Hepatitis and liver cancer Flashcards
By which route is hep A transmitted?
enterically
By which route is hep A transmitted?
enterically
Does hep A have a carrier state?
no
What are the clinical features of Hep a?
anorexia, nausea +/- vomiting malaise headache distaste for cigarettes in smokers mild fever \+/- diarrhoea \+/- upper abdominal pain icteric phase (many patients do not develop jaundice): dark urine, pale stools, hepatomegaly, splenomegaly Recovery usually 3-6 weeks
What investigations should be performed if you suspect hepatitis A?
LFTs and viral markers
ultrasound is useful to exclude bile duct obstruction especially in an older patient
By which route is hep B transmitted?
blood spread, percutaneous, sexual transmission, perinatal spread,close prolonged family contact
What percentage of patients with hep B go on to become chronic carriers?
5%
What are the clinical features of Hep a?
anorexia, nausea +/- vomiting malaise headache distaste for cigarettes in smokers mild fever \+/- diarrhoea \+/- upper abdominal pain icteric phase (many patients do not develop jaundice): dark urine, pale stools, hepatomegaly, splenomegaly Recovery usually 3-6 weeks
What are the clinical features of hep B?
anorexia, nausea +/- vomiting malaise headache distaste for cigarettes in smokers mild fever \+/- diarrhoea \+/- upper abdominal pain icteric phase: dark urine, pale stools, hepatomegaly, splenomegaly less abrupt in onset and more severe in the long term than hep A
What investigations should be performed if you suspect hepatitis A?
LFTs and viral markers
ultrasound is useful to exclude bile duct obstruction especially in an older patient
What investigations should be performed if you suspect hepatitis B?
Hepatitis B surface antigen
What investigations should be performed if you suspect hepatitis B?
Hepatitis B surface antigen
Monitor progress with 6-12 monthly LFTs, HBeAG, HBV DNA (negative HBeAG, ABV DNA = resolving, negative HBeAG, HBV DNA with anti-HBe = full recovery, positive HBeAG, HBV DNA = replicating and infective)
What are ways Hep A can be prevented?
immunisation hand hygiene no sharing cutlery good sanitisation effective garbage disposal
What are ways Hep A can be prevented?
immunisation hand hygiene no sharing cutlery good sanitisation effective garbage disposal
What are ways Hep B can be prevented?
immunisation
prenatal screening of pregnant women and appropriate use of HBIg and HB vaccine
What investigations should be performed if you suspect hepatitis c?
HCV ab = exposure
HCV RNA = chronic viraemia
CD4/ HCV = viral load
ALT raised on 3 tests over 6 months implies disease activity
If PCR positive + significant viral load + ^ ALT then perform HCV genotype as this determines treatment
A liver biopsy is the most reliable way to determine the severity of hep c
