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3: MED2 Y3 - Gastrointestinal [7] > Hepatitis C > Flashcards

Hepatitis C Flashcards

1
Q

What is hepatitis C?

A

An infectious disease caused by the hepatitis C virus that primarily affects the liver

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2
Q

Describe the initial infection of hepatitis C?

A

People often have mild or no symptoms

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3
Q

In what % of people does hepatitis C persist after initial infection?

A

75-85%

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4
Q

How can hepatitis C be transmitted?

A
  • IV drug use
  • Blood transfusions or organ transplantations
  • Skin piercings or tattoos
  • Mother to infant
  • Sexual intercourse
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5
Q

What increases the risk of hepatitis C transmission with sexual intercourse?

A

Concurrent HIV infection

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6
Q

In what % of cases does hepatitis C cause acute symptoms?

A

15%

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7
Q

What are the symptoms of acute hepatitis C infection?

A
  • Decreased appetite
  • Fatigue
  • Nausea
  • Muscle or joint pains
  • Weight loss
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8
Q

What happens in the first few decades of chronic hepatitis C infection?

A

Most experience minimal or no symptoms, however may be associated with fatigue and mild cognitive problems

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9
Q

What are the risk factors for progression of chronic hepatitis C infection?

A
  • High circulating virus levels
  • Long duration of disease
  • Male gender
  • Older age at acquisition
  • Alcohol excess
  • Co-infection with HIV/hepatitis B
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10
Q

What are the extra-hepatic manifestations of hepatitis C?

A
  • Cryoglobulinaemia
  • Membranous glomerulonephritis
  • Sjorgen’s sndrome
  • Lichen planus
  • Autoimmune hepatitis
  • Thyroiditis
  • Polyarteritis nodosum
  • Polymyositis
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11
Q

How is a diagnosis of HCV made?

A
  • Anti-HCV antibody

- HCV RNA by PCR

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12
Q

What does a positive anti-HCV antibody show?

A

Confirms exposure to HCV (but not persistent infection)

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13
Q

What does positive HCV RNA by PCR show?

A

Confirms ongoing infection

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14
Q

What initial investigations should be done in HCV?

A
  • HCV genotyping
  • Bloods
  • Look for signs of hep B infection
  • HIV testing
  • Screening for other STIs
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15
Q

What bloods should be done in HCV?

A
  • FBC
  • U&Es
  • LFTs
  • Clotting screen
  • HbA1c
  • TFTs
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16
Q

Why is FBC required in HCV?

A
  • Anaemia
  • Neutropenia
  • Thrombocytopenia
17
Q

Why are TFTs required in HCV?

A

Need to establish baseline as anti-virals can cause thyroid dysfunction

18
Q

What specialist investigations may be done in HCV?

A
  • Viral load
  • Autoantibodies
  • Liver ultrasound
  • Liver biopsy
19
Q

Why might viral load be done in HCV?

A

To assess response to treatment

20
Q

When is liver ultrasound used in HCV?

A

In patients with advanced fibrosis or cirrhosis, to screen for hepatocellular cancer

21
Q

What is the role of liver biopsy in HCV?

A

To assess extent of damage caused by inflammation, fibrosis, cirrhosis, and exclude other causes of liver damage

22
Q

Why might autoantibodies be checked in HCV?

A

Because autoimmune hepatitis may be exacerbated by anti-viral therapy

23
Q

How does chronic hep C present?

A

Chronic HCV is indicated by persistently elevated or fluctuating liver enzyme levels.

It can go undetected for ages until incidental liver testing or tries to donate blood

24
Q

What is involved in the management of hepatitis C?

A
  • Education
  • Lifestyle advice
  • Antiviral therapy
  • Liver transplantation
  • Vaccination against hepatitis A and B
25
Q

What education is required in hepatitis C?

A
  • Ensure patient is aware of natural history of disease
  • Advise not to donate blood
  • Avoid sharing razors and needles
  • Condoms for sexual contacts
  • Provide patient with sources of support and information about hepatitis C
26
Q

What lifestyle advice can be given in hepatitis C?

A
  • Stop drinking alcohol, or reduce alcohol consumption if this is not possible
  • Stop smoking
  • Maintain a healthy body weight and diet
27
Q

What should all patients with chronic hepatitis C be considered for?

A

Anti-viral therapy

28
Q

What does the treatment regime, duration of treatment, and effectiveness depend on in HCV?

A
  • HCV genotype and subtype
  • Viral load
  • Severity of liver disease
  • Co-morbidities
  • Ability to tolerate treatment
29
Q

What regime is usually used in HCV?

A

Combination dual drug therapy

30
Q

What does combination of dual drug therapy usually consist of in HCV?

A

Weekly self-administered SC injections of interferon-alpha, and daily doses of oral ribavirin

31
Q

What is added in triple therapy for HCV?

A

A protease inhibitor

32
Q

In what % of people with a sustained viral response can HCV be cured?

A

More than 99%

33
Q

Why is regular clinical and blood monitoring required in HCV?

A

To check for adverse effects and response to treatment

34
Q

What are the adverse effects of anti-viral therapy in HCV?

A
  • Flu like symptoms
  • Haemolytic anaemia
  • Depression
  • Dry skin, eczema, and itchiness
  • Hypothyroidism or hyperthyroidism
  • Insomnia
  • Weight loss
  • Fatigue
  • Alopecia
35
Q

What is the treatment of choice for people with end stage liver disease in HCV?

A

Liver transplantation

36
Q

What is the problem with liver transplantation in HCV?

A

HCV recurrence due to graft infection is common, and the course of HCV-related liver disease is accelerated in transplant recipients

37
Q

What proportion of patients who have a liver transplant for HCV will develop cirrhosis within 5 years of liver transplantation?

A

1/3

38
Q

What are the complications of HCV? -

A
  • Cirrhosis
  • Liver failure
  • Hepatocellular carcinoma
39
Q

What clerical thing should be done for HCV?

A

All suspected cases of acute viral hepatitis are reported to the local Health Protection Team - inform patient that this is being done

3: MED2 Y3 - Gastrointestinal [7] (44 decks)

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