Hepatitis Flashcards by Martha Innes

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

Acute with rapid resolution and symptomatic - Hep A and E

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

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What is hepatitis A?

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

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Who are at risk of hepatitis A?

Areas of poor sanitation and overcrowding

Men who have sex with men and PWIDs

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What is the clinical presentation of hepatitis A?

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

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When does hepatitis A require hospital admission?

If symptoms include encephalopathy

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

Hepatitis A IgM

Signifies the presence of acute infection

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What question is important to ask in hepatitis A history?

Pregnancy?

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What is the treatment for hepatitis A?

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

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What is hepatitis E?

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

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Which hepatitis is more prevalent in tropical countries?

Hepatitis E

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What is the clinical presentation in hepatitis E?

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

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What is the marker for hepatitis E?

Hep E viral RNA

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What is the management for hepatitis E?

No alcohol

Supportive treatment

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How is hepatitis B transmitted?

Bone (sex)
Baby (mother to child)
Blood

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Who tends to get hepatitis B?

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

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

Chronic - children

Acute - adults

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What are the clinical differences between hepatitis B and A

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

What are the markers for hepatitis B?

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

What is hep B surface antigen a marker for?

Present in all infectious individuals

What is hep B e antigen a marker for?

Present in highly infectious individuals

Indicates acute infection and continued infectious state

What is hep B virus DNA a marker for?

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

What is hep B c IgM a marker for?

High titre = acute

Low titre = chronic

What is hep B IgG a marker for?

Past exposure to hep B usually from a vaccine

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

Recovery/immunity to HBV

Successful vaccination

What is the prognosis of hepatitis B?

Self-resolving most of the time | If chronic, prognosis varies

What is the management for hep B?

Symptomatic management Viral marker monitoring Antivirals Minimise exposure

What is hepatitis D?

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

How is hepatitis C transmitted?

Same as HBV (bone, baby, blood)

What is the clinical presentation of acute hepatitis C?

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

What is the investigation for hepatitis C?

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

What is the management for hepatitis C?

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

When should you treat hepatitis B?

If raised ALT and high HBV DNA

How is chronic HBV treated?

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

Which sex is autoimmune hepatitis more common in?

Females (75%)

When should you suspect autoimmune hepatitis?

Young females with deranged LFTs taking oral contraceptives

What causes autoimmune hepatitis?

T cells attack hepatocyte surface antigens

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

Type 1 - ages 1-20 and again in 45-70 | Type 2 - young kids and adults

What are the clinical features of autoimmune hepatitis?

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

What investigations are done for autoimmune hepatitis?

LFTs Antibodies IgG will be raised Liver biopsy to confirm severity

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

Type 1 - ASMA and ANA positive | Type 2 - LKM positive (ASMA and ANA negative)

What is the management for autoimmune hepatitis?

Corticosteroids and azathioprine combined Gradually reduce steroids May eventually need transplant