Hepatitis Flashcards
What are the causes of hepatitis?
- Autoimmune
- NAFLD (NASH)
- Viral Hepatitis
- Alcoholic hepatitis
- Drug induced hepatitis (Paracetamol OD)
How does hepatitis present?
Asymptomatic or Non-specific:
- Fatigue
- Abdo pain
- Pruritis
- Muscle and joint aches
- N&V
- Jaundice
- Fever
What are the typical LFT findings in hepatitis
‘Hepatic Picture’:
- Raised transaminases
- ALP not as raised
- Raised bilirubin
When are transaminases released?
When the liver is inflamed
What is the most common viral hepatitis worldwide?
Hep A- but not very common in the UK
How does HepA spread?
Faecal-Oral
How does HepA present?
- N&V
- Anorexia
- Jaundice
How does HepA resolve?
Self-resolves in 1-3 months
How is HepA treated?
Analgesia
What can HepA cause?
Cholestasis
- Pale stools
- Dark urine
- Mild hepatomegaly
What should you do once discovering any viral hepatitis?
Notify public health
How does HepB spread?
Vertically or with Bodily fluids:
- Sex
- IVDU
- Contaminated household products e.g. toothbrush
How long does it take people to recover from HepB?
2 months
How many HepB sufferers go on to be chronic carriers and why?
10%- virus’ DNA integrates into the host DNA, so viral proteins produced
What does Surface antigen (HBsAg) indicate?
Active infection
What does E antigen (HBeAg) indicate?
High infectivity
What does Core antibodies (HBcAb) indicate?
Past infection (Or current)
What does Surface antibody (HBsAb) indicate?
Vaccination (Or infection)
What does Hepatitis B virus DNA (HBV DNA) indicate?
Viral load
When screening for hepatitis, which tests are done first?
- Surface antigen
- Core antibody
(Current or previous infection)
If the first hepatitis screen is positive, which tests follow?
- e Antigen
- Viral load
(Is it actively replicating and how much is there)
Which immunoglobulin indicates active infection?
IgM
Which immunoglobulin indicates previous infection?
IgG
What is in the HepB vaccine?
Surface Antigen
How is HepB treated?
- Education, alcohol abstinence
- Low threshold for screening high risk Pts e.g. IVDUs
- Test for complications e.g. FibroScan
- Antivirals to slow progression and reduce infectivity
How is HepC spread?
Bodily fluids
What proportion will fight off the HepC virus vs become chronic carriers?
1/4 fight off
3/4 carry
How is HepC treated?
Direct acting anti-virals
How long are anti-virals taken for in HepC?
8-12 weeks
How successful are HepC ant-virals?
90%
How is HepD spread?
ONLY in co-infection with HepB
How does HepD survive?
Attaches to HBsAg
How does HepE spread?
Faecal-oral
What is the disease course of HepE?
- Very mild, requires no treatment
- Clears in a month
- Very rare in the UK
What can all hepatitis lead to?
Cirrhosis and Hepatocellular Carcinoma
Which viral hepatitises are RNA?
A, C, D, E
Which viral hepatitis is DNA?
B
What are the two types of autoimmune hepatitis?
1- Only in adults (post-menopausal women)
2- Only in children/young adults
Which type of AI hepatitis is more acute?
Type 2
Which autoABs can cause type 1 AI hep?
- ANA
- Anti-actin (Anti-SM)
- Anti-soluble liver antigen (anti-SLA/LP)
Which autoABs can cause type 2 AI hep?
- Anti-liver kidney microsomes-1 (anti-LKM1)
- Anti-liver cytosol antigen type 1 (anti-LC1)
How is AI hepatitis diagnosed?
Biopsy
How is AI hepatitis treated?
1- High dose prednisolone
taper down, introduce
2- Azathioprine
Can AI hepatitis be transplanted?
Yes but it may recur
