Hepatitis Flashcards
What is hepatitis?
Inflammation of the liver
Varies from a chronic low level inflammation to acute and severe inflammation that leads to large areas of necrosis and liver failure
Caues of hepatitis (5)
Alcoholic hepatitis Non alcoholic fatty liver disease Viral hepatitis Autoimmune hepatitis Drug induced hepatitis (e.g. paracetamol overdose)
How does hepatitis present?
Abdominal pain Fatigue Pruritis (itching) Muscle and joint aches Nausea and vomiting Jaundice Fever (viral hepatitis)
What does hepatitis show on LFTs?
Deranged with high transaminases (AST/ALT)
Proportionally less of a rise in ALP
Bilirubin can also rise as a result of inflammation in liver cells
What are transaminases?
Liver enzymes that are released as a result of inflammation
Types of hepatitis and transmission
Hep A - faecal-oral Hep B - blood or bodily fluids (vertical transmission) Hep C - blood and body fluids Hep D - (Hep B) Hep E - faecal oral route
Hepatitis A
Presents with nausea, vomiting, anorexia and jaundice
Can cause cholestasis with dark urine and pale stools and moderate hepatomegaly
Resolves without treatment in 1-3 months
Management - analgesia
(notifiable to Public Health)
How is Hep B transmitted?
Blood or bodily fluids
Sexual intercourse
Sharing needles (IVDU, tattoos)
Contact between cuts
Vertical transmission
How may people get chronic hepatitis B?
Most recover within 2 months
10% become chronic hepatitis B carriers
Virus DNA has integrates into patients DNA - they continue to produce the viral proteins
Which viral marker signals active infection?
Surface antigen (HBsAg)
Which viral marker implies past or current Hep B infection?
Core antibodies (HBcAb)
IgM implies an active infection (high titre with an acute infection and a low titre with a chronic infection)
IgG indicates a past infection where the HBsAg is negative
Which viral marker implies vaccination, past, or current Hep B infection?
Surface antibody (HBsAb)
Demonstrates an immune response to HBsAg
What is E antigen (HBeAg)?
Marker of viral replication and implies high infectivity
Positive in acute phase
When they HBeAg is negative but the hepatitis B e antibody is positive this implies virus was replicating but now stopped replicating and they are less infectious (immune response)
What is the management for hepatitis B? (8)
Screen for other blood born viruses (hepatitis A and B and HIV) and other sexually transmitted diseases
Refer to gastro, hepatology or infectious diseases for specialist management
Notify Public Health (it is a notifiable disease)
Stop smoking and alcohol
Education about reducing transmission and informing potential at risk contacts
Testing for complications: FibroScan for cirrhosis and ultrasound for hepatocellular carcinoma
Antiviral medication can be used to slow the progression of the disease and reduce infectivity
Liver transplantation for end-stage liver disease
How may people get chronic hepatitis B?
1 in 4 makes a full recovery
3 in 4 progress to chronic
How do you test for Hep C?
Hepatitis C antibody is the screening test
Hepatitis C RNA testing is used to confirm the diagnosis of hepatitis C, calculate viral load and assess for the individual genotype
What is the management of Hepatitis C?
Screen for other blood born viruses (hepatitis A and B and HIV) and other sexually transmitted diseases
Refer to gastro, hepatology or infectious diseases for specialist management
Notify Public Health (it is a notifiable disease)
Stop smoking and alcohol
Education about reducing transmission and informing potential at risk contacts
Testing for complications: FibroScan for cirrhosis and ultrasound for hepatocellular carcinoma
Antiviral treatment with direct acting antivirals (DAAs) is tailored to the specific viral genotype. They successfully cure the infection in over 90% of patients. They are typically taken for 8 to 12 weeks
Liver transplantation for end-stage liver disease
What medication is available for hep b?
Peginterferon alfa-2a
Injection once a week for 48 weeks
Antiviral medicines - enofovir or entecavir
What is autoimmune hepatitis?
Rare cause of chronic hepatitis
Could be associated with a genetic predisposition and triggered by environmental factors e.g viral infection that causes a T cell-mediated response against the liver cells
Types of autoimmune hepatitis?
Type 1: occurs in adults
Typer 2: occurs in children
Both diagnosed by liver biopsy
Who/How does type 1 autoimmune hepatitis present/effect?
Women in their late forties or fifties around or after the menopause
Fatigue and features of liver disease on examination
Less acute course than type 2
Who/How does type 2 autoimmune hepatitis present/effect?
Teenage or early twenties present with acute hepatitis with high transaminases and jaundice
What autoantibodies are associated with type 1 autoimmune hepaititis?
Anti-nuclear antibodies (ANA)
Anti-smooth muscle antibodies (anti-actin)
Anti-soluble liver antigen (anti-SLA/LP)
What autoantibodies are associated with type 2 autoimmune hepaititis?
Anti-liver kidney microsomes-1 (anti-LKM1)
Anti-liver cytosol antigen type 1 (anti-LC1)
What is the treatment for autoimmune hepatitis?
High dose steroids (prednisolone) that are tapered over time as other immunosuppressants, particularly azathioprine, are introduced
Immunosuppressants usually induce remission (usually required life long)
Liver transplant may be required in end stage liver disease (can recur in transplanted livers)
