Hepatitis C

Question 1

define:

Answer 1

hepatitis caused by an infection by hep c.

It is often chronic (80%)

Question 2

aetiology/risk factors:

Answer 2

small enveloped RNA virus

HIGH MUTATION RATE.

SEXUAL AND VERTICAL TRANSMISSION.

Same RF as Hep B and D.

Question 3

epidemiology:

Answer 3

common

different stereotypes in different parts geographically.

Question 4

symptoms:

Answer 4

90% are asymp

10% get flu like symptoms

Question 5

signs:

Answer 5

may have no signs

some signs of chronic liver disease e.g. spider naevi

skin rashes

renal dysfunction

Question 6

investigations:

Answer 6

• Bloods
o HCV Serology
• Anti-HCV antibodies - IgM (acute) or IgG (past exposure or chronic)
o Reverse-transcriptase PCR
• Allows detection and genotyping of HCV
o LFT
• Acute infection: High ALT, AST and bilirubin
• Chronic infection: 2-8 x elevation of AST + ALT (often fluctuates over time)
• Liver Biopsy
o Assess the degree of inflammation and liver damage
o Useful for diagnosing cirrhosis – as these pts require monitoring for HCC

Question 7

management:

Answer 7

• Prevention
o Screen blood, blood products and organ donors
o Needle exchange schemes for IV drug users
o Instrument sterilisation
o NO VACCINE AVAILABLE
• Medical
o Acute - mainly supportive (antipyretics, antiemetics, cholestyramine)

Chronic
• Pegylated interferon-a
• Ribavirin (guanosine nucleotide analogue)
• Duration:

o Monitor HCV viral load after 12 weeks to determine treatment efficacy
o Regular US of the liver may be needed if the patient has cirrhosis

Question 8

complications:

Answer 8

• Fulminant hepatic failure
• Chronic carriage of HCV
• Hepatocellular carcinoma
• Less common: porphyria cutanea tarda, cryoglobulinaemia, glomerulonephritis

Question 9

prognosis:

Answer 9

• 80% of exposed will progress to chronic carriage

* Of these, 20-30% will develop cirrhosis over 10-20 years