Hepatitis Flashcards
Define anicteric hepatitis
symptoms but no jaundice
Define icteric hepatitis
symptoms with jaundice
Define fulminant hepatitis
severe jaundice with hepatic failure and high mortality
what enzymes’ levels will be raised in acute hepatitis and why?
alanine aminotransferase and
aspartate aminotransferase because
excess quantities are released by damaged hepatocytes
Who is likely to be Infected with hept A?
children <5yrs - anicteric or subclinical,
adults too, gets worse with age
presentation of hept A?
fever, malaise, anorexia, n/v, upper abdominal pain, jaundice and dark urine 3-10 days post incubation
How is hept A spread?
faecal-oral route,
faecal-contaminated food/water,
sex,
injecting drugs
what antibodies are present in serum in the first 3 months of infection with hept a?
HAV IgM antibodies
Prophylaxis treatment of hept a?
Human normal immunoglobulin (gives protection for 4 months)
Who should receive hept a immunisation?
sewage workers, seronegative haemophiliacs, MSM with multiple sexual partners, travellers to endemic areas, people who inject drugs (PWID), chronic liver disease
prognosis of hept a?
recovery is slow but very rare to die from fulminant hept a
Presentation of acute hepatitis B?
anorexia, lethargy, nausea, fever, abdominal discomfort, arthralgia, urticarial skin lesions, jaundice, dark urine
After infection with hepatitis B, how long until symptoms appear?
few weeks- 6 months
What are the 3 viral forms of hept b seen in blood?
infectious viral particles,
non-infectious spheres,
tubules which consist of hept b surface antigen
What are the major markers for identifying hepatitis B?
serum HBeAg and HBV-DNA show viral replication and HBsAg (acute and chronic hept B),
HBeAg (chronic hept B)
Routes of transmission of hepatitis B?
vertical,
horizontal (eg sex, needle)
what antibodies indicate recent hept B infection
anti-HBc IgM antibodies
Define chronic HBV infection?
presence of HBsAg in serum for more than 6 months
what long term sequelae are hept B patients at risk of?
chronic liver disease,
membranous glomerulonephritis,
polyarteritis nodosa
indications for anti-viral therapy in patients with hept B and no cirrhosis?
2/3:
HBV DNA >22000 IU/ml,
raised ALT,
significant liver inflammation or fibrosis
Treatment for hepatitis B?
pegylated a-interferon,
entecavir,
tenofovir,
liver transplant
what are the 3 most important ways to prevent HBV infection?
immunisation,
infection control procedures,
screening of blood donors and transplant donors
people who should receive hept b vaccine?
healthcare personnel, travelling to endemic areas, renal dialysis, change sexual partners quickly, PWID, close contact of patient with hept b, select emergency services
most common prognosis of hepatitis C?
chronic HCV infection
presentation of HCV
ususally subclinical, in 20%: malaise, anorexia, fatigue, severe hepatitis, jaundice
Transmission methods of HCV?
blood,
needles (IDU, tattoos, body piercing),
sexual transmission,
mother-to-child
Investigations for HCV?
Serum ALT,
detection of HCV antigen and HCV-RNA
Treatment for HCV?
alcohol abstention,
immunisation for hept A and B,
combination of pegylated a-interferon and ribavirin
What are the 4 response patterns to antiviral treatment?
non-responder,
viral breakthrough,
relapser,
sustained viral response
Hepatitis d is always found with which hepatitis?
B,
thus D is termed a “defective” virus
What are the 2 ways hepatitis D presents?
co-infection (simultaneous infection of hept B and D)
Superinfection (infected with D after B)
Transmission of hepatitis D?
IDU (most common),
blood,
sex
Investigations for hepatitis D?
detect IgG and IgM antibody to HDV, HDV-RNA and HDAg in serum
treatment of hepatitis D?
pegylated a-interferon,
liver transplant
HEV mean incubation period?
40 days
transmission of HEV?
sporadic,
faecal-oral route
exposure to under cooked pig products
what’s the difference between the 4 geontypes of HEV?
1 and 2 cause endemics in developing countries,
3 and 4 worldwide,
3 responsible for sporadic cases
Investigations for hepatitis E?
serological tests for IgG, IgM and HEV-RNA
What can cause hepatitis in the neonate?
prenatal- rubella, cytomegaolvirus
perinatal- cytomegalovirus, HSV, parechovirus and enterovirus)
Non-viral infections that can cause hepatitis?
leptospirosis,
Qfever,
psittacosis/ornithosis
What should you do after percuatneous exposure to blood/ bodily fluids?
encourage bleeding,
wash with soap and water,
waterproof plaste,
report injury
when are health care workers excluded from performing EPP (exposure prone procedures)
Hept B e antigen +ve,
hept B surface antigen +ve and HBV DNA of >1000copies/mL blood,
hept C PCR +ve
which hepatitis virus are spread via faecal-oral route?
Hepatitis A and E
How can hepatitis A be prevented
good personel hygiene, good sanitation, clean water, Human normal immunoglobulin, active immunisation
which hepatitis viruses are spread by infected blood?
Hepatitis B, C, D
How can hepatitis B, C and D be prevented?
Infection control precautions,
screening blood products,
hept B vaccination
what is the clinical significance of prolonged HBsAg and HBeAg carriage
risk of long term sequelae eg chronic liver disease, cirrhosis and hepatoma
what factor is essential for transmission of hepatitis D?
Presence of HBsAg
