Hepatitis Flashcards
what type of virus is hepatitis A?
RNA virus
how is hep A spread?
feacal-oral or shellfish. (travellers - Africa and S America)
what are the symptoms of hep A? (8)
- fever
- malaise
- anorexia
- nausea
- hepatosplenomegaly
- adenopathy
- jaundice (rare in children)
- arthralgia (then)
what do the blood tests show in hep A?
AST / ALT / IgG / IgM
AST and ALT rise 22-40 days after exposure (ALT may be more then >1000 micro/L) returning to normal over 5-20 weeks.
IgM rises from day 25 and means recent infection.
IgG is detectable for life.
what is the treatment for hep A?
supportive
avoid alcohol
rarely interferon alpha for fulminant hepatitis
what is the vaccine like?
inactivated viral protein
what is the prognosis?
usually self limiting.
Fulminant hepatitis is rare. chronically doesn’t occur.
what is fulminant hepatitis?
massive necrosis of liver parenchyma and decrease in liver size (acute yellow atrophy) that usually happens after infection with certain hep viruses or drug induced or exposure to toxic agents.
what type of virus is hep B virus?
DNA virus.
how is hep B spread? (4)
blood products
IV drug abusers (IVDU)
sexual
direct contact
who are those in risk of hep B?
IV drug users and sexual partners / carers
health workers
haemophiliacs
men who have sex with men
haemodyalysis ( and chronic renal failure)
sexually promiscuous
foster carers
close family members of a carrier or case
staff or residents of institutions / prisons
babies of HbsAg +ve mothers
adopted children from endemic areas
what are the signs of hep B?
(resembles hep A but urticaria and arthralgia commoner)
- nausea
- malaise
- fever
- anorexia
- jaundice (rare in children)
- arthrlagia
- adenopathy
- hepatosplenomegaly
when is HBsAg present in hep B?
(surface antigen)
present for 1-6 months after exposure
when is HBeAg present in hep B?
(e antigen)
present for 1.5 - 3 months after acute illness and implies high infectivity.
what does HBsAg who’s if persisting for more than 6 months
it defines carrier status and occurs in 5-10% of infections.
biopsy may be indicated unless ALT and HBV and DNA < 2000 iu/mL
what does antibodies to HBcAg (anti HBc) imply?
past infections
what do antibodies to HBsAg (anti-HBs) alone imply?
vaccination.
what allows monitoring of response to therapy?
HBV PCR.
when is vaccination usually given?
passive immunisation (specific anti-HBV immunoglobulin) may be given to non-immune contacts after high-risk exposure.
what are the complications of hep B?
- fulminant hepatic failure
- cirrhosis
- HCC
- cholangiocarcinoma
- crysgloblinarmia
- membranous nephropathy
- polyaarthrtis nodosa
how do you treat Hep B?
- avoid alcohol
- immunise sexual contacts
- refer all chronic liver inflammation (e.g. ALT more than 30)
- cirrhosis
- HBV DNA > 2000 IU/ml for antivirals (choice is 48 weeks PEG interferon alpha - 2a vs long term but better tolerated nucleoside analogues e.g. tenoficir, endtacait)
- the aim is to clear HBsAg and precent cirrhosis and HCC
(risk is increased if HbAg and HBeAg +ve)
what type of virus if hepatitis C virus?
RNA flavivirus
how is hep C spread?
blood:
- transfusion
- IV drug abuse
- sexual contact
what is early infection of hep C usually like?
its often mild/asymptomatic.
around 85% develop silent chronic infection. around 25% get cirrhosis in 20 yer olds - of these less than 4% get hepatocellular cancer (HCC)/yr.
what are the risk factors for progression?
- male
- older
- high viral load
- use of alcohol
- HIV
- HIB
what tests would you do for Hep C?
LFT = AST:ALT < 1:1 until cirrhosis develops
Anti-HCV antibodies confirm exposure
HCV-PCR confirms ongoing infection/chornicity
liver biopsy or non-invasive elastography if HCV-PCR +ve to assess liver damage and need for treatment
determine HCV genotype (1-6)
main treatment for hep C?
quit alcohol.
what are other complications of Hep C?
- glomerulonephritis
- cyroglubulinaemia
- thyroiditis
- autoimmune hepatitis
- PAN
- polymyositis
- porphyria cutaneia tarda
what type of virus is Hep D?
an incomplete RNA virus
Needs HBV for its assembly.
what co infection do 5% of HDV patients have?
HBV
what could HDV cause?
acute liver failure / cirrhosis
when do you ask for Anti-HDV antibody test?
if HBsAg is +ve
what is a treatment option?
if interferon alpha has limited success, liver transplantation may be needed
what type of virus is hep E?
RNA virus (similar to HAV)
what is hep E common in?
older men and commoner than hep A in UK
mortality is high in pregnancy
associated with pigs.
what is diagnosis of hep E done by?
serology
what are other infective cases of hepatitis?
- EBV
- CMV
- leptospirosis
- malaria
- Q fever
- Syphillis
- yellow fever
look at table in notes.