Hepatitis - A/B/C/D/E

Question 1

Definition

Answer 1

Inflammation in the liver. This can vary from a chronic low level inflammation to acute and severe inflammation that leads to large areas of necrosis and liver failure

Question 2

How each virus spreads

Answer 2

A - Faeco-oral routes
B - Blood products and bodily fluids
C- Blood products and bodily fluids
D- Blood products and bodily fluids
E- Faeco-oral routes

Question 3

Acute or chronic?

Answer 3

A - Acute
B - Acute + Chronic
C- Acute + Chronic
D- Acute + Chronic
E - Acute

Question 4

DNA or RNA

Answer 4

A: RNA
B: DNA
C: RNA
D: RNA - requires Hep B
E: RNA

Question 5

Epidemiology

Answer 5

A: America, South America, Children
B/D: IVDU, direct contact, worldwide
C: Male, older,
E: Indochina, commoner than hep A in UK

Question 6

Risk Factors

Answer 6

A: Shellfish, recent travel history, endemic to Africa, overcrowding, poor saturation,
B/D: IVDU, males to have sex with men, dialysis patients, healthcare workers
C: IVDU, limited vertical and sexual transmission
E: water, dogs, pigs = calicivirus

Question 7

Aetiology

Answer 7

Alcoholic hepatitis
Non-alcoholic fatty liver disease
Viral hepatitis
Autoimmune hepatitis
Drug induced hepatitis (paracetamol overdose)

Question 8

Pathophysiology

Answer 8

Inflammation of the liver due to a virus causing liver to present abnormal proteins via MHC-1 molecules
- CD8 + T cells recognise as a sign to kill cell
Cytotoxic killing = apoptosis (hepatocytes undergoing apoptosis = COUNCILMAN BODIES = typically takes place in:
- Portal tracts
- Lobules
Leads to liver damage
HBV + HDV = COINFECTION
HBV then HDV = SUPERINFETION

Question 9

Hep B transmission

Answer 9

Needles (needlestick injury, tattoo, IVDU)
Sexual
Vertical (mother -> child)
Horizontal (between children)
Found in semen and saliva

Question 10

Signs

Answer 10

A: 1-2 weeks prodrome; Fever, malaise, anorexia, nausea, arthralgia, then children (rare in children), hepatosplenomegaly, and adenopathy
B: similar to A - 6-23 weeks prodrome, deepening jaundice, dark urine and pale stools, hepatosplenomegaly, urticaria, arthralgia,
C: acutely asymptomatic, few Px with influenza like symptoms, present later with chronic liver signs, hepatosplenomegaly
E: similar to A

Question 11

Incubation period

Answer 11

A: 2 weeks - replicates in liver, excreted in bile, self-limiting within 6 weeks
B/D: 1-6 months

Question 12

Diagnosis

Answer 12

A: bloods = ESR + leukopenia, LFT = Bilirubin high, serology = IgM = acutely infected
B/D: HBV assay =
- HBVsAg -> present for 1-6 months of infection
- HBVsAb -> present after 6 months of infection = immunity (natural or immunisation)
HBcAb -> exposed to HepB at some point
HBcIgM -> acute infection
HbcIgG -> chronic infection/carrier
HBeAg -> marker of patient infectiousness (acutely infected)
HBeAB -> all chronically infected patients or if they have cleared infection
C: Serology = HCVRNA = current infection/diagnoses acute infection
HCVAb = presents 4-6 weeks of infection
E: IgM - acute infection

Question 13

Treatment

Answer 13

A: supportive, travellers vaccine available,
B/D: vaccination, tenofovir, sc pegylated interferon alpha 2a
C: direct acting antiviral (DAA) - oral ribavirin + N55A-I, N55B-I (needed for viral replication)
E: supportive treatment, self limiting, vaccine only in china

Question 14

Complications

Answer 14

A: fulminant (rapid) liver failure
B/D: associated decompensation with HCC
C: 30% progress to chronic liver failure, HCC risk
E: chronic disease in immunosuppressed, fulminant liver failure, high mortality in pregnant

Question 15

Worse prognosis

Answer 15

HBV = 90% cases in children become chronic decompensated = TRANSPLANT