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Year 4 > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

what is hepatitis?

A

inflammation in the liver

can vary from low level chronic inflammation to severe inflammation leading to large areas of necrosis and liver failure

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2
Q

causes of hepatitis?

A 
alcoholic hepatitis
non-alcoholic fatty liver disease
viral hepatitis
autoimmune hepatitis
drug induced hepatitis
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3
Q

how does hepatitis present?

A

can be asymptomatic or have non-specific symptoms such as

  • abdo pain
  • fatigue
  • itching
  • muscle and joint aches
  • nausea and vomiting
  • jaundice
  • fever (viral hepatitis)
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4
Q

typical biochemical findings in hepatitis?

A

deranged LFTs with hepatic picture
- high AST/ALT (transaminases)
- less of a rise in ALP
can also have a high bilirubin

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5
Q

what are transaminases?

A

liver enzymes that are released into the blood as a result of inflammation of the liver cells
(AST and ALT)

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6
Q

most common viral hepatitis worldwide?

A

hep A

but rare in the UK

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7
Q

how is hep A transmitted?

A

faeco-oral

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8
Q

how does hep A present?

A 
nausea
vomiting
anorexia
jaundice 
can cause cholestasis resulting in dark urine and pale stools and hepatomegaly
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9
Q

how is hep A managed?

A

usually self resolving without treatment in 1-3 months

can give analgesia to help symptoms

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10
Q

is there a hep A vaccine?

A

yes

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11
Q

what is hep B virus?

A

DNA virus

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12
Q

how is hep B spread?

A

direct contact with blood or bodily fluids (eg sexual intercourse, sharing needles, tattoos, sharing toothbrush etc)
can have vertical transmission from mother to child in pregnancy

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13
Q

course of hep B?

A

most fully recover within 2 months
10% of people go on to become chronic hep B carriers where the virus DNA has integrated into their own DNA so they continue to produce viral proteins

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14
Q

viral markers in hep B?

A 
HBsAg (surface antigen)
HBeAg (E antigen)
HBcAb (core antibody)
HBsAb (surface antibody)
HBV DNA (hep B virus DNA)
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15
Q

what does HBsAg indicate?

A

active infection

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16
Q

what does HBeAg indicate?

A

marker of viral replication therefore indicates high infectivity
where HBeAg is present, it indicates the patient is in an acute phase of infection where the virus is actively replicating

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17
Q

what does HBcAb indicate?

A

past or current infection

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18
Q

what does HBsAb indicate?

A

indicates past/current infection or vaccination
demonstrates an immune response to HBsAg so the patient has encountered HBV either through infection or vaccination
other markers are needed to determine whether a previous infection or vaccination

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19
Q

what does HBV DNA?

A

direct count of viral load

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20
Q

what viral markers are tested when screening for hep B?

A

HBcAb (for previous infection) and HBsAg (for active infection)
if these are positive then do HBeAg (for infectivity) and HBV DNA (viral load)

21
Q

why is HBcAb useful?

A

can help distinguish acute, chronic and past infections

22
Q

what are the 2 types of HBcAb?

A

IgM - indicates active infection (high in acute infection, low in chronic infection)
IgG - indicates past infection where HBsAg is negative

23
Q

does level of HBeAg correlate to infectivity?

A

yes
higher HBeAg = highly infectious
lower/negative HBeAg = virus not replicating and less infectious

24
Q

what does it indicate when HBeAb positive but HBeAg negative?

A

patient has been through a phase where the virus was replicating but virus has now stopped replicating
low infectivity

25
Q

does hep B have a vaccine?

A

yes
involves injecting hep B surface antigen then testing for HBsAb to confirm response to vaccine
requires 3 doses at different intervals
part of routine UK vaccination schedule (part of 6 in 1)

26
Q

how is hep B managed?

A

stop smoking and alcohol
test for complications (US for hepatocellular carcinoma and fibroscan for cirrhosis)
antiviral medication can slow progression of disease and reduce infectivity
liver transplant in end stage disease

27
Q

people with hep B should be screened for what other disease?

A

other blood borne viruses - hep A, hep B and HIV as well as STDs

28
Q

what type of virus is hep C?

A

RNA virus

29
Q

how is hep C spread?

A

blood and body fluids

30
Q

does hep C have a vaccine?

A

no

31
Q

can hep C be cured?

A

yes

now curable with direct acting antiviral meds

32
Q

course of hep C?

A

1 in 4 fight off disease and fully recover

3 in 4 become chronic

33
Q

complications of hep C?

A

liver cirrhosis

hepatocellular carcinoma

34
Q

investigations in hep C?

A

hep C antibody is the screening test

hep C RNA testing used to confirm diagnosis, calculate viral load and assess individual genotype

35
Q

how is hep C managed?

A

stop smoking and alcohol
test for complications (scan for cirrhosis and hepatocellular carcinoma)
antiviral treatment with direct acting antivirals tailored to specific viral genotype
liver transplant for end stage liver stage

36
Q

what type of virus is hep D virus?

A

RNA virus

37
Q

hep D can only occur in which people?

A

people with hep B infection

hep D attaches itself to HBsAg and cannot survive without it

38
Q

how is hep E transmitted?

A

faeco oral

rare in UK

39
Q

course of hep E infection?

A

usually only causes a mild illness
virus cleared within a month with no treatment required
can progress to chronic hepatitis and liver failure in rare cases (more common in immunocompromised)

40
Q

what is autoimmune hepatitis?

A

rare cause of chronic hepatitis
cause unknown but likely associated with a genetic predisposition triggered by environmental factors such as viral infection which causes T cell mediated response against the liver cells

41
Q

2 types of autoimmune hepatitis?

A 
1 = occurs in adults
2 = occurs in children
42
Q

describe type 1 autoimmune hepatitis?

A

usually affects women in late 40s or 50s
presents around menopause with fatigue and features of liver disease on examination
takes less acute course then type 2

43
Q

describe type 2 autoimmune hepatitis?

A

patients usually teenagers or in early 20s

presents with acute hepatitis with high transaminases (AST and ALT) and jaundice

44
Q

investigations in autoimmune hepatitis?

A

raised AST/ALT
raised IgG
associated with many antibodies

45
Q

type 1 autoimmune hepatitis antibodies?

A

ANA (anti-nuclear antibody)
anti-actin (anti-smooth muscle antibody)
anti-SLA/LP (anti-soluble liver antigen)

46
Q

type 2 autoimmune hepatitis antibodies?

A

anti-LMK1 (anti-liver kidney microsomes-1)

anti-LC1 (anti-liver cytosol antigen type 1)

47
Q

how is diagnosis of autoimmune hepatitis confirmed?

A

liver biopsy

48
Q

how is autoimmune hepatitis managed?

A

high dose steroids (prednisolone) that are tapered over time as other immunosuppressants are introduced (usually azathioprine)
usually successful in inducing remission but treatment needed life-long
liver transplant may be needed in end stage disease but disease can recur in transplanted liver

Year 4 (83 decks)

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