Hepatitis Flashcards
What are the general clinical features of viral hepatitis?
- Jaundice
- Hepatic tenderness
- Raised levels of ALT and AST
How does hepA present?
- Fever
- Malaise
- Anorexia
- Nausea
- Vomiting
- Upper abdominal pain
- Jaundice (3-10yrs)
- Dark urine
How can Hep A be transmitted and which groups are at higher risk?
- Faecal-oral route
- MSM
- PWID
How can Hep A be diagnosed?
Anti-HAV IgM antibodies
How can Hep A be treated and what is the prognosis?
- Supportive treatment
- Death is very rare
How can Hep A be prevented?
- Good personal hygeine and sanitation
- Prophylaxis: human normal immunoglobulin
- Immunisation: sewage workers, seronegative haemophiliacs, MSMs, PWIDs, travellers etc.
How does Hep B present?
- Anorexia
- Lethargy
- Nausea
- Fever
- Abdo discomfort
- Arthralgia
- Urticarial skin lesion
- Jaundice
- Dark urine
- Can cause DIC or encephalopathy
How can Hep B be detected?
- HBsAg is the major marker
- HbeAg can also be seen
- anti-HBc IgM antibodies in late disease
How can Hep B be transmitted?
- Vertically (mother to baby)
- Sexually
- Needlestick injury
- Transmission between family members
Which factors increase the risk of HepB in the UK?
- 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
What are the potential consequences of chronic Hep B infection?
- Chronic liver disease
- Membranous glomerulonephritis
- Polyarteritis nodosa
- Cirrhosis and hepatoma
- Rise in serum AST and ALT
What is the prognosis for HepB infection?
-25% progress to cirrhosis or hepatoma (3rd commonest cause of cancer death in the world
How can Hep B infection be treated?
- Anti viral therapy: entecavir and tenofovir
- Liver transplant (+ antiviral aenys and HBIG)
How can Hep B infection be prevented?
- 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
How does Hep C present?
- Acute: malaise, anorexia, fatigue and jaundice
- Chronic: no symptoms but serum AST and ALT may be raised
How can Hep C be transmitted?
- 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
How can Hep C be detected?
- Antibodies (may be negative for several months)
- HCV antigen
- HCV-RNA
How can Hep C be managed?
- Abstinence (alcohol accelerates the disease)
- Combined pegylated alpha-interferon and ribavirin
How can Hep D be transmitted?
- Parentally: IVDA
- Very little vertical or sexual transmission
How can Hep D be detected?
- IgM and IgG antibody to HDV
- HDV-RNA and HDAg in serum
- Co-infection: anti HBc IgM
How can Hep D infection be managed?
- Pegylated alpha-interferon
- Liver transplant
- Prevention of HBV also prevents HVD
Describe the features of Hep E infection
- Resembles HAV infection
- Most severe in elderly men
- Extra-hepatic features: arthritis, anaemia and neurological manifestations
- Transmission: foecal oral route, contaminated food and bloods
How can Hep E be detected?
- IgG and IgM
- HEV-RNA
How can Hep E be managed?
- Good hygiene, good sanitation and adequate cooking of food
- Immunisation is available in China
- Passive immunisation with HNIG
