Hepatitis (B and C) Flashcards
Give an example of a systemic virus which can cause ‘collateral’ liver damage?
EBV
Hepatitis viruses are ‘hepatotrophic’- what does this mean?
Replicate specifically in hepatocytes- destroy them
Which of the hepatitis viruses (A-E) can cause chronic illnesses?
Hep B, C, D (can only propagate with B), E (rare)
Which of the Hepatitis viruses contain DNA rather than RNA?
Hep B + (has envelope)
What is the approximate incubation period for Hep B and C?
B- 6 weeks-6months C-6-12 weeks
How can Hepatitis B be transmitted?
- Vertical transmission (75% cases globally) 2. Sexual contact 3. Injecting Drugs 4. Close household contact 6. Healthcare worker via needle stick injury ANY(significant) Blood Exposure
What are the symptoms of Acute Hep B?
(50% will have NO/vague symptoms) 1- Jaundice 2- Fatigue 3-Abdominal pain 4- Anorexia/nausea/vomiting 5- Arthralgia (joint pain)
If infected in adulthood, in what proportion of patients will Acute Hep B become Chronic?
<10%
If infected in infancy, in what proportion of patients will Acute Hep B become Chronic?
90% (asia)
Outline the progression of the serology of Acute Hepatitis B.
1, Surface antigen HBsAg- rises first (Rise ALT)
2, e-antigen HBeAg (when patient= highly infectious)
3, First antibody= Core Antibody (IgM) (HBcAb)
4, Second antibody= e-antibody HBeAb =disappearance of infectivity
5, Final antibody= Surface antibody- HBsAb= clearance of virus
6, Core Antibody (IgG) (HBcAb)= persists for life
How is Hepatitis B treated?
No cure- integrates into host genome Long life antivirals- suppress viral replication (Some may not require antivirals- low viral level etc)
What factors are tested for in a Liver function test?
- Bilirubin 2. Liver transaminases -ALT (Alanine transaminase) -AST (Aspartate aminotransferase) 3. ALP (Alkaline phosphatase) 4. Albumin (=protein synthesised in liver) 5. Coagulation tests -Clotting factors= synthesised in liver -INR -PT (prothrombin time)
Why is ALT and AST tested for a liver function test?
Assesses hepatocyte damage/cellular integrity
Why is ALP tested for in a liver function test?
To assess biliary tract cell damage (bile)/cholestasis (decreased bile flow)
What Liver Function Test results might we see if a patient has Intra-hepatic Jaundice?
-Raised Bilirubin -Raised ALT -Slightly raised ALP
What’s in the Hep B vaccination?
Genetically engineered surface antigen
How many doses does a patient need of the Hep B vaccine?
3 doses + boosters
Who’s at risk of acquiring Hepatitis C?
1- Intravenous drug users (>90%- UK) 2-Sexual contact (<1% but higher if HIV +) 3-Vertical transmission 4-Blood transfusion before 1991 5-Needle stick injuries
What’s the prognosis for Acute Hep B?
Most clear infection in 6 months Very few - sudden hepatic failure Some- becomes chronic hep B
At what point (serologically) does a patient have chronic Hepatitis B?
Persistent HBsAg for 6 months
What are 2 complications of chronic Hep B infection?
1-Liver cirrhosis (25%) 2- Hepatocellular carcinoma (5%)
Complete the following table:
Whats the prognosis for patients with Hep C?
about 80% chronically infected
If someone is chronically infected with Hep C and acquires chronic liver disease/cirrhosis what complications may follow?
-Decompensated liver disease (development of jaundice, haematoma etc) -Hepatocellular carcinoma -Transplant required -Death
What are the symptoms of Hep C?
80% no symptoms 20% Vague symptoms (fatigue, anorexia, nausea, Abdominal pain)= silent killers
How is Hep C tested for?
- Serology- anti-Hep C antibody (remains positive life-long, even after clearance+ potential to get reinfected)
- Viral PCR - if positive= chronic infection
How is Hep C treated?
Can be CURED -Direct acting antiviral drug combo 8-12 weeks (high chance of cure)
(-Can get reinfected) (NO Vaccine)
What is PEP?
Post-exposure Prophylaxis (e.g. for HIV)
What is the definition of Chronic Hep B infection?
Persitence of Surface antigen (HBsAg) after 6 months
What immediate measures should be taken following a needle stick injury?
1- First Aid, bleed and wash wound
2, Collect blood from patient and injured person
3, Inform Occupational health
4, Check injured person’s vaccine status
5, Assess need for HIV PEP
How and when should PEP for HIV be given?
3x antivirals for 28 days
Start ASAP- max 72 hrs
What long term action should be taken following a needle stick injury?
1, Conselling + follow up appointments
2, Advice to use condoms
3, HIV and Hepatitus tests at 12 weeks
Compare HIV, Hep B and Hep C:
What’s the relative risk of acquiring HIV, Hep B, Hep C following a needle stick injury?
