Hepatitis – A/B/C/D/E/autoimmune Flashcards
Define hepatitis.
Hepatitis describes 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.
How long does hepatitis persist for to be deemed chronic?
6 months.
Give 5 general causes of hepatitis.
- Alcoholic hepatitis
- Non alcoholic fatty liver disease
- Viral hepatitis
- Autoimmune hepatitis
- Drug-induced hepatitis (e.g. paracetamol overdose)
Give 3 infective causes of acute hepatitis.
Viral -
1. Hepatitis A and E infection.
2. Herpes viruses e.g. EBV, CMV, VZV
Non-viral -
3. Leptospirosis
4. Toxoplasmosis
5. Coxiella (Q fever)
Give 3 infective causes of chronic hepatitis.
- Hepatitis B (+/-D).
- Hepatits C.
- Hepatitis E.
Give 3 non-infective causes of acute and chronic hepatitis.
- Alcohol.
- Drugs.
- Toxins.
- Autoimmune.
- Hereditary metabolic.
Give 3 symptoms of acute hepatitis.
- General malaise.
- Myalgia.
- GI upset.
- Abdominal pain.
- Raised AST, ALT.
- +/- jaundice.
- Tender hepatomegaly.
Give 4 symptoms of chronic liver disease that can be seen in chronic hepatitis.
+/- signs of chronic liver disease:
- Clubbing
- Palmar erythema
- Dupuytren’s contracture (one or more fingers bending into palm of hand)
- Spider naevi
What are the potential complications of chronic hepatitis?
Uncontrolled inflammation -> fibrosis -> cirrhosis -> HCC.
Is HAV a RNA or DNA virus?
HAV is a RNA virus.
Is HAV acute or chronic?
Acute! There is 100% immunity after infection.
How is HAV transmitted?
Faeco-oral transmission. E.g. contaminated food/water; shellfish.
Who could be at risk of HAV infection?
Travellers and food handlers.
What are the risk factors for HAV?
Poor sanitation, overcrowding, contaminated food/water. (fish in sewage water)
Give 3 symptoms of HAV.
Give 2 later signs of HAV.
Symptoms: fever, malaise, anorexia, nausea, vomiting, arthralgia (joint pain).
Later signs - jaundice, moderate hepatosplenomegaly, lymphadenopathy.
Can cause cholestasis (slowing of bile flow through the biliary system) with dark urine, pale stools and moderate hepatomegaly.
How might you diagnose someone with HAV infection?
Viral serology:
Initially anti-HAV IgM (acute);
And then anti-HAV IgG (raised for life - carrier)
Blood test:
LFTs - AST/ALT are raised
Describe the management of HAV infection.
- Supportive.
- Monitor liver function to ensure no fulminant hepatic failure.
- Manage close contacts.
Describe the prevention of HAV.
Passive and active immunisation (inactivated protein).
Good hygiene.
Is HAV a notifiable disease or not?
YES!!
Is HEV a RNA or DNA virus?
HEV is a small RNA virus.
Is HEV acute or chronic?
Usually acute, but there is a risk of chronic disease in the immunocompromised.
Once you’ve had HEV, then you cannot get infected again - 100% immunity
What infection is HEV similar to?
HAV.
How is HEV transmitted?
Faeco-oral transmission.
Usually spread by contaminated water, rodents, dogs and pigs.
How might you diagnose someone with HEV infection?
Viral serology: Initially anti-HEV IgM and then anti-HEV IgG.
What can you detect in blood and stools to confirm a diagnosis of chronic HEV infection?
Use HEV RNA to detect chronic infection
Describe the primary prevention of HEV.
- Good food hygiene and sanitation.
- A vaccine is in development.
Is HEV a notifiable disease or not?
YES!!
Is HBV a RNA or DNA virus?
HBV is a DNA virus! It replicates in hepatocytes.
How is HBV transmitted?
Blood-borne transmission
e.g. blood products, IVDU, needle-stick, tattoos, sexual
HBV is found in saliva and semen
Vertical transmission:
Mother-to-child transmission (MTCT)
Horizontal transmission - particularly in children
* Through minor abrasions or close contact with other children
* HBV can survive on household articles such as toys or toothbrushes for
prolonged periods of time
HBV is highly infectious!
Name 3 at-risk groups for HBV.
- Healthcare personnel + their sexual partners and carers
- Emergency + rescue teams and morticians = exposure to blood
- CKD/haemodialysis patients
- Travellers
- Homosexual men
- IV drug users
- Babies of HBV+ mothers
- Haemophiliacs