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GI - Y2 > L17 - Viral hepatitis > Flashcards

L17 - Viral hepatitis Flashcards

1
Q

Briefly describe the hepatitis viruses?

A

Hep A, B, C, D & E
Hepatotrophic viruses

Can cause:

  • fever
  • jaundice
  • joint pain
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2
Q

Give examples of viruses which may cause acute hepatitis as part of their clinical spectrum?

A
  • Epstein-Barr virus
  • Cytomegalo virus
  • Herpes simplex
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3
Q

Hepatitis E

  • structure
  • transmission
  • treatment
A

Structure
- small RNA virus

Transmission
- Faecal-oral route

Treatment

  • supportive
  • no proven effective drugs
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4
Q

What happens to the Hep E virus when it enters body?

A
  • Crosses across wall of alimentary canal
  • Transported to liver
  • Liver damage occurs via T-Cell mediated immune responses
  • Viral replication in liver cells
  • Virus released into bile in vesciles
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5
Q

Incubation period of Hepatitis E

A

10-50 days

average: 28 days

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6
Q

Patients infected with Hepatitis E will usually present with…

Some patients will also have the following symptoms:

A

Jaundice

Fever, malaise, nausea, vomiting, upper abdominal pain

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7
Q

Hepatitis B

  • transmission
  • incubation period
  • at risk?
A 
Hep B
Parenteral, sexual, perinatal 
(40-160 days), avg. 90 days
Risk:
- injecting drug users
- infants of carrier 
- multiple sexual partners
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8
Q

Hepatitis C

  • transmission
  • incubation period
  • at risk?
A 
Hep C
Parenteral, sexual, perinatal 
(15 - 160 days) avg. 60 days 
Risk:
- recepient of unscreened blood products 
- injecting drug users
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9
Q

Hep D

  • transmission
  • incubation period
  • at risk?
A 
Hep D
- parenteral 
- (20 - 50 days) 
Risk:
- injecting drug users
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10
Q

Hep E

  • transmission
  • incubation period
  • at risk?
A 
Hep E 
- feacal oral 
- 40 days 
Risk:
- travellers to endemic areas
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11
Q

Describe investigations of IgA in diagnosing hep A

A
  • anti HAV antibodies usually present at onset of symptoms (decline over 3-6 months)
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12
Q

Presence of anti HAV IgG antibodies will reflect:

A
  • immunity from previous exposure (or immunisation)
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13
Q

Liver function test results in presence of Hep A

A
  • raised alanine
  • raised asparate aminotransferase
  • rise in bilirubin
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14
Q

Management of hep A

A
  • supportive

Prevention

  • good sanitation
  • personal hygiene
  • active immunisation with dead virus
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15
Q

Is the acute infection of hepatitis B, symptomatic or asymptomatic?

A

usually asymptomatic

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16
Q

How might you determine presence of chronic hepatits B?

A
  • presence of HBV surface antigen (HBVsAg) in blood for more than 6 months
17
Q

Hepatitis B

  • structure
  • forms
A

DNA virus
Can occur in three forms
1. Dane particle
2. & 3. Variants of HBVsAg

18
Q

Describe structure of Dane particle

A

Complete virus

HBV DNA polymerase in outer coat.

19
Q

Describe the structure of HBV core antigen?

A

HBVcAg

- formed of core protein containing incompletely double stranded circular DNA and DNA polymerase

20
Q

Clinical features of hepatitis B

A
  • acute infection present as mild illness then followed by jaundice.

Some patients:
- fever, malaise, anorexia, nausea, vomiting, upper abdominal pain.

21
Q

Characteristics of acute infection of hepatitis A

A
  1. Liver function tests
    - raised serum AST
    - raised serum ALT
    - rise in bilirubin
  2. HBVsAg: +
  3. HBVeAg: +
    - indicates high degree of infectivity
    - HBVsAg cleaves to form HBVeAg
22
Q

Hep B infection will be assessed by its serology for what

A
  • surface antigen

- early antigen

23
Q

Why must Hep B also be present if Hep D is present?

A
  • Hep D virus borrows its outer coat from hep B.

- requires coat of HBVsAg for its replication and survival

24
Q

If acute infection of hep b resolves what will occur?

A
  • HBVeAg disappears within few months
  • disappearance HBVsAg
  • normalisatoin of aminotransferases
25
Q

After resolution of acute infection of hep B

A
  • IgM antibodies to HBVcAg are lost
  • total antibodies to HBVcAb remain positive lifelong
  • most develop lifelong antibodies to HBVsAg
26
Q

Transmission of HBV

A
  • Blood borne virus

- contaminated blood, needle stick

27
Q

Clinical signs of HBV

A

Acute hepatitis

  • flu like symptoms
  • right upper quadrant discomfort
  • jaundice
28
Q

In diagnosis of HBV what do the following markers indicate:

  1. HBsAg
  2. Anti- HBs
  3. Anti- HBc
  4. HBeAg
  5. HBeAg
A
  1. HBsAg
    - antigen indicating infection
  2. Anti- HBs
    - indicates immunity
  3. Anti- HBc
    - previous or ongoing infection
  4. HBeAg
    - high infectivity
  5. HBeAg
    - low infectivity
29
Q

Management of Hep B

A

Usually supportive.

However injection of pegylated interferon may be given (1 year only)

30
Q

Prevention of Hep B

A
  • active immunisation with vaccine containing HBVsAg
  • HBV-specific immunoglobulin
  • short term, immediate, passive protection
31
Q

Describe Hep D virus

A

Rna core, requires coat of HBVsAg for its replication and survival

32
Q

Treatment for HDV

A
  • no drug therapy effective
  • liver transplantation may be required
  • PEG interferon for 48 weeks mainstay of treatment
33
Q

Describe hep C

A
  • RNA virus
  • blood borne transmission
  • vertical transmission
  • can be asymptomatic
34
Q

What occurs once hep C virus enters cell?

A
  • virus infects hepatocytes, producing virons
  • asymptomatic phase
  • immune response results in viral clearance
35
Q

HCV diagnosis

A
  • detection of hep C antibodies suggests infection at some time.
  • small rise in aminotransferases
  • presence of antibodies IgG to HCV
36
Q

Chronic infection of HCV suggested by

A

HCV RNA (viral load)

37
Q

After infection how long might it take for IgG antibodies to HCV to appear?

A

6-12 weeks approx for IgG antibodies to HCV to appear.

During that time only test for HCV RNA may be positive

38
Q

HCV RNA testing

A

Indicates viraemia

Ongoing viral replication

39
Q

After liver transplantation what is recommended to prevent HBV recurrence

A
  • combination of hepatitis B immunoglobullin HBIG and a NA

GI - Y2 (18 decks)

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