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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
Who is given a vaccine for hepatitis B?
All children born after 1st August 2017 and at risk older children and adults
26
Post exposure prophylaxis in hepatitis B
Vaccine, hyperimmune hepatitis B immunoglobulin
27
Transmission of hepatitis C virus
Mother to child, blood to blood, sex (but less easily transmitted)
28
Outcome of hepatitis C virus
Asymptomatic for years until they develop signs of chronic liver disease
29
Hepatitis C control
Minimise exposure
30
How long does of been affected defines chronic?
6 months
31
Typical time from hepatitis infection to cirrhosis
>20 years
32
Typical time from hepatitis to hepatocellular carcinoma
>30 years
33
Management of acute viral hepatitis
Monitor for encephalopathy and resolution, notify public health, immunisation of contacts, test for other infections
34
Management of chronic viral hepatitis
Antivirals, vaccination of other hepatitis viruses, infection control, decreased alcohol consumption, hepatocellular carcinoma awareness/screening
35
Screening for hepatocellular carcinoma
Serum-alpha fetoprotein and ultrasonography
36
Chronic HVB therapy
- Adefovir – commonly used - Entecavir – commonly used - Tenofovir - Lamivudine – nucleoside analogue reverse transcriptase inhibitor - Telbivudine – nucleoside analogue reverse transcriptase inhibitor - Interferon alfa
37
Chronic HVC therapy
- 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
When to treat chronic viral hepatitis
Hepatitis B with raised ALT and high HBV DNA, treat when the patient is ready, chronic hepatitis C treated right away
39
Interferon alpha: - What is it? - What is it given by? - Side effects
- 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
First option for treatment for hepatitis B: - What is it? - Examples - Advantages - Disadvantages
- Suppressive antiviral drug - Entecavir, tenofovir - Safe, increasing range available - Causes suppression but not cure, resistance can develop
41
Second option for treatment in hepatitis B: - What is it? - Advantages - Disadvantages - In which patients should this be tried?
- Peginterferon alone - Sustained cure possible from a few months of therapy - Side effects, injections - HBsAg and HBeAg positive patients with compensated
42
Definition of response in chronic hepatitis C infection
Loss of HCV RNA in blood sustained to 6 months after the end of therapy
43
Current antivirals used for hepatitis C
Simeprevir, ledipasvir, daclatasvir, ombitasvir, paritaprevir, elbasvir, grazoprevir, sofosbuvir, voxilaprevir, velpatasvir, pibrentasvir, glecaprevir

Medicine Gastrointestinal (24 decks)

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