Hepatitis A

Question 1

Transmission precedes symptoms by how many weeks?

Answer 1

2.

Question 2

Which Ig anti-hepatitis A virus serology is the test of choice for diagnosis?

Answer 2

IgM.

Question 3

What is hepatitis?

Answer 3

Inflammation of the liver caused by infection, medications, toxins and autoimmune disorders.

Question 4

Who does it affect?

Answer 4

· Travellers.

· Individuals with poor hygiene.

Question 5

What is the prognosis for Hep A?

Answer 5

· Normally self-limiting.

· 85% of patients have full recovery within 3 months.

Question 6

What is the aetiology of Hep A?

Answer 6

· RNA virus.
· Resistant to bile lysis due to a lack of a lipid envelope.
· Virus survives on human hands and requires high temperatures for inactivation.
· Lives for extended periods in sea, fresh and waste water and soil.
· Picornavirus, replicates in the liver, excreted in the bile and then faeces for ~2wks before onset of symptoms and for 7 days after

Question 7

How is Hep A transmitted?

Answer 7

By close contact with an infected person or by contact with contaminated food or water.

Question 8

What are the risk factors for Hep A?

Answer 8

· Living in an endemic condition with poor sanitation.
· Close personal contact with an infected person.
· MSM (men who have sex with men).
· Known food-borne outbreak.

Question 9

What signs and symptoms are common with Hep A?

Answer 9

· Prodrome of flu-like symptoms: Fever, Malaise, Anorexia, N&V.
· Jaundice. 
· Hepatomegaly.
· RUQ pain. 
· Clay-coloured stools. 
· Fatigue. 
· Headache. 
· Dark urine.

Question 10

What investigations should be done if Hep A is suspected?

Answer 10

· Serum transaminases. Elevated. 
· Serum bilirubin. Elevated. 
   - LFTs: ↑ AST/ALT and bilirubin.
· Urea. 
· Creatinine. 
· Prothrombin time. 
· IgM anti-hepatitis A virus - will be positive.

Question 11

Suggest some differential diagnoses.

Answer 11

· Acute hepatitis B. 
· Hepatitis E. 
· Acute hepatitis C. 
· EBV infection. 
· Coxsackie virus. 
· CMV infection. 
· HSV infection.

Question 12

What is the treatment for Hep A?

Answer 12

· Unvaccinated people with recent exposure to hepatitis A (<2 weeks):
- Hepatitis A vaccine or immune globulin.

· Confirmed hepatitis A:

• 1st line - Supportive care.
• With worsening jaundice and encephalopathy&raquo_space;> liver transplant.

Question 13

Who is vaccinated against Hep A and when are they vaccinated?

Answer 13

Most frequent vaccine preventable disease in travellers.

Ideally started at least 2-3 weeks before you leave.

Extra doses of the vaccine are recommended after 6-12 months if you need long-term protection.

Question 14

What complications can occur with Hep A?

Answer 14

· Cholecystitis.
· Pancreatitis.
· Auto-immune haemolysis.
· Acute renal failure.