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infection > hepatitis > Flashcards

hepatitis Flashcards

1
Q

what is most obvious sign hepatitis

A

jaundice with hepatic tenderness

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2
Q

viral hepatitis should be notified to

A

public health

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3
Q

subacute illness

A

no symptoms

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4
Q

anicteric illness

A

symptoms with no jaundice

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5
Q

icteric illness

A

symptoms w jaundice

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6
Q

fulminant hepatitis

A

severe jaundice with hepatic failure and high mortality

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7
Q

acute infections biochemistry

A

raised ALT and AST which are released into serum in excess quantities by damaged hepatocytes

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8
Q

HAV severity

A

usually mild and often subclinical/anicteric in <5yrs

severity inc w age but fulminant hepatitis is rare

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9
Q

HAV incubation

A

mean incubation 28ay s

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10
Q

HAV clinical features

A 
fever, malaise
N&V
anorexia
upper abdo pain 
jaundice developing 3-10days later
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11
Q

spread of HAV

A

fecal-oral route

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12
Q

when is HAV most infectious

A

~1wk before jaundice and a few days after

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13
Q

HAV virological diagnosis

A

antiHAV-IgM present in serum from onset symtoms until 3-6mo

antiHAV-IgG represents immunity

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14
Q

HAV Mx

A

no specific treatment

supportive management

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15
Q

who is at risk of HAV in UK

A 
travellers to endemic areas
sewage workers 
contacts of cases
MSM
PWID
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16
Q

prevention of HAV

A

good personal hygiene + sanitation
HNIg (prophylaxis for contacts)
innactivated vaccing

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17
Q

HAV who is offered vaccine

A 
PWID
MSM multiple partners
travellers to endemic areas
sewage workers
seronegative haemophiliacs
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18
Q

when may acute hepatitis occur after HBV infection

A

few weeks - 6mo

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19
Q

symptoms acute hepatitis

A 
anorexia
lethargy 
nausea
fever
abdominal pain 
urticarial skin lesions 
jaundice
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20
Q

HBV viral forms seen in blood

A

infectious viral particles

non-infectious spheres and tubules containing HBsAg

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21
Q

HBV: core/nucleocaspid contains

A

HBcAg

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22
Q

hepaitits B core e antigen

A

splits of from HBcAg in liver cells during new virus formation + released in free soluble form in the serum

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23
Q

HBV: markers for viral replication

A

HBeAg

HBV-DNA

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24
Q

where is HBV-DNA present

A

infectious viral particles in the serum

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25
Q

HBsAg

A

on outershell of HBV

marker for acute + chronic HBV infection

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26
Q

HBV routes of transmission

A

perinatal
parenteral
sexual

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27
Q

HBV: main populations at risk UK

A 
immigrants from high prevelence areas
PWID
multiple sexual partners
healthcare workers
babies of HBsAg + mums
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28
Q

HBeAg chronically infected patients

A

highly infectious

at risk of chronic liver disease and hepatoma

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29
Q

diagnosing acute HBV

A

HBsAg in serum

anti-HBV IgM

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30
Q

chronic HBV infection

A

persistence of HBsAg in serum >6mo

90% infants
40% kids
5-10% adults

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31
Q

HBV: who is chronic infection more common in

A

men, immunodeficient

patients with mild/asymptomatic acute infection rather than severe symptoms

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32
Q

chronic HBV long-term sequelae

A

chronic hepatitis
cirrhosis
hepatoma

33
Q

clinical features of chronic HBV

A

fatigue, anorexia, depression

jaundice unusual unless advanced disease

34
Q

who gets HBV anti-viral Rx

A

those w asymptomatic HBV w raised ALT, HBeAg positive + progressive lier disease

those w cirrhosis + evidence of viral replication (HBV-DNA)

35
Q

HBV: ART indications in those without cirrhosis

A

2/3 of

  • raised ALT
  • HBV-DNA >2000
  • signigicant liver inflammation, fibrosis
36
Q

HBV Rx options

A

pegylated alpha-interferon injection
nucleoside analogues
liver transplant

37
Q

HBV nucleoside analogues

A

inhibit viral enzyme transcriptase

entecavir, tenofovir

38
Q

HBV vaccine poor responders

A

> 40yrs
obese
wrong injection site
immunocompromised

39
Q

HBV vaccine >100

A

good response

40
Q

HBV vaccine 10-99

A

poor response - booster now and in 5yrs

41
Q

HBV vaccine <10

A

no response

repeat course

42
Q

who gets HBV vaccine

A 
healthcare workers
PWID
multiple sexual partners
renal dialysis 
travellers to endemic areas
43
Q

HBV passive immunisation

A

HBIg

  • infants born to HbsAg positive mothers
  • healthcare worked without anti-bodies who are exposed
  • close contacts cases
44
Q

HCV acute infection

A

usually subclinical/mild

malasie, anorexia, fatigue

severe hepatitis w jaundice may occur

45
Q

HCV chronic infection

A

develops in most
most no symptoms
wide variations AST/ALT levels

46
Q

HCV transmission

A

blood-borne
sexual
perinatal

47
Q

HCV main populations at risk UK

A

PWID

recipients of unscreened blood products

48
Q

HCV diagnosis

A

antiHCV-IgG

HCV-RNA

49
Q

HCV chronic sequelae

A

chronic hepatitis
cirrhosis
hepatoma

50
Q

HCV Mx

A

hep A + B vaccine

combo of pegylated alpha-interferon and ribavirin

51
Q

HCV Rx: non-responsed

A

virus remains detectable

52
Q

HCV Rx: viral breakthrough

A

initial response to ART followed by increase circulating level virus

53
Q

HCV Rx: relapser

A

virus undetectable during ART but beomes detectable when stop Rx

54
Q

HCV Rx: sustained viral response

A

virus undetectable for 6mo after

55
Q

HVC: response to Rx varies according to

A 
viral genotype 
age
gender
stage liver disease
viral load
56
Q

how is HDV a defective virus

A

always found with HBV

HBV essential for its transmission

57
Q

HDV co-infection

A

simultaneous infection w HDV and HBV

58
Q

HDV superinfection

A

person w chronic HBV catches HDV

59
Q

HDV transmission

A

parenteral

60
Q

HDV main pops at risk UK

A

PWID

61
Q

HDV chronic sequelae

A

chronic heaptitis

cirrhosi s

62
Q

HDV diagnosis

A

anti-HDV IgM, IgG

63
Q

HDV how can co-infection and superinfection be distinguished

A

high levels anti-HBV IgM in co-infection

64
Q

HDV Rx

A

pegylated alpha-interferon

65
Q

HEV

A

subclinial/mild ilmness

most severe disease in elderly men

66
Q

HEV incubation

A

40ays

67
Q

HEV route

A

fecal-oral

68
Q

HEV developing countries

A

extra-hepatic features e.g. arthritis, anaemia

69
Q

HEV chronic infection

A

immunocompromosed

persistent hepatitis and cirrhosis

70
Q

HEV main pop at risk UK

A

travellers to endemic areas

exposure to under-cooked pig products

71
Q

HEV genotypes 1 + 2

A

developing countries

72
Q

HEV genotypes 3 + 4

A

developed countries

73
Q

HEV diagnosis

A

IgM, IgG

HEV-RNA

74
Q

HEV Mx

A

no licensed Rx, mostly self limiting

75
Q

HEV prevention

A

good personal hygiene and sanitation
adequate cooking food
vaccine in china only

76
Q

HBV incubation

A

90 days

77
Q

HCV incubation

A

60 days

78
Q

when are healthcare workers with hepatitis excluded from performign EPP

A

HBeAg positive
HBsAg positive + HBV-DNA 1000+
HCV PCR +ive

79
Q

exposure prone procedure

A

risk that injury to worker may result in exposure of patient’s open tissues to blood of worker

infection (36 decks)

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