Hepatitis (B and C)

Question 1

Give an example of a systemic virus which can cause ‘collateral’ liver damage?

Answer 1

EBV

Question 2

Hepatitis viruses are ‘hepatotrophic’- what does this mean?

Answer 2

Replicate specifically in hepatocytes- destroy them

Question 3

Which of the hepatitis viruses (A-E) can cause chronic illnesses?

Answer 3

Hep B, C, D (can only propagate with B), E (rare)

Question 4

Which of the Hepatitis viruses contain DNA rather than RNA?

Answer 4

Hep B + (has envelope)

Question 5

What is the approximate incubation period for Hep B and C?

Answer 5

B- 6 weeks-6months C-6-12 weeks

Question 6

How can Hepatitis B be transmitted?

Answer 6

1. 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

Question 7

What are the symptoms of Acute Hep B?

Answer 7

(50% will have NO/vague symptoms) 1- Jaundice 2- Fatigue 3-Abdominal pain 4- Anorexia/nausea/vomiting 5- Arthralgia (joint pain)

Question 8

If infected in adulthood, in what proportion of patients will Acute Hep B become Chronic?

Answer 8

<10%

Question 9

If infected in infancy, in what proportion of patients will Acute Hep B become Chronic?

Answer 9

90% (asia)

Question 10

Outline the progression of the serology of Acute Hepatitis B.

Answer 10

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

Question 11

How is Hepatitis B treated?

Answer 11

No cure- integrates into host genome Long life antivirals- suppress viral replication (Some may not require antivirals- low viral level etc)

Question 12

What factors are tested for in a Liver function test?

Answer 12

1. 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)

Question 13

Why is ALT and AST tested for a liver function test?

Answer 13

Assesses hepatocyte damage/cellular integrity

Question 14

Why is ALP tested for in a liver function test?

Answer 14

To assess biliary tract cell damage (bile)/cholestasis (decreased bile flow)

Question 15

What Liver Function Test results might we see if a patient has Intra-hepatic Jaundice?

Answer 15

-Raised Bilirubin -Raised ALT -Slightly raised ALP

Question 16

What’s in the Hep B vaccination?

Answer 16

Genetically engineered surface antigen

Question 17

How many doses does a patient need of the Hep B vaccine?

Answer 17

3 doses + boosters

Question 18

Who’s at risk of acquiring Hepatitis C?

Answer 18

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

Question 19

What’s the prognosis for Acute Hep B?

Answer 19

Most clear infection in 6 months Very few - sudden hepatic failure Some- becomes chronic hep B

Question 20

At what point (serologically) does a patient have chronic Hepatitis B?

Answer 20

Persistent HBsAg for 6 months

Question 21

What are 2 complications of chronic Hep B infection?

Answer 21

1-Liver cirrhosis (25%) 2- Hepatocellular carcinoma (5%)

Question 22

Complete the following table:

Answer 22

Question 23

Whats the prognosis for patients with Hep C?

Answer 23

about 80% chronically infected

Question 24

If someone is chronically infected with Hep C and acquires chronic liver disease/cirrhosis what complications may follow?

Answer 24

-Decompensated liver disease (development of jaundice, haematoma etc) -Hepatocellular carcinoma -Transplant required -Death

Question 25

What are the symptoms of Hep C?

Answer 25

80% no symptoms 20% Vague symptoms (fatigue, anorexia, nausea, Abdominal pain)= silent killers

Question 26

How is Hep C tested for?

Answer 26

• Serology- anti-Hep C antibody (remains positive life-long, even after clearance+ potential to get reinfected)
• Viral PCR - if positive= chronic infection

Question 27

How is Hep C treated?

Answer 27

Can be CURED -Direct acting antiviral drug combo 8-12 weeks (high chance of cure)

(-Can get reinfected) (NO Vaccine)

Question 28

What is PEP?

Answer 28

Post-exposure Prophylaxis (e.g. for HIV)

Question 29

What is the definition of Chronic Hep B infection?

Answer 29

Persitence of Surface antigen (HBsAg) after 6 months

Question 30

What immediate measures should be taken following a needle stick injury?

Answer 30

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

Question 31

How and when should PEP for HIV be given?

Answer 31

3x antivirals for 28 days

Start ASAP- max 72 hrs

Question 32

What long term action should be taken following a needle stick injury?

Answer 32

1, Conselling + follow up appointments

2, Advice to use condoms

3, HIV and Hepatitus tests at 12 weeks

Question 33

Compare HIV, Hep B and Hep C:

Answer 33

Question 34

What’s the relative risk of acquiring HIV, Hep B, Hep C following a needle stick injury?

Answer 34