Hepatitis Flashcards
In hep A when is someone infectious?
2 weeks before and 1 week after jaundice period
What % of adults are asymptomatic?
50%
Hep A incubation period
2-6 weeks
Average 28 days
Symptoms in prodromal period and how long does it last?
General flu like symptoms eg malaise myalgia fever
RUQ pain
Lasts 3-10 days
Symptoms of icteric illness and how long does this last?
Jaundice anorexia nausea fatigue
Pale stool dark urine
Lasts 1-3 weeks usually but can persist for 12 or more
Acute liver failure rate in hep A?
0.4%
Chronic infection rate in hep A
Tiny!
Hep A mortality
<0.1%
How long do the following blood tests remain positive
A) HAV IgM
B) HAV total antibody
A) 6 months
B) can be life long
General advice for hep A patients
Avoid food handling and sex until non infectious.
Avoid alcohol until ALT is normal
Notifiable disease therefore inform public health
Hep A follow up
One or two weekly intervals until ALT normalises (usually 4-12 weeks)
Immunity is usually life long
PN for hep A
Sexuak contact during infectious period ie 2 weeks before and 1 week after jaundice
Post exposure prophylaxis options for hep A
1) hep A vaccination within 14 days
2) HNIG 250-500mg IM within 28 days if inc risk of complications ie over 50, HIV, chronic liver disease
What are potential routes of hep B transmission?
Sexual
Vertical
IVDU
Hep B incubation period
40-160 days
What % of babies born to HBeAg positive mothers become chronically infected?
70-90%
What % of babies born to anti-HBe mothers will become chronically infected?
5-20%
What factors are associated with hep B chronicity?
Young age ie neonatal infection
Male gender
Immuno suppression
Post exposure prophylaxis options for hep B
Hep B vaccine within 6 weeks post exposure (offer to sexual risks and household contacts)
Hep B specific immunoglobulin ideally <48 hours post exposure. Max 7 days post (if upsi with a high infectivity case)
Chronic infection is seen in what % of symptomatic hep b patients
5-10%
What % of hep B chronic carriers will get cirrhosis ?
10-50%
When would you treat hep B?
If HBV DNA level >2000 IU/ ml
What are treatment options for hep B?
Tenofovir
Entecavir
Pegylated interferon
In what cases would you screen for HCC?
How often
And how?
If significant fibrosis/ cirrhosis (or family history if HCC or if >20 and African or >40 and asian)
6-12 monthly
USS and AFP
