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Nagasaki Flashcard Extravaganza > Hepatitis Emily > Flashcards

Hepatitis Emily Flashcards

1
Q

What kind of virus is Hep B?

A

DNA virus

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2
Q

What kind of virus is Hep D?

A

RNA virus

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3
Q

4 ways in which Hep B / C / D is transmitted?

A

Blood borne:
Infected transfusions
IVDU / needlestick
Sexually
Vertically (at birth not in utero)

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4
Q

What is the clinical syndrome of Hep B +/- Hep D infection?

A

Incubation = 6 weeks to 6 months

Viral prodrome +/- resolving as jaundicing hepatitis appears

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5
Q

What is the natural progression / outcomes of Hep B?

A

Clearance at 6 months with lifelong immunity in 95% of adults (only 10% in neonates)

Fulminant hepatitis +/- death in 1%

Chronic Hep B in 5% adults, 90% children

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6
Q

What are 3 complications of chronic Hep B infection?

A

HCC 10%
Liver failure 20%
Cirrhosis 30%

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7
Q

What bloods would demonstrate ACUTE hep B infection?

A

HBsAg
HBeAg
HBV DNA
HBsAg IgM

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8
Q

What bloods would demonstrate CHRONIC Hep B infection?

A

HBsAg
HBeAg +/- Anti HBeAg
HBV DNA

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9
Q

What bloods would demonstrate CLEARANCE of Hep B?

A

Anti - HBsAg
Anti - HBeAg
IgG

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10
Q

What bloods would demonstrate successful Hep B vaccination?

A

Anti HBsAg only

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11
Q

How is Hep B (Chronic) managed?

A

Tenofovir lifelong

6 monthly USS for HCC
Vaccinate against Hep A
Avoid ETOH etc

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12
Q

How can Hep B be prevented?

A

Vaccination (recombinant) –> needs cold chain. Given at birth / later in life if high risk

Needle exchange, screening blood products etc

HB vaccine plus hep B immunoglobulin to babies born to Hep B positive mothers

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13
Q

What kind of virus is Hep A?

A

RNA picornavirus, NOT enveloped

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14
Q

How is Hep A transmitted?

A

Faecal oral
Contaminated food / water

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15
Q

What are the clinical features of HepA?

A

Rare in adults in endemic areas (infection in childhood –> lifelong immunity)

Incubation = 2-6 weeks

Initial flu like progressing to cholestatic jaundice as flu like sx resolve

Fulminant hepatitis = 0.4%. Rest recover and have lifelong immunity. Chronic carriage not seen

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16
Q

When are patients with Hep A infectious?

A

2 weeks before jaundice –> >2 weeks after jaundice

17
Q

What are some complications of Hep A?

A

Fulminant hepatitis 0.4%
Guillain Barre
Haemolysis
Renal failure
Vasculitis

18
Q

How is Hep A diagnosed?

A

HAV IgM present from symptom onset

HAV IgG after 2/52 –> persists lifelong (immunity)

PCR of stool to detect viral shedding

19
Q

How can Hep A be prevented?

A

Vaccinate high risk (MSM, travelers to endemic areas, Hep B, HIV)
Vaccine = inactivated

Improved sanitation

20
Q

How is Hep E spread?

A

Contaminated pork / shellfish
Poor sanitation

21
Q

What type of virus is Hep E?

A

Herpes virus, RNA, non enveloped

22
Q

What is the clinical syndrome of Hep E?

A

As per Hep A: initial flu like illness progressing to jaundice as symptoms resolve

Fulminant hepatitis + death in 20% of pregnant women, risk highest in 3rd trimester

Self limiting, chronic carriage does not occur

23
Q

How can Hep E be prevented?

A

Improve sanitation
Avoid risks (undercooked pork and shellfish)
Vaccines in trials (China has one approved which no one else uses yet)

24
Q

How can Hep E be diagnosed?

A

IgM and IgG both present acutely, before IgM levels fall

IgG persists lifelong (immunity)

PCR for viral DNA in blood rarely used

25
Q

What kind of virus is hep C?

A

Flavivirus
ssRNA
enveloped

26
Q

How is Hep C transmitted?

A

Blood borne
Sexually
Vertically

27
Q

What is the clinical syndrome of Hep C?

A

20% asymptomatic –> clearance without treatment

80% –> non specific malaise, cirrhosis, HCC ~4% risk per year

Rarely cryoglobulinaemia (arthralgia, glomerulonephritis)

28
Q

How is Hep C diagnosed?

A

IgG present after 6 weeks of illness

PCR for HCVirus distuinguishes clearance / chronic carriage in those with positive IgG

USS / fibroscan / biopsy for cirrhosis +/- HCC

29
Q

How is Hep C managed?

A

New therapies = 95% cure rate
All end in “avir” eg dacaltavir. Constantly changing, no established guideline yet

Vaccinate for Hep B and Hep A

30
Q

How can Hep C be managed?

A

Improved screening of blood transfusion

Barrier contraception

Needle exchange

Vaccines in development

Nagasaki Flashcard Extravaganza (34 decks)

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