Hepatitis

Question 1

Why hepatitis type is caused by a DNA virus

Answer 1

Hepatitis B

Question 2

Transmission of each hepatitis

Answer 2

A - faeco - oral 
B - sexual, vertical, parenteral
C - parenteral (IVDU)
D - parenteral, sexual 
E - faeco oral

Question 3

Which hepatitis can be passed from mother to baby

Answer 3

Hepatitis B

Question 4

Which hepatitis is chronic

Answer 4

Hepatitis C

Question 5

Risk factor of hepatitis A

Answer 5

Travelling to Asia or Africa

Question 6

Clinical feature of hepatitis

Answer 6

Symptoms 
RUQ pain 
Pruritis 
Nausea and vomiting 
Anorexia 
Joint pain 

Signs:
RUQ tenderness
Jaundice
Flu symptoms

Question 7

Investigations

Answer 7

Abdominal examination
Obs
Bloods - LFTs, U+Es, FBC, CRP, prothrombin time, serology

Question 8

Serology

Answer 8

Surface antigen - active infection
Surface antibody - immunity - past infection or vaccinated
Core IgM - acute infection
Core IgG - past infection
e antigen - infectious - active replication

Question 9

Vaccinated serology

Answer 9

Surface antigen - negative
Surface antibody - positive
IgM - negative
IgG - negative

Question 10

Chronic infection serology

Answer 10

Surface antigen - positive
Surface antibody - negative
IgM - negative
IgG - positive

Question 11

Immune last infection serology

Answer 11

Surface antigen - negative
Surface antibody - positive
IgM - negative
IgG - positive

Question 12

Acute infection serology

Answer 12

Surface antigen - positive
Surface antibody - negative
IgM - positive
IgG - positive

Question 13

Definition of chronic hepatitis

Answer 13

Hepatitis lasting for 6 months or longer

Question 14

Management of hepatitis

Answer 14

A - supportive care
B - antivirals - pegylated IFN- a (no cure)
C - antivirals +/- ribaviran

Question 15

Hepatitis E risk factors

Answer 15

Farm animals

Immunocompromised

Question 16

Complication of hepatitis

Answer 16

Chronic liver disease - cirrhosis

Hepatocellular carcinoma

Question 17

Most common worldwide and in Europe

Answer 17

Worldwide - B

Europe - C

Question 18

Which hepatitis has vaccine

Answer 18

Hep B

Question 19

Hereditary haemochromatosis

Answer 19

Inherited disorder resulting from abnormal

iron metabolism

Question 20

Hereditary haemochromatosis complications

Answer 20

Myocardial:

• Dilated cardiomyopathy
• Arrhythmias

Endocrine:
Pancreas: DM
Pituitary: hypogonadism → amenorrhoea, infertility

Parathyroid:

• hypocalcaemia and osteoporosis
• Arthritis- 2nd and 3rd MCP joints, knees and shoulders

Liver
Chronic liver disease → cirrhosis → HCC
Hepatomegaly

Skin:
Slate grey discolouration

Question 21

HHC Mx

Answer 21

Iron removal
- Venesection

General:

• Monitor DM
• Low Fe diet

Screening:
Se ferritin and genotype
Screen 1st degree relatives

Transplant in cirrhosis

Question 22

α1-Antitrypsin Deficiency

Answer 22

α1AT inhibits neutrophil elastase therefore deficiency causes increased elastase

α1AT is synthesised in the liver

• Causes COPD in younger pts

Question 23

Ix of α1-Antitrypsin Deficiency

Answer 23

Blood: ↓ se α1AT levels
Liver biopsy: 
CXR: emphysematous changes
Spirometry: obstructive defect
Prenatal Dx: possible by CVS

Question 24

Wilson’s Disease

Answer 24

Mutation of Cu transporting ATPase
Impaired hepatocyte incorporation of Cu into
caeruloplasmin and excretion into bile.

Cu accumulation in liver and, later, other organs

Question 25

Wilson’s disease Ix

Answer 25

Bloods: ↓Cu, ↓caeruloplasmin
( may be high during infection) 
↑ 24h urinary Cu
Liver biopsy: ↑ hepatic Cu
MRI: basal-ganglia degeneration

Question 26

Rx for Wilson’s disease

Answer 26

Diet: avoid high Cu foods: liver, chocolate, nuts

Penicillamine lifelong (Cu chelator)

Monitor FBC and urinary Cu excretion

Liver Tx if severe liver disease

Screen siblings

Question 27

Diseases associated with AIH

Answer 27

Autoimmune thyroiditis
DM
Pernicious anaemia
PSC
UC
Glomerulonephritis
AIHA (Coombs +ve)