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Infective Hepatitis Flashcards

1
Q

What is hepatitis?

A
  • inflammation of the hepatocytes along the portal tracts
  • on histology presents lobular or periportal (close to portal vein)
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2
Q

How does inflammation present on histology around the cholangiocytes?

A
  • around the bile duct
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3
Q

In the images below, which is inflammation of the hepatocytes (presents as lobular or periportal inflammation) and which is inflammation of the cholangiocytes (epithelial cells of bilary tree) which presents around the bile duct?

A
  • A = hepatocytes
  • B = cholangiocytes
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4
Q

What are some common causes of hepatitis?

A
  • drugs such as paracetamol
  • alcohol
  • viruses
  • autoimmune disease.
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5
Q

What are some common clinical presentations of hepatitis?

A
  • nausea, vomiting, fevers, joint pain and muscle aches, jaundice, abdominal pain, itchy skin, pale stools and dark urine
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6
Q

Patients with hepatitis can present with pale stools, why is this?

A
  • bile may not be secreted
  • ultimatley stercobilin not in GIT so no dark stool colour
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7
Q

Patients with hepatitis can present with dark urine, why is this?

A
  • bile re-absorbed
  • high levels of stercobilin reabsorbed and enters circulation
  • makes its way to kidneys
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8
Q

What is the difference between acite and chronic hepatitis?

A
  • chronic means inflammation perseveres
  • inflammation leads to scarring, fibrosis and cirrhosis
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9
Q

What common drug can cause acute hepatitis?

A
  • paracetamol
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10
Q

What virus can cause acute hepatitis?

A
  • hepatitis A and E
  • spread in food and dirty water in travellers
  • A+E are vowels so its in the bowels
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11
Q

What virus can cause chronic hepatitis?

A
  • hepatits B and C
  • transmitted through bodily fluids and circulation
  • generally spread by blood-to-blood contact associated with injection drug use, poorly sterilized medical equipment, needlestick injuries in healthcare, and transfusions
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12
Q

In addition to hepatitis C, what other condition can cause chronic hepatitis?

A
  • autoimmune hepatitis
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13
Q

What viruses can cause both chronic and acute hepatitis?

A
  • hepatitis B and E
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14
Q

If the ALT is really high but other liver enzymes are not affected, what can this be indicitive of?

A
  • hepatitis consistent with acute viral causes or paracetamol
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15
Q

What 3 liver conditions do not tend to cause an increase in liver enzymes?

A

1 - alcohol

2 - NAFLD

3 - autoimmune hepatitis

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16
Q

At what stage of hepatitis can be reversed?

A
  • before it becomes fibrotic
  • stimulus for damage must be stopped
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17
Q

Where is hepatitis A prevelent?

A
  • developing countries
  • south east asia
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18
Q

What type of virus is hepatitis A?

A
  • picornavirus
  • single stand of RNA surrounded by capsid
  • no lipid membrane
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19
Q

How many people a year are affected by hepatitis A and how is it spread?

A
  • 3 million people worldwide
  • faecal oral route, contaminated water and food
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20
Q

Does hepatitis A cause symptoms dstraigh away or is the an incubation period?

A
  • incubation of between 2-6 weeks
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21
Q

How is hepatitis A diagnosed?

A
  • B cells secrete IgM anti-HAV in serum detected in the blood
  • HAV = hepatitis A virus
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22
Q

Is hepatitis A acute or chronic and generally what symptoms do patients present with?

A
  • acute
  • jaundice, fever, lethargy
23
Q

How is hepatitis A treated and the risk of catching it reduced?

A
  • treatment is supportive with fluids
  • vaccines can provide immunity
24
Q

What type pf virus is hepatitis E?

A
  • hepevirus
  • single stand of RNA surrounded by capsid
  • no lipid membrane
25
How is hepatitis E spread?
- through stool - through blood products
26
Who is most affected by hepatits E and do they always present with symptoms?
- middle age men - pregnant women are susceptible - most patients remain asymptomatic
27
Although hepatits E patients are generally asymptomatic, what symptoms can they present with?
- jaundice, fever, myalgia, vomiting and abdominal pain - **DOES NOT CAUSE CIRRHOSIS**
28
Do patients with hepatits E present with symptoms immediatley or is there an incubation period?
- incubation periods 2-9 weeks
29
How is hepatits E diagnosed?
- B cells secrete IgM anti-HEV detectable in blood - HEV = hepatic E virus
30
What type of virus is the hepatitis B virus?
- partially double-stranded DNA virus
31
Where is hepatitis B common and how many people does it affect?
- Sub-Saharan Africa and South East Asia - 350 million people worldwide
32
How is hepatitis B transmitted?
- vertically (mother to baby) - can be acquired in early childhood - unportected sex and drugs
33
Hepatitis B generally causes chronic liver disease. What are the 2 most common effects on the liver?
1 - cirrhosis 2 - hepatocellular cancer
34
Hepatitis B can be vertically transmitted between mother and baby, how does this occur?
- vertical transmission = passage of a disease-causing agent (pathogen) from mother to baby during the period immediately before and after birth - can be transmitted across the placenta, in the breast milk, or through direct contact during or after birth
35
What is the definition of chronic hepatitis B?
- \>6 month infection but patients can often be asymptotic
36
What are the 4 stages of chronic hepatitis B?
1 - immune tolerant 2 - immune reactive 3 - inactive 4 - immune active
37
There are 4 stages of chronic hepatitis B? 1 - immune tolerant 2 - immune reactive 3 - inactive 4 - immune active How are the stages divided?
- on the basis of if E antigen is present - abnormal liver tests - viral load
38
Which 2 stages of the 4 stages of chronic hepatitis B are classed as positive E antigen?
1 - immune tolerant 2 - immune reactive
39
Which 2 stages of the 4 stages of chronic hepatitis B are classed as negative E antigen?
1 - inactive 2 - immune active
40
Which 2 stages of the 4 stages of chronic hepatitis B require treatment?
1 - immune reactive 2 - immune active
41
In patients with acute hepatitis B, patients are mostly asymptomatic, but if not what 2 symptoms can they present with?
- jaundice - fever
42
In patients with acute hepatitis B, patients are mostly asymptomatic, but but can experience jaundice and fevers. What % of patients with acute hepatitis B go on to develop chronic hepatitis B?
- 5%
43
In patients with hepatitis B and they have a high viral load and have become fibrotit, what would their treatment be?
- lifelong antivirals - offer vaccinations
44
What type of virus is hepatitis D?
- RNA virus
45
What other hepatitis virus does hepatitis D require to replicate?
- hepatitis B - 5% of patients with hepatitis B are affected
46
Where is hepatitis D most common?
- Eastern Europe, Brazil, and North Africa
47
What type of virus is hepatitis C?
- small enveloped RNA virus
48
How many people worldwide are affected by hepatitis C and where is it most common?
- 3-4 million people infected every year - 170 million people have hepatitis C worldwide - high prevalence in Egypt, Pakistan and China
49
How hepatitis C transmitted?
- via contaminated blood transfusions - sexual intercourse - vertical transmission is low
50
Do all patients with hepatitis C present with symptoms?
- no most are asymptomatic - fatigue is common and jaundice can occur - 85% of those acutely infected develop chronic infection
51
How is hepatitis C detected?
- hepatitis C virus (HCV) anti-body (Ab) - HCV RNA - HCV Genotype (determines treatment)
52
If a patient with hepatitis C is not treated, what % progress to cirrhosis over 1-20 years?
- 30% - this develops another 30% every 20-30 years
53
If a patient with hepatitis C, what % will develop hepatocarinoma?
- 1-3%
54
If a patient with hepatitis C is effectively treated, what is the curing rate?
- 98-99% cured

NME COPY (61 decks)

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