Hepatitis A-E Flashcards
Viral hepatitis is…
inflammation of the liver resulting from viral replication within hepatocytes
Hepatitis A is a p______
picornavirus
Hepatitis A is spread…
faeco-orally
Where is hepatitis A most common?
Africa
True or false: Hep A can persist in water
True
What are ways to become infected with Hep 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
The first 2 weeks of infection is called p_____ phase and may not have characteristic symptoms
prodromal phase
May have malaise, N&V and fever
What are symptoms of Hep A after the first 2 week prodromal phase?
Jaundice
Dark urine
Pale stools
Hepatosplenomegaly
Rare complication = fulminant liver failure
Is Hep A a notifiable disease?
Yes to PHE
Is there an incubation period for Hep A?
Yes, 2 weeks.
Virus replicates in liver, excreted in bile.
Self limiting within 6 weeks.
Is there a vaccine for Hep A?
Yes, it is an inactivated virus, grown in human diploid cells
Traveller’s vaccine available
How often do you need the booster Hep A vaccine?
Once every 10 years
Is there a post-exposure prophylaxis for Hep A?
Yes, HAV immunoglobulins
Can Hep A lead to chronic liver disease?
No, it is self-limiting and acute
How would you diagnose Hepatitis A?
Bloods:
Increased ESR
Leukopenia
LFT:
Increased bilirubin when jaundiced (yellow from jaundice = icteric)
HAV serology:
HAV IgM when acutely infected
True or false: you have 100% immunity after infection of Hepatitis A
True
Is hepatitis E chronic?
Usually no, only acute condition.
However, in immunosuppressed can cause chronic disease and fulminant (sudden in onset) liver failure.
How is Hep E spread?
Faeco-orally
(water, dogs, pigs)
What type of virus is Hep E?
calcivirus
True or false: Hep E is less common than Hep A in the UK
False
Hep E is more common than Hep A in the UK
What is a major cause of Hep E?
Undercooked pork
What is the mortality rate for pregnant ladies with Hep E?
10-20%
How do you diagnose Hep E?
HEV IgM in acute infection due to HEV RNA
What is the treatment for Hep E?
It is self-limiting
Supportive
There is a vaccine only in China
How is Hep D spread?
Bloodborne
(IV drug users, tattoos, injection)
True or false: You have 100% immunity after Hep E infection
True
Can Hep D be chronic?
Yes
Hepatitis D requires what to replicate?
Hepatitis B
What percentage of those with Hep B infection are affected by Hep D infection?
5%
What immunoglobulins will someone infected with Hep D have?
IgM HDV and IgM HBV
What is treatment for Hep D?
Pegylated interferon alpha
Over at least 48 weeks
Has significant side effects so not for those with uncompensated liver cirrhosis.
Low treatment success rates
What type of virus is Hep C?
Flavivirus
How does Hep C spread?
Blood borne - IV drug users
Limited vertical/ sexual transmission
Can Hep C be chronic?
Yes
In the acute phase, what are symptoms of Hep C?
Mostly asymptomatic
Some may have influenza like symptoms
What are later symptoms of Hep C
Chronic liver failure signs
Hepatosplenomegaly
How do you diagnose Hep C?
Serology:
HCV RNA = current acute infection
HCV Ab = within 4-6 weeks of infection
How do you treat Hep C?
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.
What are complications of Hep C?
HCC
Liver cirrhosis
Is the Hep B virus DNA or RNA?
DNA
How does hepatitis B spread?
Through the blood or bodily fluids (semen, saliva)
eg. needle stick, tattoos, sexual, vertical
True or false: hepatitis B is highly infectious
True, only a tiny amount is needed
Can hepatitis B cause chronic hepatitis?
Yes, if viral DNA is inserted into cell nucleus and continue to produce viral proteins.
Cirrhosis and HCC
What are symptoms of Hep B?
V similar to Hep A
1-2 week prodrome
Jaundice
Dark urine
Pale stools
Hepatosplenomegaly
Urticaria (hives)
Arthralgia
What is the incubation period for Hep B?
1-6 months
How do you diagnose Hep B?
Serology
What are key viral markers of Hep B?
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
We can measure Ig_ and Ig_ versions of the HBcAb
IgM and IgG
A high titre of IgM indicates
Active acute infection
A low titre of IgM indicates
Active chronic infection
IgG indicates…
A past infection
Is there a vaccination for Hep B?
Yes, 3 doses
Inject HBsAg, then test HBsAB to check response.
Hepatitis B is characterised by l______ infiltrate leading to portal and lobular inflammation
lymphocytic
Can Hepatitis B be spread vertically?
Yes
How long do symptoms of Hep B last?
6-12 weeks
How do you manage Hep B?
Pegylated interferon alpha 2a
Avoid alcohol
Educate about reducing transmission
Contact tracing
USS for HCC
Antiviral meds
Liver transplant for fulminant hepatitis
