Hepatitis virus

Question 1

What is hepatitis A?

Answer 1

RNA picornavirus.

Question 2

How is hepatitis A transmitted?

Answer 2

Faecal-oral transmission, associated with contaminated shellfish.
The virus passes into bile after replication within liver cells.
The immune system is activated by this process and leads to necrosis predominantly in zone 3 of the hepatic lobule.

Question 3

What is the incubation period of hepatitis A?

Answer 3

2-3 weeks

Question 4

What investigation is performed for hepatitis A?

Answer 4

Anti-HAV IgM in serum.

Question 5

What is the conservative treatment of hepatitis A?

Answer 5

Vaccine for travellers to endemic areas.

Question 6

What is the medical treatment of hepatitis A?

Answer 6

Supportive since HAV is often self-resolving.

Question 7

What is a complication of hepatitis A?

Answer 7

Liver failure (rare)

Question 8

What is hepatitis B?

Answer 8

A partially stranded, enveloped DNA virus.

It has an e-antigen that indicates increased infectivity.

Question 9

How is hepatitis B transmitted?

Answer 9

Vertical transmission
Contaminated needles
Infected blood products
Sexual intercourse

Question 10

What is the incubation period of hepatitis B?

Answer 10

1-5 months

Question 11

What investigations are performed for hepatitis B?

Answer 11

HBV DNA serum, HBsAg, HBeAg, anti-HBc; HBsAg presents on histology with a ‘ground glass’ appearance.

Question 12

What is the conservative treatment of hepatitis B?

Answer 12

Education and prevention of disease.

Vaccine for at-risk groups, e.g. health workers.

Question 13

What is the medical treatment of hepatitis B?

Answer 13

Antiviral medications, e.g. regulated alpha-2a interferon, adefovir, entecavir, lamivudine, tenofovir, telbivudine.

Question 14

What are the complications of hepatitis B?

Answer 14

Hepatic cirrhosis
Hepatocellular carcinoma
Fulminant hepatitis B

Question 15

What is hepatitis C (HCV)?

Answer 15

Single stranded, enveloped RNA virus and member of flavivirus family.

Question 16

How is HCV transmitted?

Answer 16

Vertical transmission (occasionally)
Contaminated needles
Infected blood products

Question 17

What is the incubation period of HCV?

Answer 17

Intermediate (6-9 weeks)

Question 18

What investigations are performed for HCV?

Answer 18

Antibody to HCV in serum.

Question 19

What is the conservative treatment of HCV?

Answer 19

Education and prevention of disease.

Question 20

What is the medical treatment of HCV?

Answer 20

Antiviral medications, e.g. pegylated alpha-2 interferon, ribavirin, taribavirin, teleprevir.

Question 21

What are the complications of HCV?

Answer 21

Hepatic cirrhosis
Hepatocellular carcinoma
Liver failure

Question 22

What is hepatitis D (HDV)?

Answer 22

Single stranded defective RNA virus that co-infects with hepatitis B virus.
Co-infectivity with HDV leads to an increased chance of liver failure.

Question 23

How is HDV transmitted?

Answer 23

Contaminated needles
Infected blood products
Sexual intercourse (rare)

Question 24

What is the incubation period of HDV?

Answer 24

1-5 months

Question 25

What investigations are performed for HDV?

Answer 25

Serum IgM anti-D.

Question 26

What is the treatment of HDV?

Answer 26

Pegylated alpha-2 interferon

Question 27

What are the complications of HDV?

Answer 27

Hepatic cirrhosis

Hepatocellular carcinoma

Question 28

What is hepatitis E (HEV)?

Answer 28

Single stranded RNA virus.

Question 29

How is HEV transmitted?

Answer 29

Faecal-oral transmission, associated with contaminated water.

Question 30

What is the incubation period of HEV?

Answer 30

2-3 weeks

Question 31

What investigations are performed for HEV?

Answer 31

IgG and IgM anti-HEV.

Question 32

What is the treatment of HEV?

Answer 32

Usually self-limiting.

Question 33

What are the complications of HEV?

Answer 33

High mortality of pregnant women (~20%).