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A - MSRA Gynaecology > Hepatitis B > Flashcards

Hepatitis B Flashcards

1
Q

What is hepatitis B?

A

An infection of the liver caused by the hepatitis B virus (HBV)

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2
Q

What type of virus is HBV?

A

A double-stranded DNA virus which replicates by reverse transcriptase

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3
Q

How many people worldwide have hepatitis B?

A

Over 350 million

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4
Q

What proportion of the UK is thought to have hepatitis B?

A

1 in 350

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5
Q

How is hepatitis B transmitted?

A

Parenterally via infected blood or body fluids

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6
Q

What are the routes of transmission of HBV?

A
  • Vaginal or anal intercourse
  • Sharing needles
  • Sharps injuries
  • Vertical transmission
  • Blood transfusion
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7
Q

What is the effect of the HBV?

A

Interferes with the functions of the liver by replicating in hepatocytes

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8
Q

What causes damage to the liver in hepatitis B?

A

Hosts immune response causing hepatocellular damage

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9
Q

What are the risk factors for hepatitis B?

A
  • IV drug use
  • Multiple sexual partners
  • MSM
  • Born in highly endemic region
  • Household contact with EBV
  • Infected with HIV or Hep C
  • Dialysis
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10
Q

What are the two forms of hepatitis B infection?

A
  • Acute infection

- Chronic infection

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11
Q

How can acute hepatitis B infection present?

A
  • Can be asymptomatic

- Can have acute viral hepatitis

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12
Q

What are the features of acute viral hepatitis?

A
  • General ill-health
  • Loss of appetite
  • Body aches
  • Mild fever
  • Dark urine
  • Progressive jaundice
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13
Q

How long do the symptoms of acute viral hepatitis last?

A

A few weeks and then gradually improves

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14
Q

What can acute hepatitis occasionally lead to?

A

Fulminant hepatitis

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15
Q

What is the danger of fulminant hepatitis?

A

It can be fatal

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16
Q

What is chronic hepatitis B?

A

A spectrum of disease characterised by the presence of detectable hepatitis B surface antigen (HbsAg) in the blood for longer than 6 months

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17
Q

How can chronic hepatitis progress?

A
  • Inactive
  • Liver fibrosis
  • Cirrhosis
  • Hepatocellular carcinoma
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18
Q

How can chronic hepatitis B be classified?

A
  • e antigen positive

- e antigen negative

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19
Q

What is the presence of hepatitis B e antigen associated with?

A
  • Higher rates of viral replication

- Increased infectivity

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20
Q

What are the potential symptoms of chronic hepatitis B?

A
  • Fatigue
  • Anorexia
  • RUQ pain
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21
Q

What investigations are used for hepatitis B?

A
  • Serological markers
  • General liver investigations
  • Tests for Hep C and HIV
  • Screening for liver cancer
  • Staging investigations
22
Q

What are some general liver investigations?

A
  • FBC
  • Bilirubin
  • Liver enzymes
  • Clotting
  • Ferritin
  • Lipid profile
  • Autoantibody screen
  • Caeruloplasmin
23
Q

What test can be used to screen for liver cancer?

A
  • Ultrasonography

- Alpha-fetoprotein

24
Q

What are some hepatitis B staging investigations?

A
  • Transient elastography

- Liver biopsy

25
What can be used to determine a person's hepatitis B infection status?
Serological markers
26
What are the serological markers looked at in hepatitis B?
- Surface antigen (HbsAg) - Core antibody (HbcAb) - Surface antibody (HbsAb)
27
What are the serological markers of an acute infection?
- HbsAg +ve - HbcAb (IgM) +ve - HbsAb +ve/-ve
28
What are the serological markers of a cleared hepatitis B infection?
- HbsAg -ve - HbcAb (IgG) +ve - HbsAb +ve
29
What are the serological markers of a chronic hepatitis B infection?
- HbsAg +ve - HbcAb (IgG) +ve - HbsAb -ve
30
What are the serological markers of a person vaccinated for hepatitis B?
- HbsAg -ve - HbcAb -ve - HbsAb +ve
31
What general advise is given to patients with hepatitis B?
- Avoid unprotected sex until non-infectious - Give explanation of the condition and long-term health implications - Advise not to give blood - Avoid alcohol until liver enzymes normal
32
Where can acute hepatitis B be treated?
In primary care unless seriously ill
33
What are the main treatment options for acute hepatitis B?
Supportive management with fluids, anti-emetics and rest
34
When is anti-viral treatment indicated in hepatitis B?
Fulminant hepatitis
35
How is chronic hepatitis B cured?
There is no cure
36
How is chronic hepatitis B managed?
Through life-long anti-virals to suppress replication
37
Who may not require life-long anti-virals in chronic hepatitis B?
Those who are inactive carriers
38
When do inactive carriers of hepatitis B not require antiviral treatment?
- Low viral load - Normal LFTs - Mild fibrosis
39
What drug can be used to treat hepatitis B?
Peginterferon alfa-2a
40
What is the action of peginterferon alpha-2a?
Stimulates the immune system to attack the virus
41
What are the common side-effects of peginterferon alpha-2a?
Flu-like symptoms
42
What is the main method of preventing hepatitis B?
Vaccination
43
What is the hepatitis B vaccination?
A genetically engineered surface antigen
44
How many doses of hepatitis B vaccine are provided to give coverage?
3 + boosters if required
45
Who is the hepatitis B vaccine most effective in?
Younger people
46
What is defined as a protective response to the hepatitis B vaccine?
≥10mlU/ml of anti-HB antibodies in the serum
47
When is the hepatitis B vaccine routinely given?
To all babies at 8, 12, and 16 weeks
48
Who is hepatitis B vaccine given to if not received as a baby?
Those at risk of hepatitis B or complications
49
What are the potential complications of hepatitis B?
- Fulminant hepatic failure - Cirrhosis - Hepatocellular carcinoma - Cryoglobulinaemia - Membranous nephropathy - Polyarteritis nodosa
50
What is the important public health consideration with hepatitis B?
It is a notifiable disease
51
What is meant by hepatitis B being a notifiable disease?
All suspected cases should be reported to the local Health Protection Team via notification form
52
Should a patient be told that the local health protection team is being notified of their hepatitis B?
Yes

A - MSRA Gynaecology (52 decks)

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