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GIHEP > L5: Viral Hepatitis > Flashcards

L5: Viral Hepatitis Flashcards

1
Q

The hepatitis D virus can only infect a person if they are co-infected with…?

A

Hepatitis B

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2
Q

The hepatitis D virus uses what to aid in its propagation?

A

Hepatitis B surface antigen - HBsAg

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3
Q

What is the main transmission method(s) of Hepatitis A?

A
  • person to person via faecal oral route
  • contaminated food and water
  • MSM
  • travelers to endemic countries
  • household or sexual contacts of known cases
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4
Q

What is the incubation period for Hepatitis A?

A

range: 15 - 50 (30 days)

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5
Q

What is the period of infectiousness for hepatitis A?

A

2 weeks before onset of symptoms and

1 week after onset of symptoms

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6
Q

What is the main transmission method(s) of Hepatitis E?

A
  • via food (UNDERCOOKED meats)
  • directly through handling animals
  • contaminated water (poor sanitation - e.g. faecally contaminated water)

similar to HAV - faecal oral route

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7
Q

What is the incubation period for Hepatitis E?

A

range: 15 to 60 days (40 days)

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8
Q

Genotypes 1 + 2 of Hepatitis E are prevalent where in the world? What are they associated with?

A
  • developing countries

- transmitted via faecally-contaminated water

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9
Q

Genotypes 3 + 4 of Hepatitis E are prevalent where in the world? What are they associated with?

A
  • genotype 3 prevalent in Europe
  • genotype 3 infections food-borne

generally, 3 and 4 are a/w contact with humans, pigs and other mammals

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10
Q

What are the main transmission methods of Hepatitis B?

A
  • perinatally
  • sexually
  • parenterally (blood-borne virus)
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11
Q

What is the incubation period of Hepatitis B?

A

1 to 6 months

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12
Q

In high prevalence areas of hepatitis B, what is the main mechanism of spread?

A

intrapartum or close household contact (vertical + horizontal transmission)

think of developing countries

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13
Q

In low prevalence areas of hepatitis B, what is the main mechanism of spread?

A

sexually/parenterally

think of Western countries

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14
Q

What are the main transmission methods of Hepatitis C?

A
  • perinatally
  • sexually
  • parenterally (blood-borne virus)
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15
Q

What is the incubation period of Hepatitis C?

A

8 weeks (average)

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16
Q

If a patient is symptomatic with a viral hepatitis, how would they present?

A

Conjugated Hyperbilirubinaemia

  • prodromal symptoms (fever, nausea, fatigue)
  • dark urine
  • pale stools
  • jaundice
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17
Q

What is the clinical course for hepatitis A?

A

acute infection

  • no chronic state
  • no carrier state
  • acute hepatitis failure may occur (<1%)
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18
Q

What is the clinical course for hepatitis E?

A
  • acute infection

- chronic infection (very rarely - usually in immunosuppressed pts e.g. transplant pts, HIV…)

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19
Q

An acute infection of hepatitis E may lead to fulminant hepatitis in which population? Which genotype is life-threatening in this population?

A

Genotype 1 is life-threatening to mum + fetus

pregnant women at risk of fulminant hepatitis

20
Q

A chronic infection of hepatitis E may lead to mortality in which population? Which genotype is life-threatening in this population?

A

immunosuppressed patients - liver transplant recipients

genotype 3

21
Q

What are the 3 outcomes of a hepatitis B acute infection?

A
  • resolution
  • chronic infection
  • fulminant hepatic failure (1% of cases)
22
Q

What is the definition of a chronic hepatitis B infection?

A

infections persisting for more than 6 months with detection of HBsAg (surface antigen)

23
Q

What are the main transmission methods for hepatitis D?

A
  • perinatally
  • sexually
  • parenterally (blood-borne virus)
24
Q

What is the clinical course for hepatitis C?

A
  • acute infection (most develop into chronic)

- chronic infection

25
Q

Which hepatitis is it most common to have extrahepatic features in?

A

Hepatitis C

26
Q

What are some risk factors that may lead to an increased risk of progression of a hepatitis C infection?

A
  • ALCOHOL*

- co-infection with HBV or HIV (a superinfection)

27
Q

What are some extra-hepatic features that are common in hepatitis C?

A

Haemotological - mixed cryoglobulinaemia

Endocrine - diabetes, thyroiditis

Rheumatological - PAN

Dermatological

28
Q

What is the significance of HbcAb (IgG) [antibody to core antigen] in regards to hepatitis B?

A

usually POSITIVE FOR LIFE - can check if anyone has EVER been infected with hep B

29
Q

What is the last hepatitis B antibody to appear and which indicates that the infection is resolved?

A

Anti-HBs (antibody to s antigen)

30
Q

When will the hepatitis C antibody appear on serology? What does this suggest?

A

positive 2-6 months after exposure - this means that it may not show up on serology if the patient has an acute infection

31
Q

What is the main treatment of Hepatitis A?

A

supportive care

32
Q

When is PEP given for hepatitis A? What populations may it be given to?

A

within 2 weeks of exposure to be effective

persons aged over 60
children more than 12 months and at risk of severe complications

33
Q

What is the main treatment for an ACUTE hepatitis E infection?

A

symptomatic treatment

34
Q

What is the main treatment for a CHRONIC hepatitis E infection?

A

chronic infections often occur in transplant patients!

  • reduce immunosuppression
  • antivirals
35
Q

What is the main treatment for an ACUTE hepatitis B infection?

A

supportive therapy

36
Q

What is the main treatment strategies for treating a chronic hepatitis B infection?

A
  1. Antiviral Therapy (+ Pegylated Interferon Alpha)
  2. Monitor for Liver Cancer
  3. Transplant
  4. Patient Education
  5. Vaccination
37
Q

What is the main treatment for an ACUTE hepatitis C infection?

A

no PEP

- see if spontaneous clearance

38
Q

What is the main treatment for a CHRONIC hepatitis C infection?

A

trying to achieve a Sustained Virological Response

depends on genotype and other co-infections but…

  • Directly Acting Antivirals ± Interferon
  • give Hep A and B Vaccine
39
Q

Which forms of viral hepatitis are there vaccines for? Which ones are there no vaccines for?

A

Vaccine = A + B (D is inadvertently covered)

No Vaccine = C, E

40
Q

Are the hepatitis viruses RNA or DNA viruses?

A

everything RNA except for hepatitis B (which is a DNA virus)

41
Q

Which 2 hepatitis viruses are considered blood-borne viruses?

A

Hepatitis B and Hepatitis C

42
Q

List some of the complications of a hepatitis B infection

A
  • cirrhosis
  • hepatocellular cancer
  • reactivation of a hepatitis B infection (if immunosuppressed)
43
Q

If a person is given the hepatitis B vaccine, which HBV marker would be the only one positive?

A

Anti-HBs

44
Q

What is Alpha Fetoprotein a tumour marker for?

A

Hepatocellular Cancer

45
Q

How many doses of the Hepatitis B vaccine are administered?

A

3 doses

46
Q

Why should the hepatitis A and B vaccine be given when treating someone with a chronic hepatitis C infection?

A

to minimize the # of insults to the liver

GIHEP (24 decks)

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