Hepatitis E

Question 1

Hepatitis E (HVE) does not always cause symptoms immediately. What is the typically incubation period of HVA?

1 - 1-2 days
2 - 1 week
3 - 2-9 weeks
4 - 8-10 weeks

Answer 1

3 - 2-9 weeks

Question 2

How is hepatitis E diagnosed?

1 - antibodies IgM and IgG
2 - HBV surface antigen (HBsAg = HBV surface antigen)
3 - core HBV antigen (HBcAg = HBV core antigen)
4 - E antigen produced by infected cells

Answer 2

1 - antibodies IgM and IgG
- HEV = hepatic E virus

This will tell us if the infection is acute or chronic

Question 3

How is Hepatitis E, an RNA virus transmitted?

1 - sexual activity
2 - faecal oral
3 - needle sharing
4 - childbirth

Answer 3

2 - faecal oral

Not common in the UK

Question 4

Which of the following is NOT a common location where hepatitis E is common?

1 - Asia
2 - Africa
3 - North America
4 - South America
5 - Middle East

Answer 4

3 - North America

Question 5

Does Hepatitis E always present wit symptoms?

Answer 5

• No

Question 6

Not all patients with hepatitis E present with symptoms. However, they can present with symptoms, including all of the following , EXCEPT which one?

1 - abdo pain
2 - jaundice
3 - cholestasis
4 - pruritus and significant jaundice
5 - haematuria
6 - dark urine and pale stools.

Answer 6

5 - haematuria

Similar symptoms to hepatitis A, but antibodies and antigens will confirm diagnosis

Question 7

In rare cases hepatitis E can lead to chronic hepatitis and liver failure. Which of the patients would NOT be at risk of this?

1 - type 1 diabetes
2 - lupus
3 - COPD
4 - antiphospholipid syndrome

Answer 7

3 - COPD

Risk of liver complications increases in autoimmune patients

Auto-immune patients are monitered at 1, 3 and 6 monthly interval

Question 8

Although hepatitis E is typically not severe, it has a high mortality of what during pregnancy?

1 - 0.2%
2 - 2%
3 - 20%
4 - 60%

Answer 8

3 - 20%

Question 9

Is there a vaccination for hepatitis E?

Answer 9

• no

Question 10

Do all patients with hepatitis E need treating?

Answer 10

• no

Infection mainly clears on its own

Question 11

Although treatment in hepatitis E is typically supportive, in immunocomprimised patients, what can they be treated with if required?

1 - dexamethasone
2 - IV ribavirin
3 - imatanib
4 - furosemide

Answer 11

2 - IV ribavirin

Essentially dampens the immune response for a short period

Question 12

Are viral hepatitis notifiable diseases?

Answer 12

• Yes

All viral hepatitis are notifiable

UK Health Security Agency need to be alerted

Question 13

When managing a patient who has been diagnosed with hepatitis B, which of the following must be implemented:

1 - Partner Notification & Treatment
2 - Education, health promotion
3 - Abstinence – 7 days AND until partner treated
4 - Antibiotic treatment and no alcohol
5 - Condoms
6 - Prevention and risk reduction
7 - all of the above

Answer 13

7 - all of the above

Question 14

65 years, Male presents with poor
appetite, jaundice, tiredness. He has had diarrhoea, nausea but no other symptoms. No travel history or previous medical history. States he ate some undercooked food a few days ago, and another person had similar symptoms. Results are in the image. Which of these results and history make you consider hepatitis?

Answer 14

• Jaundice abdo pain and fatigue
• ALT 2350 U/L (normal range: 0-50)
• Total Bilirubin: 32 umol/L (normal range: 0-22)
• ALP: 567 U/L (normal range: 30-130)

Question 15

Doe the results below suggest an acute or chronic hepatitis E infection?

• HEV IgM (Immunoglobulin M): Detected
• HEV IgG (Immunoglobulin G): Detected
• HEV RNA: 320,000 IU/ml

Answer 15

• Acute

Presence of IgM suggest still early, supported by high viral load