Hepatitis Flashcards
what is hepatitis?
inflammation in the liver
can vary from low level chronic inflammation to severe inflammation leading to large areas of necrosis and liver failure
causes of hepatitis?
alcoholic hepatitis non-alcoholic fatty liver disease viral hepatitis autoimmune hepatitis drug induced hepatitis
how does hepatitis present?
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)
typical biochemical findings in hepatitis?
deranged LFTs with hepatic picture
- high AST/ALT (transaminases)
- less of a rise in ALP
can also have a high bilirubin
what are transaminases?
liver enzymes that are released into the blood as a result of inflammation of the liver cells
(AST and ALT)
most common viral hepatitis worldwide?
hep A
but rare in the UK
how is hep A transmitted?
faeco-oral
how does hep A present?
nausea vomiting anorexia jaundice can cause cholestasis resulting in dark urine and pale stools and hepatomegaly
how is hep A managed?
usually self resolving without treatment in 1-3 months
can give analgesia to help symptoms
is there a hep A vaccine?
yes
what is hep B virus?
DNA virus
how is hep B spread?
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
course of hep B?
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
viral markers in hep B?
HBsAg (surface antigen) HBeAg (E antigen) HBcAb (core antibody) HBsAb (surface antibody) HBV DNA (hep B virus DNA)
what does HBsAg indicate?
active infection
what does HBeAg indicate?
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
what does HBcAb indicate?
past or current infection
what does HBsAb indicate?
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
what does HBV DNA?
direct count of viral load
what viral markers are tested when screening for hep B?
HBcAb (for previous infection) and HBsAg (for active infection)
if these are positive then do HBeAg (for infectivity) and HBV DNA (viral load)
why is HBcAb useful?
can help distinguish acute, chronic and past infections
what are the 2 types of HBcAb?
IgM - indicates active infection (high in acute infection, low in chronic infection)
IgG - indicates past infection where HBsAg is negative
does level of HBeAg correlate to infectivity?
yes
higher HBeAg = highly infectious
lower/negative HBeAg = virus not replicating and less infectious
what does it indicate when HBeAb positive but HBeAg negative?
patient has been through a phase where the virus was replicating but virus has now stopped replicating
low infectivity
does hep B have a vaccine?
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)
how is hep B managed?
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
people with hep B should be screened for what other disease?
other blood borne viruses - hep A, hep B and HIV as well as STDs
what type of virus is hep C?
RNA virus
how is hep C spread?
blood and body fluids
does hep C have a vaccine?
no
can hep C be cured?
yes
now curable with direct acting antiviral meds
course of hep C?
1 in 4 fight off disease and fully recover
3 in 4 become chronic
complications of hep C?
liver cirrhosis
hepatocellular carcinoma
investigations in hep C?
hep C antibody is the screening test
hep C RNA testing used to confirm diagnosis, calculate viral load and assess individual genotype
how is hep C managed?
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
what type of virus is hep D virus?
RNA virus
hep D can only occur in which people?
people with hep B infection
hep D attaches itself to HBsAg and cannot survive without it
how is hep E transmitted?
faeco oral
rare in UK
course of hep E infection?
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)
what is autoimmune hepatitis?
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
2 types of autoimmune hepatitis?
1 = occurs in adults 2 = occurs in children
describe type 1 autoimmune hepatitis?
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
describe type 2 autoimmune hepatitis?
patients usually teenagers or in early 20s
presents with acute hepatitis with high transaminases (AST and ALT) and jaundice
investigations in autoimmune hepatitis?
raised AST/ALT
raised IgG
associated with many antibodies
type 1 autoimmune hepatitis antibodies?
ANA (anti-nuclear antibody)
anti-actin (anti-smooth muscle antibody)
anti-SLA/LP (anti-soluble liver antigen)
type 2 autoimmune hepatitis antibodies?
anti-LMK1 (anti-liver kidney microsomes-1)
anti-LC1 (anti-liver cytosol antigen type 1)
how is diagnosis of autoimmune hepatitis confirmed?
liver biopsy
how is autoimmune hepatitis managed?
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
