Lecture 15- Hepatitis

Question 1

What is hepatitis?

Answer 1

Inflammation of the liver

Question 2

Hep B?

Answer 2

6weeks to 6 months incubation and can be a chronic illness

Hep C- 6 to 12 weeks incubation can also be a chronic illness

Both transmitted through blood and sex

Hep B also transmitted vertically

Question 3

Jaundice types?

Answer 3

Pre-hepatic- caused by increased haemolysis rate

Hepatic- caused by Hepatitis, cirrhosis, alcohol and drugs

Extra hepatic- caused by blockage of bile duct…. duct stones etc

Question 4

How to determine jaundice type from blood test results?

Answer 4

Hepatic results from increased bilirubin and high alanine transaminase (ALT)

Extra hepatic results from high bilirubin and high ALP alkaline phosphatase

Question 5

What liver function tests are ther?

Answer 5

Liver transaminases like ALT, AST

Alkaline phosphatase

Albumin

Coagulation tests like prothrombin time and INR

Question 6

How is HEP B spread?

Answer 6

75% vertical transmission 
Sexual contact 
Drug injectors 
Needlestick
Blood exposure

Question 7

Symptoms of acute Hep B?

Answer 7

Jaundice, nausea, fatigue , abdominal pain

Question 8

Acute HEP B?

Answer 8

6 weeks to 6 months incubation

AST/alt in thousands

Up to half have vague or no symptoms

Up to 80% clear infection within 6 months

Chronic in 10% of adults

Question 9

Hep B serology?

Answer 9

HBsAg surface antigen with rise in ALT/AST indicates infection

Then HBeAg which means very infectious

Core antibody IgM

E-antibody which means e antigen and infectivity disappears

HBsAb surface antibody indicates clearance of infection

Core antibody HBcAb IgG persists for life and gives immunity

Question 10

How is chronic Hep B infection defined?

Answer 10

HBsAg after 6 months

Question 11

What happens if you end up with chronic Hep B?

Answer 11

No cure so go on life long anti retro virals

Question 12

Hep B vaccine?

Answer 12

Genetically engineered surface antigen produces surface antibody response

Question 13

What’s the status of Hep B infection given certain results?

Answer 13

See table in lecture

Question 14

Hep C transmission?

Answer 14

Vast majority IV drug users

Also sexual and needlestick but far less common

Question 15

How does Hep C progress?

Answer 15

80% will get chronic infection

Question 16

Hep C blood test?

Answer 16

Test for surface antibody and if present will tell you that patient either has Hep C chronically or has had it acutely before

Must do PCR is positive to confirm if currently infected or not

Question 17

Hep B and Hep C immunity?

Answer 17

Hep B surface antibody gives immunity Hep C one doesn’t. Must stop injecting drugs etc to prevent infection

Question 18

Hep C treatment?

Answer 18

Can be cured with expensive anti retroviral drug combo but no vaccine and can get re infected

Question 19

What to do with needlestick injury?

Answer 19

Wash wound 
Take blood sample from worker and patient 
Report to occupational health 
Check worker vaccination records 
Assess risk and need for HIV pep

If for example Hep c antibody or HIV detected to follow up Hep C PCR and give HIV pep and repeat tests at 12 weeks