Hepatitis

Question 1

What are the 2 types of hepatitis infection, and which strains of hepatitis cause each?

Answer 1

Acute with rapid resolution and symptomatic - Hep A and E

Chronic where infection is asymptomatic and picked up incidentally - Hep B, C, D

Question 2

What is hepatitis A?

Answer 2

Most common worldwide
Faecal-oral transmission
Acute infection, doesn’t become chronic

Question 3

Who are at risk of hepatitis A?

Answer 3

Areas of poor sanitation and overcrowding

Men who have sex with men and PWIDs

Question 4

What is the clinical presentation of hepatitis A?

Answer 4

General systemic upset
Jaundice (with dark urine and normal stools)
Vomiting and altered mental state (encephalopathy)
Enlarged liver
Maybe splenomegaly

Question 5

When does hepatitis A require hospital admission?

Answer 5

If symptoms include encephalopathy

Question 6

What is the marker for hepatitis A and what does it signify?

Answer 6

Hepatitis A IgM

Signifies the presence of acute infection

Question 7

What question is important to ask in hepatitis A history?

Answer 7

Pregnancy?

Question 8

What is the treatment for hepatitis A?

Answer 8

No alcohol
Supportive treatment
Vaccines in people or areas of higher risk

Question 9

What is hepatitis E?

Answer 9

Similar presentation to hepatitis A
Acute
Faecal-oral transmission
Contaminated water
Pregnancy makes disease more severe

Question 10

Which hepatitis is more prevalent in tropical countries?

Answer 10

Hepatitis E

Question 11

What is the clinical presentation in hepatitis E?

Answer 11

General systemic upset
Jaundice (with dark urine and normal stools)
Vomiting and altered mental state (encephalopathy)
Enlarged liver
Maybe splenomegaly

Question 12

What is the marker for hepatitis E?

Answer 12

Hep E viral RNA

Question 13

What is the management for hepatitis E?

Answer 13

No alcohol

Supportive treatment

Question 14

How is hepatitis B transmitted?

Answer 14

Bone (sex)
Baby (mother to child)
Blood

Question 15

Who tends to get hepatitis B?

Answer 15

Born in areas of higher prevalence
Multiple sexual partners
Men who have sex with men
PWIDs
Children of infected  mothers

Question 16

Who are more likely to develop chronic and acute hepatitis B infections?

Answer 16

Chronic - children

Acute - adults

Question 17

What are the clinical differences between hepatitis B and A

Answer 17

B may be more severe
B may include:
- Itchy rashes
-  Arthritis affecting the hands and feet
- Fever
- Diarrhoea and abdominal pain

Question 18

What are the markers for hepatitis B?

Answer 18

Hep B surface antigen
Hep B e antigen
Hep B virus DNA
Hep B c IgM
Hep B IgG
Anti-HBs

Question 19

What is hep B surface antigen a marker for?

Answer 19

Present in all infectious individuals

Question 20

What is hep B e antigen a marker for?

Answer 20

Present in highly infectious individuals

Indicates acute infection and continued infectious state

Question 21

What is hep B virus DNA a marker for?

Answer 21

Present in highly infectious individuals
Measures response to antiviral therapy
Best marker of prognosis

Question 22

What is hep B c IgM a marker for?

Answer 22

High titre = acute

Low titre = chronic

Question 23

What is hep B IgG a marker for?

Answer 23

Past exposure to hep B usually from a vaccine

Question 24

What is anti HBs (HBV surface antibodies) a marker for?

Answer 24

Recovery/immunity to HBV

Successful vaccination

Question 25

What is the prognosis of hepatitis B?

Answer 25

Self-resolving most of the time

If chronic, prognosis varies

Question 26

What is the management for hep B?

Answer 26

Symptomatic management
Viral marker monitoring
Antivirals
Minimise exposure

Question 27

What is hepatitis D?

Answer 27

Only found in those with a hepatitis B infection and exacerbates it

Question 28

How is hepatitis C transmitted?

Answer 28

Same as HBV (bone, baby, blood)

Question 29

What is the clinical presentation of acute hepatitis C?

Answer 29

Acute infections tend to be asymptomatic but may have mild flu-like symptoms, jaundice and altered LFTs

Question 30

What is the investigation for hepatitis C?

Answer 30

Anti-HCV antibody test - if positive there is past or active infection
HCV-RNA - indicates currently active infection

Question 31

What is the management for hepatitis C?

Answer 31

Monitor HCV levels as they can fluctuate and hep C can go into spontaneous remission in the first few months but not after
Antivirals

Question 32

When should you treat hepatitis B?

Answer 32

If raised ALT and high HBV DNA

Question 33

How is chronic HBV treated?

Answer 33

Peginterferon Alfa-2a initially
If HBsAg does not fall to the required level then tenofovir used
Entecavir can be used instead if contraindications

Question 34

Which sex is autoimmune hepatitis more common in?

Answer 34

Females (75%)

Question 35

When should you suspect autoimmune hepatitis?

Answer 35

Young females with deranged LFTs taking oral contraceptives

Question 36

What causes autoimmune hepatitis?

Answer 36

T cells attack hepatocyte surface antigens

Question 37

What ages do the two types of autoimmune hepatitis present in?

Answer 37

Type 1 - ages 1-20 and again in 45-70

Type 2 - young kids and adults

Question 38

What are the clinical features of autoimmune hepatitis?

Answer 38

Hepatomegaly
Jaundice
Signs of chronic liver disease
May present similarly to acute onset hepaitis

Question 39

What investigations are done for autoimmune hepatitis?

Answer 39

LFTs
Antibodies
IgG will be raised
Liver biopsy to confirm severity

Question 40

What antibody tests are done for type 1 and type 2 autoimmune hepatitis?

Answer 40

Type 1 - ASMA and ANA positive

Type 2 - LKM positive (ASMA and ANA negative)

Question 41

What is the management for autoimmune hepatitis?

Answer 41

Corticosteroids and azathioprine combined
Gradually reduce steroids
May eventually need transplant