Hepatitis Flashcards
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
What is hepatitis A?
Most common worldwide
Faecal-oral transmission
Acute infection, doesn’t become chronic
Who are at risk of hepatitis A?
Areas of poor sanitation and overcrowding
Men who have sex with men and PWIDs
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
When does hepatitis A require hospital admission?
If symptoms include encephalopathy
What is the marker for hepatitis A and what does it signify?
Hepatitis A IgM
Signifies the presence of acute infection
What question is important to ask in hepatitis A history?
Pregnancy?
What is the treatment for hepatitis A?
No alcohol
Supportive treatment
Vaccines in people or areas of higher risk
What is hepatitis E?
Similar presentation to hepatitis A Acute Faecal-oral transmission Contaminated water Pregnancy makes disease more severe
Which hepatitis is more prevalent in tropical countries?
Hepatitis E
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
What is the marker for hepatitis E?
Hep E viral RNA
What is the management for hepatitis E?
No alcohol
Supportive treatment
How is hepatitis B transmitted?
Bone (sex)
Baby (mother to child)
Blood
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
Who are more likely to develop chronic and acute hepatitis B infections?
Chronic - children
Acute - adults
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
