HEpatitis Flashcards by rebecca duff

How are each of the hepatitis viruses transmitted?

Most can be transmitted parenterally i.e. by IVDA or blood products (except E and A only rarely)

A & E are mostly Faecal-Oral

B & C can also be transmitted sexually & perinatally

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How long does hepatitis take to incubate?

A - 28days
E - 40days
C - 60days
B - 90 days

D comes with Hep B

All have a wide range of incubation time so can come on as short as 10 days (A) or as long as 160 days (B & C)

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What type of hepatitis is commonest in travellers & immigrants?

A, B & E

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What type of hepatitis is commonest in IVDUs?

B, C & D (remember D comes with B)

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What type of hepatitis is commonest in people with multiple sexual partners (esp MSM)?

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What type of hepatitis can sewage workers get more of?

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What type of hepatitis is most likely in healthcare workers?

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What type of hepatitis is commonest in people recieiving blood products?

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How often does hepatitis progress to chronic infection?

60-80% in Hep C

E will if immunocompromised

B rarely does

A never does

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What types of hepatitis are likely to cause cirrhosis?

All except A can

E only if immunocompromised

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What types of hepatitis are ass with hepatoma formation?

B & C

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How do you diagnose hepatitis?

With viral serology so IgM & IgG

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Which hepatitis does not have detectable IgM Abs?

You can do Antigen and RNA detection

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What vaccines are available for each hepatitis?

Inactivated vaccine for A (only if in a high risk group)

Recombinant vaccine for B ( HbsAg)
(also covers D)

No vaccine available for C & E (e is available in china)

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What passive immunisation can we offer for hepatitis?

To people with exposure risk such as close contacts of a Hep sufferer:

a = Human Normal IG

B = Hep B IG

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Which hepatitises are DNA vs RNA?

All are RNA viruses except B

What symptoms tend to come with hepatitis?

Fever
Anorexia
Fatigue/lethargy
N&V
Abdo pain
Jaundice

Can also suffer from arthralgia, urticaria

Fulimative hepatitis can result in complications such as encephalopathy, DIC etc.

How do we treat Hep A?

Supportively, most will eventually recover with no lasting damage

How do we treat Hep B?

Antiviral:

Pegylated alpha-interferon SC for 12 months
5 Nuceloside analogues e.g. Tenofovir

How do we treat Hep C?

Pegylated Alpha-interferon

Ribavarin

Treating Hep D?

Pegylated Alpha-interferon

How do we treat Hep E?

Often found in the immunocompromise so minimising/reversing this may be all that’s needed

Also Ribavirin

How do we prevent hepatitis infections?

Screen all blood products
Screen liver transplants
Passive & Active immunisation
Hygiene

Encouraging safe sex & needle use

What happens to a healthcare worker who’s Hepatitis +ve?

Not allowed to perform Exposure Prone Procedures(EPPs)

As a healthcare worker what should you do after percutaneous exposure to blood/bodily fluids?

1) Encourage bleeding 2) Wash thoroughly with hot running water and soap 3) Waterproof plaster 4) Report to supervisor

How do we manage risk of BBVs in an exposed healthcare worker?

Testing of the source patient Counselling Store blood at time of injury Testing at 3 & 6 months Active or passive immunisation depending on immunisation history

What are the different types Hep B Antigen?

HbsAg = used for identifying acute & chronic infection HbcAg indicates recent infection HbeAg & HBV-DNA both indicate actively replicating virus

At what point is Hep B considered Chronic?

When HbsAg is detectable for >6months

What percentage of people with Hep B become chronic?

Infants = 90% Kids = 40% Adults - 5-10%

What's the particular danger of Hep B patients with prolonged HbsAg & HbeAg?

At a higher risk of sequelae incl: - Chronic liver disease - Cirrhosis - Hepatoma

Who should be vaccinated against Hep B?

- Healthcare workers - Close contacts - Some police/emergency services - IVDUs - MSM & sex workers - Some chronic liver disease/renal failure - Inmates

What's the big danger of Hep c?

Has the highest rate of progression to chronic liver disease & cirrhosis (60-80%)

What tests can you do for Hep C other than IgM?

Serum ALT for liver damage | HCV RNA

How can we prevent transmission to neonates?

Treat mom | Give immediate active & passive immunisation to neonate after birth

I've only covered what I found to be the most important stuff as exams are in 7 days (LUL)

So i'd advise reading the booklet if you have time

what blood test is indicative of acute infection in Hep B

Anti- HBc IgM

How do you know if a patient is a good responder to HBV vaccine?

Over 100mlU/ml of anti HBs If 10-100 moderate responder

How do we investigate hepatitis?

- Serology - LFTSs - US and liver biopsy

what is important to exclude in the management of hepatitis?

Hepatic carcinoma