Hepatits and types

Question 1

Definition

Answer 1

Acute parenchymal liver damage that can be caused by many different agents

The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer

Acute hepatitis:
– most likely caused by one of the hepatitis viruses, will return to normal function.

Chronic hepatitis:
– any hepatitis lasting for 6 months or more and is classified according to the aetiology

Viral hepatitis:
– there are 5 main types:
– hep A, B, C, D and E

Question 2

Causes of chronic hepatitis

Answer 2

Viral:
– hepatitis B + D
– hepatitis C

Autoimmune:
- Drugs:
– methyldopa
– nitrofurantoin
– isoniazid
– ketoconazole

• Hereditary:
  – Wilson’s disease

Others:
– IBD
– alcohol

Question 3

Hepatitis A

Answer 3

Most common type of acute viral hepatitis

Occurs worldwide and particularly affects children and young adults

Spread is faecal-oral and arises from the ingestion of contaminated food or water.

Clinical presentation:
– after an average incubation period of 28 days, the viraemia causes non-specific symptoms such as:
—- nausea
—- anorexia
—- distaste for cigarettes

– after 1 or 2 weeks some patients become jaundiced, with dark urine and pale stools
– spleen palpable in 10% of cases

Question 4

Hepatitis B

Answer 4

Present world-wide and is particularly prevelant in parts of Africa, the middle and Far East.

Vertical transmission from mother to child during parturition is the most common method of transmission world-wide

Also spread between blood and blood products, sexual intercourse (particularly men on men)

Can be acute or chronic

Hepatitis B and HIV co-infection:
– routes of infection are similar, and co-infection occurs in 10-20% of cases

Clinical presentation:
- Acute:
– clinical picture similar to that of Hep A but may be more severe
– rashes
– polyarthritis affecting small joints (occurring in up to 25% cases)

• chronic:
  – approx 1-10% of patients will not clear the virus and will develop a chronic hep B infection

Question 5

Hepatitis D

Answer 5

Occur’s as a co-infection with Hepatitis B (HBV)

Dual infection of hep B and D can result in more serious disease and worsened outcomes

Hep B vaccines provides protection from Hep D

Question 6

Hepatitis C

Answer 6

Transmitted through the exposure too infective blood

Sexual transmission also possible but much less common

No vaccine for Hep C

Clinical presentation:
- acute:
– most are asymptomatic
– about 10% of patients may have mild influenza-like illness with jaundice and a rise in serum aminotransferases

• chronic:
  – usually asymptomatic

Question 7

Hep E

Answer 7

Mostly transmitted through consumption of contaminated water or food

Common in developing countries

Vaccines available but are not widely available