high risk)
Complications of Hep A
No chronic damage
Prolonged fatigue / jaundice
How is Hep B transmitted
Vertical - babies
Horizontal - blood / sexual / body fluids
Who is high risk of Hep B and advised active immunisation?
PWID MSM Multiple partners Immigration Haemodialysis / haemophiliac Babies with risk mother Close contacts Health care personal Tattoos / piercings
Explain hepatitis B virus virology?
HbsAg = surface antigen
HBcAg = core antigen which secretes E antigen detected in blood
Viral DNA
E antigen and viral DNA = highly infectious
What is the incubation of Hep B
Weeks - 6 months
What are the symptoms of Hep B
Fever Lethargy Anorexia N+V Abdominal pain Arthralgia Skin lesion Dark urine Jaundice
What is the risk of chronic infection with Hep B?
Neonates = 90% chronic
In adults = 90% recovery
Fulminant Hepatic Necrosis <1%
- DIC
- Encephalpathy
What is chronic Hep B
Presence of HBsAg > 6 months
More likely if immunocompromised
Complications of chronic Hep B
Cirrhosis Hepatoma Membranous GN Polyarteritis Nodosa Cryroglobulinaemia Vasculitis rash
EPP restrictions with Hep B
Can’t perform if
HBeAg / HBsAg +ve
Viral DNA >1000
Hep C
How do you diagnose Hep B
Increased liver enzymes
Anti HbC IgM + IgG
How do you treat Hep B
Anti-viral if
- cirrhosis
- HBV >2000
- increased ALT
- significant inflammation
Hb IG
Pegylated interferon
Liver transplant
Prophylactic Rx of Hep B
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
How is Hep C transmitted
Blood borne
Very low risk of sexual
RF for hep C transmission
PWID
HAemophiliac
Blood products / transfusion / dialysis
Tattoo / piercing
Symptoms of Hep C
Mild Malaise Anorexia Fatique Jaundice
Risk of chronic infection with hep C
Develops in most
Complications of Chronic
Cirrhosis
Hepatoma
Can be asymptomatic for years
What accelerates Hep C
Alcohol
How do you diagnose Hep C
Increased liver enzymes
No IgM
IgG not detected for months
HVC antigen detection
How do you treat Hep C
Pegylated interferon
RIbavarin
No PEP or vaccine
Response to Rx
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
How is Hep D transmitted
Parenteral - PWID
Little vertical / sexual
Need HBV
Who is at risk of Hep D
PWID
How do you diagnose Hep D
IgM and IgG
Rx of Hep D
Pegylated interferon
Liver transplant
prevent Hep B
What are the chronic complications of hep D
Chronic Hep B
Cirrhosis
What are the symptoms of Hep D
More severe Hep B symptoms
How is Hep E transmitted
Faecal-oral
What is the incubation for Hep E
40 days
What are the symptoms of Hep E
Resembles HVA High mortality in pregnant women Increased transaminase Arthritis Anaemia Neurological
What are the complications of Hep E
Persistent infection in immunocompromised
Liver failure if chronic liver disease
How do you diagnose Hep E
IgG and IgM
No specific test so under diagnosed
How do you treat Hep E
Mostly self-limiting
No licensed treatment
Vaccine in China
What infections are associated with Hepatitis
Rubella CMV / EBV HSV Enterovirus VZV Yellow fever Leptospirosis Q fever Psittacosis
Transmission of Hep B
Blood borne Needles Sexual Vertical Horizontal
What should a pregnant lady with Hep B have given to her baby?
Hep B specific antigen
Ig 1, 2, 3 and 12
What is Hep B e a measure of?
Infectivity
Is hepatitis a notifiable disease?
Yes
Which hepatitis cannot be vaccinated against?
Hep C
Complication of Hep C
Liver cirrhosis
HCC
Which hepatitis may cause chronic disease?
Hep B
What hepatitis infections cause HCC?
B
C
What vaccine should be offered to patients with chronic hepatitis?
Pneumococcal
How to monitor Hep C infection
Viral load
