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Medicine Gastrointestinal > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

Hepatitis A transmission

A

Faecal-oral spread, poor hygiene

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2
Q

Investigation

A

Clotted blood for serology (Gold top), hepatitis A IgM

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3
Q

Control of hepatitis A

A

Hygiene, vaccine prophylaxis

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4
Q

Where is hepatitis E more common?

A

Tropics

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5
Q

Hepatitis E transmission

A

Faecal-oral transmission

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6
Q

Cases of hepatitis E in the UK are thought to be what?

A

Zoonoses

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7
Q

Hepatitis D - which other hepatitis virus is it found with?

A

Hepatitis B

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8
Q

Clinical significance of hepatitis D

A

Exacerbates hepatitis B

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9
Q

Transmission of hepatitis B

A

Sex, mother to child, blood to blood

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10
Q

People at higher risk of hepatitis B

A

People born in areas with higher prevalence, multiple sexual partners, PWID, children of affected mothers

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11
Q

Which test can differentiate acute from chronic infection of hepatitis B?

A

IgM test

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12
Q

What indicates low infectivity in hepatitis B?

A

Anti-HBe

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13
Q

What is present in the blood of all individuals affected with hepatitis B?

A

HBsAg - hepatitis B surface antigen

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14
Q

Which antigen is present in highly infectious individuals with hepatitis B?

A

HBeAg - hepatitis B e antigen

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15
Q

What present in high titre in highly infectious individuals with hepatitis B (not antigen)

A

Hepatitis B DNA

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16
Q

What is most likely to be present in recently affected individuals with hepatitis B?

A

Hepatitis B IgM

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17
Q

What is present in patients with immunity to hepatitis B?

A

Anti-HBs

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18
Q

Clinical course of chronic hepatitis B infection

A

Immune tolerance, immune clearance, immune control, immune escape

19
Q

Immune tolerance in hepatitis B infection:

  • HBV DNA level
  • LFTs
  • Hepatitis B e antigen
  • Treatment
A
  • High HBV DNA level
  • Normal LFTs
  • Hepatitis B e antigen positive
  • Monitor every 6-12 months
20
Q

Immune clearance in hepatitis B infection:

  • HBV DNA level
  • LFTs
  • Hepatitis B e antigen
  • Treatment
A
  • High HBV DNA level
  • Abnormal LFTs
  • Hepatitis B e antigen positive
  • At risk of progression to cirrhosis and hepatocellular carcinoma so should be referred for consideration of treatment
21
Q

Immune control in hepatitis B infection:

  • HBV DNA level
  • LFTs
  • Hepatits B e antigen
  • Treatment
A
  • Low HBV DNA level
  • Normal LFTs
  • Hepatitis B e antigen negative
  • Monitor every 6-12 months
22
Q

Immune escape in hepatitis B infection:

  • HBV DNA level
  • LFTs
  • Hepatitis B e antigen
  • Hepatitis B e antibody
  • Treatment
A
  • High HBV DNA level
  • Abnormal LFTs
  • Hepatitis B e antigen negative
  • Hepatitis B e antibody positive
  • At risk of progression to cirrhosis and hepatocellular carcinoma therefore should be referred for consideration of treatment
23
Q

Control of hepatitis B

A

Minimise exposure, pre-exposure vaccinations UK, post-exposure prophylaxis

24
Q

Steps taken to minimise exposure of hepatitis B

A

Safe blood, safe sex, needle exchange, prevention of needlesticks, screening of pregnant women

25
Q

Who is given a vaccine for hepatitis B?

A

All children born after 1st August 2017 and at risk older children and adults

26
Q

Post exposure prophylaxis in hepatitis B

A

Vaccine, hyperimmune hepatitis B immunoglobulin

27
Q

Transmission of hepatitis C virus

A

Mother to child, blood to blood, sex (but less easily transmitted)

28
Q

Outcome of hepatitis C virus

A

Asymptomatic for years until they develop signs of chronic liver disease

29
Q

Hepatitis C control

A

Minimise exposure

30
Q

How long does of been affected defines chronic?

A

6 months

31
Q

Typical time from hepatitis infection to cirrhosis

A

> 20 years

32
Q

Typical time from hepatitis to hepatocellular carcinoma

A

> 30 years

33
Q

Management of acute viral hepatitis

A

Monitor for encephalopathy and resolution, notify public health, immunisation of contacts, test for other infections

34
Q

Management of chronic viral hepatitis

A

Antivirals, vaccination of other hepatitis viruses, infection control, decreased alcohol consumption, hepatocellular carcinoma awareness/screening

35
Q

Screening for hepatocellular carcinoma

A

Serum-alpha fetoprotein and ultrasonography

36
Q

Chronic HVB therapy

A
  • Adefovir – commonly used
  • Entecavir – commonly used
  • Tenofovir
  • Lamivudine – nucleoside analogue reverse transcriptase inhibitor
  • Telbivudine – nucleoside analogue reverse transcriptase inhibitor
  • Interferon alfa
37
Q

Chronic HVC therapy

A
  • Peg interferon alpha, usually given with ribavirin
  • Boceprevir or telaprevir licensed to be given with peginterferon alfa and ribavirin in genotype 1 infection.
  • Sofosbuvir
  • Ledipasivir
  • Daclatasivir
    Dabasuvir
  • Ombitasivir / paritaprevir
  • Simeprevir
38
Q

When to treat chronic viral hepatitis

A

Hepatitis B with raised ALT and high HBV DNA, treat when the patient is ready, chronic hepatitis C treated right away

39
Q

Interferon alpha:

  • What is it?
  • What is it given by?
  • Side effects
A
  • Human protein that is part of the immune response to viral infection
  • Injection as pegylated interferon
  • Chills, sore muscles, malaise, thyroid disease, autoimmune disease, psychiatric disease
40
Q

First option for treatment for hepatitis B:

  • What is it?
  • Examples
  • Advantages
  • Disadvantages
A
  • Suppressive antiviral drug
  • Entecavir, tenofovir
  • Safe, increasing range available
  • Causes suppression but not cure, resistance can develop
41
Q

Second option for treatment in hepatitis B:

  • What is it?
  • Advantages
  • Disadvantages
  • In which patients should this be tried?
A
  • Peginterferon alone
  • Sustained cure possible from a few months of therapy
  • Side effects, injections
  • HBsAg and HBeAg positive patients with compensated
42
Q

Definition of response in chronic hepatitis C infection

A

Loss of HCV RNA in blood sustained to 6 months after the end of therapy

43
Q

Current antivirals used for hepatitis C

A

Simeprevir, ledipasvir, daclatasvir, ombitasvir, paritaprevir, elbasvir, grazoprevir, sofosbuvir, voxilaprevir, velpatasvir, pibrentasvir, glecaprevir

Medicine Gastrointestinal (24 decks)

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