Hepatitis

Question 1

what type of virus is hepatitis A?

Answer 1

RNA virus

Question 2

how is hep A spread?

Answer 2

feacal-oral or shellfish. (travellers - Africa and S America)

Question 3

what are the symptoms of hep A? (8)

Answer 3

• fever
• malaise
• anorexia
• nausea
• hepatosplenomegaly
• adenopathy
• jaundice (rare in children)
• arthralgia (then)

Question 4

what do the blood tests show in hep A?

AST / ALT / IgG / IgM

Answer 4

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.

Question 5

what is the treatment for hep A?

Answer 5

supportive
avoid alcohol
rarely interferon alpha for fulminant hepatitis

Question 6

what is the vaccine like?

Answer 6

inactivated viral protein

Question 7

what is the prognosis?

Answer 7

usually self limiting.

Fulminant hepatitis is rare. chronically doesn’t occur.

Question 8

what is fulminant hepatitis?

Answer 8

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.

Question 9

what type of virus is hep B virus?

Answer 9

DNA virus.

Question 10

how is hep B spread? (4)

Answer 10

blood products
IV drug abusers (IVDU)
sexual
direct contact

Question 11

who are those in risk of hep B?

Answer 11

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

Question 12

what are the signs of hep B?

Answer 12

(resembles hep A but urticaria and arthralgia commoner)

• nausea
• malaise
• fever
• anorexia
• jaundice (rare in children)
• arthrlagia
• adenopathy
• hepatosplenomegaly

Question 13

when is HBsAg present in hep B?

Answer 13

(surface antigen)

present for 1-6 months after exposure

Question 14

when is HBeAg present in hep B?

Answer 14

(e antigen)

present for 1.5 - 3 months after acute illness and implies high infectivity.

Question 15

what does HBsAg who’s if persisting for more than 6 months

Answer 15

it defines carrier status and occurs in 5-10% of infections.
biopsy may be indicated unless ALT and HBV and DNA < 2000 iu/mL

Question 16

what does antibodies to HBcAg (anti HBc) imply?

Answer 16

past infections

Question 17

what do antibodies to HBsAg (anti-HBs) alone imply?

Answer 17

vaccination.

Question 18

what allows monitoring of response to therapy?

Answer 18

HBV PCR.

Question 19

when is vaccination usually given?

Answer 19

passive immunisation (specific anti-HBV immunoglobulin) may be given to non-immune contacts after high-risk exposure.

Question 20

what are the complications of hep B?

Answer 20

• fulminant hepatic failure
• cirrhosis
• HCC
• cholangiocarcinoma
• crysgloblinarmia
• membranous nephropathy
• polyaarthrtis nodosa

Question 21

how do you treat Hep B?

Answer 21

• 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)

Question 22

what type of virus if hepatitis C virus?

Answer 22

RNA flavivirus

Question 23

how is hep C spread?

Answer 23

blood:
- transfusion
- IV drug abuse
- sexual contact

Question 24

what is early infection of hep C usually like?

Answer 24

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.

Question 25

what are the risk factors for progression?

Answer 25

• male
• older
• high viral load
• use of alcohol
• HIV
• HIB

Question 26

what tests would you do for Hep C?

Answer 26

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)

Question 27

main treatment for hep C?

Answer 27

quit alcohol.

Question 28

what are other complications of Hep C?

Answer 28

• glomerulonephritis
• cyroglubulinaemia
• thyroiditis
• autoimmune hepatitis
• PAN
• polymyositis
• porphyria cutaneia tarda

Question 29

what type of virus is Hep D?

Answer 29

an incomplete RNA virus

Needs HBV for its assembly.

Question 30

what co infection do 5% of HDV patients have?

Answer 30

HBV

Question 31

what could HDV cause?

Answer 31

acute liver failure / cirrhosis

Question 32

when do you ask for Anti-HDV antibody test?

Answer 32

if HBsAg is +ve

Question 33

what is a treatment option?

Answer 33

if interferon alpha has limited success, liver transplantation may be needed

Question 34

what type of virus is hep E?

Answer 34

RNA virus (similar to HAV)

Question 35

what is hep E common in?

Answer 35

older men and commoner than hep A in UK
mortality is high in pregnancy
associated with pigs.

Question 36

what is diagnosis of hep E done by?

Answer 36

serology

Question 37

what are other infective cases of hepatitis?

Answer 37

• EBV
• CMV
• leptospirosis
• malaria
• Q fever
• Syphillis
• yellow fever

look at table in notes.