Hepatobiliary - Hepatitis, Hep A, Hep E

Question 1

Hepatitis - what is it?

Answer 1

Hepatitis describes inflammation in the liver

Can range from chronic low level inflamm to acute and severe inflamm that leads to necrosis and liver failure

Question 2

Hepatitis - what are the causes?

Answer 2

Viral hepatitis

Alcoholic hepatitis

Autoimmune hepatitis

Non-alcoholic fatty liver disease

Drug induced hepatitis - e.g. paracetamol overdose

Question 3

Hepatitis - what is the classical presentation?

Answer 3

May be asymptomatic

Non-specific symptoms:

• Abdo pain
• Fatigue
• Pruritus
• Muscle and joint ache
• N+V
• Jaundice
  
  • Fever

Question 4

Hepatitis - what do you see in liver function tests?

Answer 4

Typical biochemical findings are that liver function tests become deranged with high transaminases (AST / ALT) with proportionally less of a rise in ALP

This is referred to as a “hepatitic picture”

Question 5

Hepatitis - what are transaminases?

Answer 5

Transaminases are liver enzymes that are released into the blood as a result of inflammation of the liver cells

Bilirubin can also rise as a result of inflammation of the liver cells

Question 6

Hepatitis A - what is it?

Answer 6

Typically benign, self-limiting disease (resolves within 1-3 months)

Most common viral hepatitis worldwide

RNA virus

Does not cause chronic disease

Question 7

Hepatitis A - what is the incubation period?

Answer 7

2-4 weeks

Question 8

Hepatitis A - how is it transmitted?

Answer 8

Faecal - oral spread

Often in institutions

Question 9

Hepatitis A - clinical features?

Answer 9

Flu-like prodrome

Abdo pain - RUQ

Tender hepatomegaly

Jaundice

Nausea, vomiting

Anorexia

Cholestasis (slowing of bile flow through the biliary system)

Dark urine and pale stools

Question 10

Hepatitis A - AST/ALT levels

Answer 10

AST/ALT high 22-40 days after exposure

Can remain high for 20 weeks

Question 11

Hepatitis A - how long does it take to resolve without treatment?

Answer 11

1-3 months

Question 12

Hepatitis A - immunisation available?

Answer 12

Vaccine available

After initial dose (1 yr immunity), booster 6-12 months later (then 20 yrs immunity)

Question 13

Hepatitis A - management?

Answer 13

Self-limiting, so supportive and analgesia

Question 14

Hepatitis E - what is it, and similarities to Hep A?

Answer 14

Also a RNA virus

Similar disease to Hep A, but serious in pregnancy, mortality 20%

Also transmitted by faecal-oral route

Rare in UK

Question 15

Hepatitis E - incubation period?

Answer 15

3-8 weeks

Question 16

Hepatitis E - illness itself, clinical features and managment?

Answer 16

Produces mild illness

Virus cleared within a month

No treatment is required

Question 17

Hepatitis E - immunisation?

Answer 17

No vaccine available in UK