Hepatitis B and D

Question 1

define:

Answer 1

hepatitis due to infection with the DNA virus of Hep B.

Can be acute or chronic (more than six months)

Hep D is a defective virus that can only be co-infected with hep B or superinfect when a person is HBV carrier

Question 2

Aetiology/risk factors:

Answer 2

TRANSMISSION IS THROUGH BLOOD.

RF:

• Unsafe sex
• Blood transfusions with blood that has no been screened
• vertically (from mother to baby)
• IVDU
• unsteralised equipment

HBV = DNA virus. Has core and surface antigens. E antigens are when it is highly infective.

Hep D = RNA virus.

Work in the same way as all viral hep.

Question 3

epidemiology:

Answer 3

common.

1-2 million deaths annually.

Common in the Mediterranean, Africa and south east Asia.

Question 4

symptoms:

Answer 4

incubation for 3-6 months.

Malaise
fever
nausea and vomiting
jaundice 
anorexia
rash 
RUQ pain
diarrhoea
headache

Question 5

signs:

Answer 5

jaundice
tender hepatomegaly
palpable spleen
pyrexia

chronic often has no signs besides liver deompensation.

Question 6

investigations:

Answer 6

LFT’s
Clotting time
Viral serology (see notes for more)
liver biopsy

Question 7

management:

Answer 7

Prevention - sanitation, using protection, vaccination

Symptomatic treatment (anti-emetic/pyretic)

nucleoside/tide analogues (for life)

Anti-virals such as tenofvir

Question 8

complications:

Answer 8

1% fulminant hepatitis 
HCC
Chronic HBV
cirrhosis 
acute liver failure with HDV
immune complex disorders

Question 9

prognosis

Answer 9

adults 10% will get chronic HBV.

With chronic 20-30% will get cirrhosis.