Hepatitis B

Question 1

Where is prevalence highest?

Answer 1

East Asia
Africa
Amazon

Question 2

Why is there a low prevalence in the UK?

Answer 2

Vaccination

Question 3

how is hepatitis transmitted?

Answer 3

1. Mostly vertical

2. Horizontal - sexual, blood transfusion, needles, household (razors or toothbrushes)

Question 4

What is HBsAg?

Answer 4

hepatitis B surface antigen - found in blood or serum of current inf, usually diagnostic confirmation of infection

Question 5

What is HbEAg

Answer 5

envelope antigen used in assessment of phase

Question 6

What is HbSAb

Answer 6

abs immune system makes in response to surface antigen of hep B, indicates immunity

Question 7

What is HbcAb

Answer 7

first antibody to appear follow acute inf and will persist in high levels following resolution of inf and in chronically infected patients

Question 8

What is IgM core ab used for

Answer 8

to identify acute infection

Question 9

How is HBV DNA measured and what is it used for?

Answer 9

quantified by PCR and determines grade of replication and virus activity

Question 10

When does HBV become chronic?

Answer 10

> 6m

Question 11

When is rate of infection becoming chronic higher?

Answer 11

at birth (90%)

Question 12

At what age is there a high chance of HBV being self limiting ?

Answer 12

5 yrs

Question 13

How does hep B present?

Answer 13

usually asymptomatic

can be fever, jaundice + elevated liver transaminases

Question 14

How can hep B be prevented

Answer 14

immunisation + immunoglobulin post exposure

Question 15

is hep b curable

Answer 15

no

Question 16

What groups should be vaccinated?

Answer 16

healthcare workers
IVDU
sex workers
close contacts 
ppl having blood transfusions regularly
CKD pts needing RRT

Question 17

When are children vaccinated ?

Answer 17

2,3,4 months

Question 18

What tests should be done pre-treatment

Answer 18

1. HBeAg, HBV DNA, IgM ab to HBcAb
2. Hep C, D, A ab, HIV ab
3. LFTs: ALT, AST, GGT, albumin, total bilirubin, total globulin
4. FBC and PTT
5. Serum alpha-fetoprotein + liver US for hepatocellular carcinoma

Question 19

What are possible sx that need to be treated and with what?

Answer 19

1. pain - simple analgesia
2. nausea - metoclopramide (max 5 days), cyclizine
3. Itch - cool well ventilated environment, loose clothing, chlorphenamine, ursodeoxycholic acid

Question 20

What markers are used to monitor hep B

Answer 20

HBV DNA

ALT

Question 21

When is treatment needed

Answer 21

HBsAg +ve 
\+
HBV DNA ≥ 20000 IU per ml 
\+
↑ serum ALT

Question 22

What is the aim of treatment

Answer 22

Seroconversion of HBeAg

↓ of HBV DNA to undetectable levels

Question 23

What is the pharmacological treatment of HBV, how are they given and how do they work?

Answer 23

1. Pegylated interferon alpha (subcut - inhibits viral replication + ↑ immune response to virus)
2. Tenofovir, entecavir

Question 24

What are the complications of Hep B?

Answer 24

chronic hepatitis
fulminant hepatic failure
hepatocellular carcinoma
GN
Polyarteritis nodosa
cryoglobulinaemia

Question 25

Look at notes with monitoring

Answer 25

:)

Question 26

Who should be screened for hep B in pregnancy?

Answer 26

EVERYONE

Question 27

When should babies be treated and with what?

Answer 27

Babies born to mums chronically infected w Hep B or have acute hep B during pregnancy Rx: complete course of vaccination + hep B Ig

Question 28

Can hep B be transmitted via breast feeding?

Answer 28

no

Question 29

How can vertical transmission be prevented?

Answer 29

Rx to reduce level of virus towards the end of pregnancy with Ig + immunisation