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Infection > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

What are the general clinical features of viral hepatitis?

A
  • Jaundice
  • Hepatic tenderness
  • Raised levels of ALT and AST
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2
Q

How does hepA present?

A
  • Fever
  • Malaise
  • Anorexia
  • Nausea
  • Vomiting
  • Upper abdominal pain
  • Jaundice (3-10yrs)
  • Dark urine
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3
Q

How can Hep A be transmitted and which groups are at higher risk?

A
  • Faecal-oral route
  • MSM
  • PWID
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4
Q

How can Hep A be diagnosed?

A

Anti-HAV IgM antibodies

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5
Q

How can Hep A be treated and what is the prognosis?

A
  • Supportive treatment

- Death is very rare

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6
Q

How can Hep A be prevented?

A
  • Good personal hygeine and sanitation
  • Prophylaxis: human normal immunoglobulin
  • Immunisation: sewage workers, seronegative haemophiliacs, MSMs, PWIDs, travellers etc.
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7
Q

How does Hep B present?

A
  • Anorexia
  • Lethargy
  • Nausea
  • Fever
  • Abdo discomfort
  • Arthralgia
  • Urticarial skin lesion
  • Jaundice
  • Dark urine
  • Can cause DIC or encephalopathy
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8
Q

How can Hep B be detected?

A
  • HBsAg is the major marker
  • HbeAg can also be seen
  • anti-HBc IgM antibodies in late disease
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9
Q

How can Hep B be transmitted?

A
  • Vertically (mother to baby)
  • Sexually
  • Needlestick injury
  • Transmission between family members
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10
Q

Which factors increase the risk of HepB in the UK?

A
  • IVDA
  • Multiple sexual partners
  • Immigration from areas of high endemnicity
  • Patients with a LD who live in residential care
  • Patients on haemodialysis or with haemophilia
  • Sexual partners of patients with risk factors
  • Babies born to mothers who are high risk
  • Tattooing or body piercing with non sterile equipment
  • Medical equipment if not adequately decontaminated
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11
Q

What are the potential consequences of chronic Hep B infection?

A
  • Chronic liver disease
  • Membranous glomerulonephritis
  • Polyarteritis nodosa
  • Cirrhosis and hepatoma
  • Rise in serum AST and ALT
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12
Q

What is the prognosis for HepB infection?

A

-25% progress to cirrhosis or hepatoma (3rd commonest cause of cancer death in the world

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13
Q

How can Hep B infection be treated?

A
  • Anti viral therapy: entecavir and tenofovir

- Liver transplant (+ antiviral aenys and HBIG)

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14
Q

How can Hep B infection be prevented?

A
  • Active Immunisation: healthcare workers, travellers to endemic areas, renal dialysis patients, MSM, sex workers, PWID, selected police/emergency services personnel and close contacts of those with acute or chronic Hep B infection
  • Passive: infants born to mothers with HBV, health care workers without adequate anti-HBs and previously unprotected sexual contacts
  • Infection Control Procedures
  • Screening of blood and transplant donors
  • Prophylactic antiviral therapy for those on immunosuppressive chemotherapy
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15
Q

How does Hep C present?

A
  • Acute: malaise, anorexia, fatigue and jaundice

- Chronic: no symptoms but serum AST and ALT may be raised

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16
Q

How can Hep C be transmitted?

A
  • IVDA
  • Haemophiliacs who received non-heat treated concentrates (Pre 1989)
  • Needle stick injuries
  • Dialysis patients
  • Tattooing, piercing etc. with non sterile equipment
  • Sexual transmission (low)
  • Mother to child
  • Sharing razors, toothbrushes etc.
  • Inadequately decontaminated medical/dental equipment
17
Q

How can Hep C be detected?

A
  • Antibodies (may be negative for several months)
  • HCV antigen
  • HCV-RNA
18
Q

How can Hep C be managed?

A
  • Abstinence (alcohol accelerates the disease)

- Combined pegylated alpha-interferon and ribavirin

19
Q

How can Hep D be transmitted?

A
  • Parentally: IVDA

- Very little vertical or sexual transmission

20
Q

How can Hep D be detected?

A
  • IgM and IgG antibody to HDV
  • HDV-RNA and HDAg in serum
  • Co-infection: anti HBc IgM
21
Q

How can Hep D infection be managed?

A
  • Pegylated alpha-interferon
  • Liver transplant
  • Prevention of HBV also prevents HVD
22
Q

Describe the features of Hep E infection

A
  • Resembles HAV infection
  • Most severe in elderly men
  • Extra-hepatic features: arthritis, anaemia and neurological manifestations
  • Transmission: foecal oral route, contaminated food and bloods
23
Q

How can Hep E be detected?

A
  • IgG and IgM

- HEV-RNA

24
Q

How can Hep E be managed?

A
  • Good hygiene, good sanitation and adequate cooking of food
  • Immunisation is available in China
  • Passive immunisation with HNIG
25
Q

Name some other infections associated with hepatitis

A
  • Neonate: rubella CMV, HSV etc.
  • Children and adults: CMV and EMV
  • Immunocompromised: CMV. varicella-zoster and HSV
  • Leptospirosis
  • Q fever
  • Psittacosis/ornithosis
26
Q

In which situations can health care workers with hepatitis not perform EPP?

A
  • Hepatitis Be antigen positive
  • Hepatitis B surface antigen positive and HBV DNA of 1000/ml in blood or more
  • Hepatitis C PCR positive

Infection (15 decks)

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