Hepatitis (liver symposium)

Question 1

What causes viral hepatitis?

Answer 1

Hepatitis A, B, C, D & E

Question 2

What type of virus is each type of Hepatitis?

Answer 2

Hep A & E are enteric viruses

Hep B, C, D are parenteral viruses

Question 3

What is the difference between an enteric and parenteral virus?

Answer 3

Enteric means the virus enters the body through the mouth/ingestion

Parenteral means the virus enters the body by any way other than the mouth/alimentary canal

Question 4

What is the nature of infection by hepatitis A or hepatitis E?

Answer 4

A & E cause Self limiting acute infections

Question 5

What is the nature of infection by Hepatitis B, C or D?

Answer 5

B, C & D cause chronic infections

Question 6

How many people are killed by Viral hepatitis every year?

Answer 6

~1 million

Question 7

Where is Hepatitis A most prevalent?

Answer 7

High prevalence in:

• South America
• Africa
• Middle east
• Asia
• Greenland

Question 8

What does Viraemia mean?

Answer 8

Presence of virus particle in the blood

Question 9

What signs in the blood would indicate infection with Hep A?

(look at the table for this)

During clinical illness - which of these is elevated?

Answer 9

Viraemia - present for 6 weeks after inf.

ALT - indicates liver damage - highest 4 weeks after inf.

IgM - highest 4 weeks after inf.

IgG - steady increase from 3rd week onwards

Clinical illness - ALT & IGM elevated most

Question 10

What is the transmission route for Hep A?

Answer 10

Faecal - oral
sexual
blood

Question 11

Who is most at risk of infection by Hep A?

Answer 11

5 - 14 year olds

Question 12

What clinical biomarker is used to diagnose Hep A infection?

Answer 12

IgM antibodies

Question 13

What groups of people should be immunised against Hep A?

Answer 13

Travellers

Patients with chronic liver disease
- IDU (especially with HCV or HBV)

Haemophiliacs

Occupational exposure

• lab workers
• big medical lads

Men who have sex with men (MSM)

Question 14

Where in the world is Hep B most present?

Answer 14

Canada, Alaska, Greenland

Parts of South America, Asia and most of Africa

Question 15

HBV has several antigens which can be used to detect its presence in the blood

What are these antigens?

Answer 15

HBsAg - surface antigen

HBeAg - ‘e’ antigen

HBcAg - core antigen (cant be detected in blood tho)

(HBV DNA can also be used) - not antigen

Question 16

What does each HBV antigen indicate about the virus’ activity in the body?

Answer 16

HBsAg (surface ant) only indicates the presence in the blood

HBeAg & HBV DNA indicate Active replication

HBcAg also indicates active replication, but cant be detected so is pretty useless

Question 17

Certain Antibodies to HBV in the body have different purposes/indications

What are the different types of HBV antibodies and what do they indicate?

Answer 17

Anti-HB’s = protection

IgM anti-HBc = ACUTE INFECTION

IgG anti-HBs = Chronic infection / exposure

Anti HBe = inactive virus

Question 18

Summarise how someone with an acute HBV infection would be tested for/diagnosed?

Answer 18

1) HBsAg test = postive?
\/
2) Clinical evidence of acute infection?
\/
3) IgM anti-HBc test = Positive?
\/
4) Congrats

Question 19

Chronic Hepatitis B has a detrimental effect on which organ in the body?

Describe how

Answer 19

Liver

Chronic infection causes damage which may cause Cirrhosis

Cirrhosed liver over time may develop Hepatocellular carcinoma (HCC) and finish with End Stage liver disease (ESLD)

Question 20

What are the 2 main treatment options for HBV infection?

Answer 20

Oral antiviral drugs

Pegylated interferon

Question 21

What are the Oral antiviral drugs available for use against HBV?

Answer 21

Lamivudine

Adefovir

Entecavir!

Telbivudine

Tenofovir

Question 22

Hep C infections are most commonly ______

Answer 22

Chronic (85%)

Question 23

What are the potential effects of infection by Hep C?

Answer 23

Jaundice - 10% of patients

Acute liver failure - Rarely causes this

Sometimes Liver cirrhosis with possible progression to HCC - leading cause of liver transplantation in the UK

Question 24

What is the risk of someone with HCV infection getting liver cirrhosis?

Answer 24

20% of people with a Chronic HCV infection will develop liver cirrhosis

25% of these people with Liv Cirrhosis will develop Hepatocellular carcinoma (HCC)

Question 25

Describe the blood stuff pattern of a patient infected with HCV (who recovers)

Answer 25

• 2/3 months after infection - ALT levels in the blood reach maximum level
• Anti HCV levels rise steadily and plateau at maximum after about 1 year
• HCV RNA can be detected in the blood for about 6 months after infection

Question 26

Classically, what drugs were used to treat HCV infection?

Answer 26

PEGylated IFN alpha

Ribavirin

Question 27

What drugs are used nowadays to treat HCV infection?

Answer 27

PEGylated IFN

Question 28

What features of Hep D virus make it different to other Heps?

Answer 28

Small RNA virus:

• Doesnt code for its own protein coat
• Enveloped by HBsAg

Co-infects or super-infects alongside Hep B
(transmits in same way)

Very resistant to treatment

Question 29

Where is Hepatitis E found most?

Answer 29

Asia
Mexico
Parts of Africa

Becoming increasingly recognised in the UK

Question 30

Is HEV a problem in the UK?

Answer 30

Commonest cause of acute hepatitis in NHS grampian

Question 31

How does HEV infection tend to progress?

Answer 31

Self limiting, with no long term sequelae

Question 32

What are the treatment/vaccination options for HEV?

Answer 32

No effective vaccine

No specific treatment (but its self limiting so who cares eh)