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Gwen - GI and General surgery > Hepato-biliary: Hepatitis > Flashcards

Hepato-biliary: Hepatitis Flashcards

1
Q

How is hepatitis A spread?

A
  • Faecal oral - faecally contiminated water
  • Shellfish
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2
Q

What is the incubation period for hepatitis A?

A

2-6 weeks

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3
Q

What are non-viral infections which can cause hepatitis?

A
  • Toxoplasma gondii
  • Leptospira
  • Coxiella burnetii (Q fever)
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4
Q

What are viral causes of hepatitis?

A
  • Hep A - E
  • EBV
  • CMV
  • Yellow fever
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5
Q

What drugs can cause hepatitis?

A
  • Paracetamol
  • Alcohol
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6
Q

What are symptoms of hepatitis A?

A
  • Fever
  • Malaise
  • Anorexia
  • Nausea
  • Athralgia
  • Jaundice
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7
Q

What are signs of hepatitis A?

A
  • Hepatomegaly
  • Lymphadenopathy
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8
Q

Blood tests hep A

A

FBC - raised ESR, WCC

LFTs - bilirubin, aminotransferases (ALT and AST)

Immunoglobulins - riased HAV IgM

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9
Q

Management hep A

A

Rest and no alcohol

Prophylacis for travellers, pateints with CLD, IDY, haemophilliacs, occupational exposure, MSM

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10
Q

How is HBV spread?

A
  • Blood products
  • IVDU
  • Sexual
  • Direct contact
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11
Q

What groups are most at risk of HBV infection?

A
  • IVDU and sexual partners
  • Health workers
  • Haemophiliacs
  • MSM
  • Haemodialysis/CKD
  • Sexually promiscuous
  • Foster carers
  • Close family memebers of carrier
  • Staff/residernts of institutions/prisons
  • Babies of HBsAg +ve mothers
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12
Q

What is the incubation period HBV?

A

1-6 months

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13
Q

What are features of acute HBV infection?

A
  • Anorexia
  • Lethargy
  • Nausea
  • Fever
  • Abdominal Discomfort
  • Arthralgia
  • Urticarial skin lesions
  • Jaundice + Dark coloured urine
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14
Q

What is HBsAg, and what does its presence indicate?

A

Hepatitis B surface antigen - acute or chronic infection

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15
Q

What is HBeAg, and what does it indicate?

A

Pre-core antigen for HBV - Acute hepatitis B

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16
Q

What is Anti-HBs, and what does its presence indicate?

A

Antibodies against HB surface protein - immunity to HBV, previous epxosure or vaccination

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17
Q

What is Anti-HBe, and what does it’s presence indicate?

A

Antibodies against E-protein - Seroconversion

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18
Q

What is HBc-IgM, and what does its presence indicate?

A

IgM produced against HB core protein - indicates acute hepatitis B in high titres, and chornic hepatitis B with low titres

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19
Q

What is Anti-HBc IgG, and what does its presence indicate?

A

Past exposure to hepatitis B

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20
Q

What hepatitis virology and LFT results would indicate that someone has an acute HBV infection?

A
  • Markedly increased LFT
  • Positive HBsAg
  • Positive HBeAg
  • Positive Anti-HBc IgM
  • Positive Anti-HBc IgG
  • Anti-HBs negative
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21
Q

What hepatitis virology and LFT results would indicate that someone is a carrier of HBV?

A
  • Raised LFTs
  • Positive HBsAg
  • Positive/Negative HBeAg
  • Anti-HBe positive/negative
  • Anti-HBc IgM positive/negative
  • Anti-HBc IgG positive
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22
Q

What hepatitis virology and LFT results would indicate that someone has been vaccinated?

A
  • Normal LFTs
  • HBsAg negative
  • Anti-HBc negative
  • Anti-HBs positive
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23
Q

What viral component is looked at first before doing a full HBV screen?

A

HBsAg, or Anti-HBc IgM in acute infection

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24
Q

What does HBsAg presisting for > 6 months imply?

A

The person is a carrier

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25
Q

What proportion of those with hepatitis B fully recover following acute infection?

A

90-95%

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26
Q

What proportion of those with hepatitis B develop chornic hepatitis?

A

5-10%

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27
Q

What proportion of those with acute HBV infection develop fulminant hepatic necrosis?

A

1%

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28
Q

What are the different outcomes of chronic HBV infection?

A
  • Asymptomatic chronic infection (carrier)
  • Chronic active hepatits -> Cirrhosis/Primary liver cancer
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29
Q

What are features of chronic HBV infection?

A
  • Fatigue, anorexia, depression
  • Signs of advanced disease
    • Chronic liver disease - jaundice, hepatoma, cirrhosis
    • Membranous glomerulonephritis
    • Polyarteritis nodosa
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30
Q

What investigations would you do if you suspected HAV?

A
  • LFTs - raised due to hepatocellular injury
  • Anti-HAV IgM - acute
  • Anti-HAV IgG - previously infected
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31
Q

How would you manage someone with confirmed acute hepatitis A?

A
  • Conservative management
  • Avoid alcohol
  • Interferon alpha - if fulminant hepatitis
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32
Q

What are complications that can occur in heptatitis A?

A
  • Cholestatic jaundice
  • Relapsing hepatitis (may be more severe than first episode)
  • Aplastic anaemia
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33
Q

Is there a form of immunisation available for HAV? If so, what is it?

A

Yes - inactivated viral protein

34
Q

Who would you consider giving HAV vaccination to?

A
  • MSM with multiple sexual partners
  • Sewage workers
  • Seronegative haemophiliacs
  • Travellers to endemic areas
35
Q

What does the presence of HBV DNA indicate?

A

Implies viral replication. Levels indicate response to treatment

36
Q

What are complications of Hepatitis B?

A
  • Fulminant hepatic failure
  • cirrhosis
  • HCC
  • Cholangiocarcinoma
  • Cryoglobulinaemia
  • Membranous nephropthy
  • Polyarteritis nodosa
37
Q

How would you manage someone with hepatitis B?

A

Conservative

  • Avoid alcohol

Medical

  • Pegylated alpha-2a interferon
  • Nucleoside analgogues - tenofovir, entecavir

Surgical

  • Liver transplantation
38
Q

What are indications for anti-viral therapy in hepatitis B?

A
  • Asymptomatic chronic HBV with raised ALT and HBeAg positive
  • Cirrhosis with evidence of ongoing viral replicaton
  • Those without cirrhosis, with 2/3 of following criteria
    • HBV DNA > 2000 IU/ml
    • Raised ALT
    • Significant liver inflammation/fibrosis

Eg - Tenofovit, entecavit, interferon

Indications = ongoing viral replication, deranged liver enzymes, liver damage

39
Q

Is there a method of immunisation available for hepatitis B? If so, what is it?

A

Yes

  • Passive immunisation with specific anti-HBV
  • Active immunisation - HBsAg recombinant vaccine
40
Q

What is the dose regimen used for the HBV vaccine?

A

One of:

  • Three doses at 0, 1 and 6 months
  • Four doses at 0, 1, 2 and 12 months
  • Four doses at 0, 7, 21 days and 12 months - rapid protection
41
Q

How would you determine whether someone had a good response to active HBV vaccination?

A

Post vaccine anti-HBs levels

42
Q

What public health measure would you want to take if someone was confirmed to have HBV?

A

Contact tracing

43
Q

How is hepatitis C spread?

A
  • Blood - transfusion, IV abuse
  • Sexual contact
44
Q

What are risk factors for progression of hepatitis C to chronic disease?

A
  • Male
  • Older
  • Higher viral load
  • Use of alcohol
  • HIV
  • HBV
45
Q

What are features of acute HCV infection?

A

Most asymptomatic, but 10%:

  • Mild flu-like symptoms - malaise, anorexia, fatigue
  • Jaundice
46
Q

What are features of chronic hepatitis C infection?

A

Asymptomatic, or:

  • Variations in AST/ALT - over short time period
  • Cirrhosis
  • Hepatoma
47
Q

How would you investigate for HCV?

A
  • Bloods - LFTs, Anti-HCV antibodies
  • HCV-PCR - detects ongoing infection
  • HCV Elisa - screening test
48
Q

What investigations would you perform in someone who you suspected had hepatitis B?

A

Bloods

  • LFTs
  • HBsAg - If positive, then full HBV screen
    • HBeAg
    • Anti-HBs
    • Anti-HBe
    • Anti-HBc IgM
    • Anti-HBc IgM

Liver Biopsy

49
Q

How would you manage someone with HCV?

A

Conservative

  • Alcohol cessation

Medical

  • Pegylated interferon + Ribrivarin
  • Consider protease inhibitors - genotype 1
50
Q

What proportion of those with HCV infection progress to chronic infection?

A

60-80%

51
Q

What proporrtion of those with chronic HCV progress without cirrhosis?

A

50-80%

52
Q

What proportion of those with chronic HCV infection progress to cirrhosis within 30 years?

A

20-50%

53
Q

What proportion of those with chronic HCV progress to hepatoma?

A

10%

54
Q

How is hepatitis D spread?

A

Parenteral infection - related to IVDU

Little vertical/sexual transmission

55
Q

What is needs to be present for HDV infection to spread?

A

Hepatitis B - needs to be there in order for HDV to spread - HBV used for HDV assembly

56
Q

How does HDV present?

A

Clinically indistinguishable from HBV infection

57
Q

How would you investigate for HDV infection?

A
  • LFTs
  • HDV - IgM/IgG
  • HDV RNA - IgM/IgG
  • HDAg - IgM, IgG
58
Q

How would you manage someoen with HDV?

A
  • Consider interferon alfa
  • Liver transplantation
59
Q

What complications can occur in those with HDV?

A

Severe chronic hepatitis

60
Q

How is Hepatitis E spread?

A

Enterally transmitted

  • From pork meat - sausages
  • Blood exposure - abattoir workers
61
Q

How does HEV present?

A

Subclinical or mild illness in woman and young people

Most severe illness in elderly

  • Liver failure
  • Arthritis
  • Anaemia
  • Neurological manifestations
62
Q

What blood test would you do to look for HEV?

A

HEV-RNA - IgG, IgM

63
Q

How would you manage someone with HEV?

A

Most is self limiting + No licensed treatment

  • Consider ribrivarin therapy
64
Q

What sex does autoimmune hepatitis occur most commonly in?

A

Women

65
Q

What are features of autoimmune hepatitis?

A
  • Acute hepatitis with jaundice
  • Clinical features of cirrhosis - hepatosplenomegaly, cutaneous striae, acne, hirsutes, bruises and, sometimes, ascites.
  • Features of an autoimmune disease - fever, urticarial rash, migratory polyarthritis, glomerulonephritis, pleurisy, pulmonary infiltration or lung fibrosis.
  • Can have amenorrhoea
66
Q

What are infective causes of hepatitis?

A
  • EBV
  • CMV
  • Leptospirosis
  • Malaria
  • Q fever
  • Syphilis
  • Yellow fever
  • Hep A-E
67
Q

What investigations would you do if you suspected autoimmune hepatitis?

A
  • Bloods - LFTs, FBC, ANA, ASMA, Soluble liver antigenAnti-LKM1, CYP2D6
  • Liver biopsy
68
Q

How would you manage autoimmune hepatitis?

A
  • Steroids - induce remission
  • Azathioprine - Maintenance
  • Immunosuppressants - Mycophenolate, ciclosporin, tacrolimus
69
Q

What are complications of autoimmune hepatitis?

A
  • Cirrhosis
  • Complications fo drug therapy
70
Q

What diseases are associated with atuoimmune hepaititis?

A
  • Penicious anaemia
  • UC
  • GN
  • Autoimmune thyroiditis
  • Autoimmune haemolysis
  • Diabetes mellitus
  • PSC
  • HLA A1, B8, DR3 haplotype
71
Q

What age range does autoimmune hepaitits most commonly affect?

A

Bimodal distribution - 10-30 years, then > 40 years

72
Q

What is chronic hepaptitis defined as?

A

Hepatitis lasting > 6 months

73
Q

What proportion of individuals who chronically misuse alcohol develop alcoholic hepatitis?

A

<20%

74
Q

What are the signs/symptoms of alcoholic hepatitis?

A

Alcohol use, plus:

  • Asymptomatic, or
  • Symptomatic
    • Tender hepatomegaly +/- Jaundice
    • Ascites
    • D+V
    • Encephalopathy
    • Malnutrition -> Anorexia/Malaise
    • Bleeding
    • Decompensated hepatic function
75
Q

What factors determine whether an individual with alcoholic hepatitis will develop alcoholic liver cirrhosis?

A
  • Drinking behaviour
  • Gender
  • Severity of histiological lesions
76
Q

What might you see on blood panel in someone with alcoholic hepatitis?

A
  • Increased WCC
  • Decreased platelets
  • Increased INR
  • Increased AST
  • Increased MCV
  • Increased Urea
77
Q

What might jaundice indicate in someone with alcoholic hepatitis?

A

Hepatitis is severe

78
Q

What might encephalopathy in someone with alcoholic hepatitis indicate?

A

Severe hepatitis

79
Q

How would yoiu manage someone with acute alcoholic hepatitis?

A

Admit

  • Catheterise
  • Screen for infection +/- ascitic tap looking for SBP
  • Stop alcohol and manage DTs
  • Pabrinex + Vit K
  • Optimise nutrition
  • Steroids in severe disease
  • Monitoring - weight, Bloods (FBC, LFTs, U+E’s, INR)
80
Q

List the types of virus (DNA or RNA)

A

HepA: RNA

HepB: DNA

HepC: RNA

81
Q

What hepatitis are carcionogenic?

A

Hep B and C

Gwen - GI and General surgery (44 decks)

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