Hepatitis Flashcards
Viral hep
Inform public health
A, B, C and E
Hepatotrophic
Mainly affect liver
A, B, C, D, E
Hep A symptoms
incubation 28 days Fever Malaise Anorexia Nausea Vomiting Upper abdo pain Jaundice Dark urine
Hep A route
Faecal oral
Faecal contaminated food or water
Hep A risk UK
Men having sex with men
Injecting drugs
Hep A treatment
No cure but there is a vaccine which mostly works after 2 weeks
Second booster given 20 years after first if ongoing risk
Who gets immunised hep A
Sewage workers Seronegative haemophilliacs Gay men with multiple partners Travelling to endemic areas PWID Patients w chronic liver disease
Hep B symptoms
Few weeks to 6 months Anorexia Lethargy Nausea Fever Abdo discomfort Arthralgia Urticarial skin lesions Jaundice Dark urine
Hep B transmission
Verticle (perinatal)
Horizontal (sexual, needles)
Hep B risks
IVDU
Multiple sexual partners
Patients w learning difficulties
Patients w haemophilia or in haemodialysis units
Babies born to mother at risk
Tattoos or piercings non sterile
Medical equipment not adequately decontaminated
Test for hep B
HBsAg positive in serum
anti- HBc IgM if later
Chronic HBV
Persistent HBsAg in serum for more than 6 months
Highest risk if infant and high if child
Chronic HBV follow on
Chronic liver disease
Cirrhosis and hepatoma
Membranous glomerulonephritis
Poluarteritis nodosa
Chronic HBV treatment
If raised ALT and HBeAg pos w progressing liver disease
Give anti viral therapy aimed at HBV replication
If cirrhosis and evidence viral replication give anti virals
If no cirrosis need 2 of;
HBV DNA>2000IU/ml
Raised ALT
signif liver inflam or fibrosis
Anti virals
Pegylated alpha interferon subcut
Entecavir and tenofovir
Liver transplant is severe
Immunisations active
Test for antibodies 2-4 mnths later for certian groups like HCW HCWs Travel to endemic areas for prolonged stay over 1 year Renal dialysis patients Incr sexual partners frequency PWID Police and emergency services at risk Close contacts of those with chronic HBV
Passive immunosations
Infants bron to mothers with chronic HBV
HCWs not known to ave adequare levels of anti HBs
Prev unprotected sexual contacts or family of those with acute or chronic HBV
HBV propylaxis
HBsAg pos and on chemo need to be referred to specialised clinic
Hep c symptoms
Vague malaise Anorexia Fatigue Jaundice is severe Usually subclinical or milk
Hep C tests
AST and ALT to check for chronic progression
Increased AST:ALT ratio shows fibrosis/cirrhosis
Hep C transmission
Blood borne
Hep C risks
Sexual contact and mother to child is low unless mother pos HIV
Higher in japan, new guinea, gambua, zaire
higher in UK if IVDU or haemophilliacs
Healthcare staff at risk
Alcohol excess
Hep C routes transmission
IV drugs Blood products prior to heat treatment Blood transfusions before antibdot screening Tattoos and peircings Sexual trans Mother to child Sharing razors/toothbrushes Medical equipment not fully cleaned
Hep C treatment
Aplha interferon and ribavirin
Drugs that inhibit HCV protease enzyme
Hep D
Always found w hep B
Can occur alongside hep B or after hep B infection
Hep D transmission
IVDU commonest
Family/sex less likely
Hep D diagnosis
IgG and IgM to HDV
HDV-RNA and HDVAg in serum
Hep D treat
Pegylated alpha interferon
Liver transplant
Hep E symptoms
Symptoms after 40 days
Clinically resembles HAV apart from incr incidence of fulminant infection w high mortality in pregnant women
In UK normally subclin or mild in women and young people w severe in elderly men
May oresent w arthirits, anaemia and neurological manifestations
Hep E development
Liver failure esp if pre existing liver disease
Hep E investigations
Serology IgG and IgM
HEVRNA
No licenced treatment and usually self limiting
