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2a Liver and GI > Hepatitis A-E > Flashcards

Hepatitis A-E Flashcards

1
Q

Viral hepatitis is…

A

inflammation of the liver resulting from viral replication within hepatocytes

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2
Q

Hepatitis A is a p______

A

picornavirus

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3
Q

Hepatitis A is spread…

A

faeco-orally

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4
Q

Where is hepatitis A most common?

A

Africa

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5
Q

True or false: Hep A can persist in water

A

True

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6
Q

What are ways to become infected with Hep A?

A

Travelling
Shellfish
Contaminated food or water
Poor sanitation
Close household contact
Overcrowding
Sexual contact
Contact through childcare groups
IV drug users
Infected food handlers

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7
Q

The first 2 weeks of infection is called p_____ phase and may not have characteristic symptoms

A

prodromal phase
May have malaise, N&V and fever

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8
Q

What are symptoms of Hep A after the first 2 week prodromal phase?

A

Jaundice
Dark urine
Pale stools
Hepatosplenomegaly

Rare complication = fulminant liver failure

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9
Q

Is Hep A a notifiable disease?

A

Yes to PHE

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10
Q

Is there an incubation period for Hep A?

A

Yes, 2 weeks.
Virus replicates in liver, excreted in bile.
Self limiting within 6 weeks.

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11
Q

Is there a vaccine for Hep A?

A

Yes, it is an inactivated virus, grown in human diploid cells

Traveller’s vaccine available

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12
Q

How often do you need the booster Hep A vaccine?

A

Once every 10 years

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13
Q

Is there a post-exposure prophylaxis for Hep A?

A

Yes, HAV immunoglobulins

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14
Q

Can Hep A lead to chronic liver disease?

A

No, it is self-limiting and acute

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15
Q

How would you diagnose Hepatitis A?

A

Bloods:
Increased ESR
Leukopenia

LFT:
Increased bilirubin when jaundiced (yellow from jaundice = icteric)

HAV serology:
HAV IgM when acutely infected

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16
Q

True or false: you have 100% immunity after infection of Hepatitis A

A

True

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17
Q

Is hepatitis E chronic?

A

Usually no, only acute condition.

However, in immunosuppressed can cause chronic disease and fulminant (sudden in onset) liver failure.

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18
Q

How is Hep E spread?

A

Faeco-orally
(water, dogs, pigs)

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19
Q

What type of virus is Hep E?

A

calcivirus

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20
Q

True or false: Hep E is less common than Hep A in the UK

A

False
Hep E is more common than Hep A in the UK

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21
Q

What is a major cause of Hep E?

A

Undercooked pork

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22
Q

What is the mortality rate for pregnant ladies with Hep E?

A

10-20%

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23
Q

How do you diagnose Hep E?

A

HEV IgM in acute infection due to HEV RNA

24
Q

What is the treatment for Hep E?

A

It is self-limiting
Supportive
There is a vaccine only in China

25
Q

How is Hep D spread?

A

Bloodborne

(IV drug users, tattoos, injection)

26
Q

True or false: You have 100% immunity after Hep E infection

A

True

27
Q

Can Hep D be chronic?

A

Yes

28
Q

Hepatitis D requires what to replicate?

A

Hepatitis B

29
Q

What percentage of those with Hep B infection are affected by Hep D infection?

A

5%

30
Q

What immunoglobulins will someone infected with Hep D have?

A

IgM HDV and IgM HBV

31
Q

What is treatment for Hep D?

A

Pegylated interferon alpha
Over at least 48 weeks
Has significant side effects so not for those with uncompensated liver cirrhosis.
Low treatment success rates

32
Q

What type of virus is Hep C?

A

Flavivirus

33
Q

How does Hep C spread?

A

Blood borne - IV drug users

Limited vertical/ sexual transmission

34
Q

Can Hep C be chronic?

A

Yes

35
Q

In the acute phase, what are symptoms of Hep C?

A

Mostly asymptomatic
Some may have influenza like symptoms

36
Q

What are later symptoms of Hep C

A

Chronic liver failure signs
Hepatosplenomegaly

37
Q

How do you diagnose Hep C?

A

Serology:
HCV RNA = current acute infection
HCV Ab = within 4-6 weeks of infection

38
Q

How do you treat Hep C?

A

Direct Acting Antivirals (DAA):

Sofosbuvir
Oral ribavirin with other meds.

Typically takes 8-12 weeks

Some won’t need treatment (1 in 4)
Treatment always needed for chronic infection.

39
Q

What are complications of Hep C?

A

HCC
Liver cirrhosis

40
Q

Is the Hep B virus DNA or RNA?

A

DNA

41
Q

How does hepatitis B spread?

A

Through the blood or bodily fluids (semen, saliva)
eg. needle stick, tattoos, sexual, vertical

42
Q

True or false: hepatitis B is highly infectious

A

True, only a tiny amount is needed

43
Q

Can hepatitis B cause chronic hepatitis?

A

Yes, if viral DNA is inserted into cell nucleus and continue to produce viral proteins.
Cirrhosis and HCC

44
Q

What are symptoms of Hep B?

A

V similar to Hep A
1-2 week prodrome

Jaundice
Dark urine
Pale stools
Hepatosplenomegaly
Urticaria (hives)
Arthralgia

45
Q

What is the incubation period for Hep B?

A

1-6 months

46
Q

How do you diagnose Hep B?

A

Serology

47
Q

What are key viral markers of Hep B?

A

HBsAG (surface antigen) = active infection

HBcAG (core antigens) = current or past infection

HBsAB (surface antibodies) = current or past infection or vaccination. Shows immunity

HBeAG (E antigen) = marker of viral replication implying high infectivity

HBV DNA = direct count of viral load

48
Q

We can measure Ig_ and Ig_ versions of the HBcAb

A

IgM and IgG

49
Q

A high titre of IgM indicates

A

Active acute infection

50
Q

A low titre of IgM indicates

A

Active chronic infection

51
Q

IgG indicates…

A

A past infection

52
Q

Is there a vaccination for Hep B?

A

Yes, 3 doses
Inject HBsAg, then test HBsAB to check response.

53
Q

Hepatitis B is characterised by l______ infiltrate leading to portal and lobular inflammation

A

lymphocytic

54
Q

Can Hepatitis B be spread vertically?

A

Yes

55
Q

How long do symptoms of Hep B last?

A

6-12 weeks

56
Q

How do you manage Hep B?

A

Pegylated interferon alpha 2a
Avoid alcohol
Educate about reducing transmission
Contact tracing
USS for HCC
Antiviral meds
Liver transplant for fulminant hepatitis

2a Liver and GI (61 decks)

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