Hepatitis

Question 1

In hep A when is someone infectious?

Answer 1

2 weeks before and 1 week after jaundice period

Question 2

What % of adults are asymptomatic?

Answer 2

50%

Question 3

Hep A incubation period

Answer 3

2-6 weeks

Average 28 days

Question 4

Symptoms in prodromal period and how long does it last?

Answer 4

General flu like symptoms eg malaise myalgia fever
RUQ pain
Lasts 3-10 days

Question 5

Symptoms of icteric illness and how long does this last?

Answer 5

Jaundice anorexia nausea fatigue
Pale stool dark urine

Lasts 1-3 weeks usually but can persist for 12 or more

Question 6

Acute liver failure rate in hep A?

Answer 6

0.4%

Question 7

Chronic infection rate in hep A

Answer 7

Tiny!

Question 8

Hep A mortality

Answer 8

<0.1%

Question 9

How long do the following blood tests remain positive
A) HAV IgM
B) HAV total antibody

Answer 9

A) 6 months

B) can be life long

Question 10

General advice for hep A patients

Answer 10

Avoid food handling and sex until non infectious.
Avoid alcohol until ALT is normal
Notifiable disease therefore inform public health

Question 11

Hep A follow up

Answer 11

One or two weekly intervals until ALT normalises (usually 4-12 weeks)

Immunity is usually life long

Question 12

PN for hep A

Answer 12

Sexuak contact during infectious period ie 2 weeks before and 1 week after jaundice

Question 13

Post exposure prophylaxis options for hep A

Answer 13

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

Question 14

What are potential routes of hep B transmission?

Answer 14

Sexual
Vertical
IVDU

Question 15

Hep B incubation period

Answer 15

40-160 days

Question 16

What % of babies born to HBeAg positive mothers become chronically infected?

Answer 16

70-90%

Question 17

What % of babies born to anti-HBe mothers will become chronically infected?

Answer 17

5-20%

Question 18

What factors are associated with hep B chronicity?

Answer 18

Young age ie neonatal infection
Male gender
Immuno suppression

Question 19

Post exposure prophylaxis options for hep B

Answer 19

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)

Question 20

Chronic infection is seen in what % of symptomatic hep b patients

Answer 20

5-10%

Question 21

What % of hep B chronic carriers will get cirrhosis ?

Answer 21

10-50%

Question 22

When would you treat hep B?

Answer 22

If HBV DNA level >2000 IU/ ml

Question 23

What are treatment options for hep B?

Answer 23

Tenofovir
Entecavir
Pegylated interferon

Question 24

In what cases would you screen for HCC?
How often
And how?

Answer 24

If significant fibrosis/ cirrhosis (or family history if HCC or if >20 and African or >40 and asian)
6-12 monthly
USS and AFP

Question 25

Hep C chronic carriers rate?

Answer 25

50-85%

Question 26

What % of hep c is asymptomatic?

Answer 26

> 60%

Question 27

What % of hep C patients will get end stage liver disease?

Answer 27

30%

Question 28

Hep C bloods and timing

Answer 28

HCV RNA: 2-6 weeks

HCV antibody: 4-12 weeks

Question 29

Follow up and when to treat hep C

Answer 29

F/U every 4 weeks

Treat if less than 2 log 10 drop in HCV RNA or if it remains positive at 12 weeks