Lecture 41: Patient with Jaundice- viral hepatitis

Question 1

Presentation of Viral Hepatitis?

Answer 1

• Jaundice
  
  • pre-hepatic: haemolysis
  • Hepatic: failure to conjugate
  • Post-hepatic: biliary system
• Oedema
  
  • decreased albumin production by liver lowers oncotic BP and fluid leaks from vessels
• Bruise easily
  
  • Insufficient coagulation protein synthesis by liver

Question 2

45 y/o Korean man presents to GP with abnormal blood tests, feeling run-down, thinks he has lost some weight and his friends remar that he is looking yellow. Recently his legs and abdomen have become swollen and he seems to bruise easily.

Most likely cause?

Why is he bruising easily?

Answer 2

Most likely to be Chronic Liver disease (although could be acute hepatits but less likely)

Chronic liver disease = fibrosis = back pressure in the portal vein leads to oedema in gut, ascites and pressure in splenic vein = spleen enlarged = low platelets due to sequestration in the spleen

Question 3

Hepatitis viruses _____?

Answer 3

Are unrelated viruses that are hepatotropic

Question 4

HAV?

Answer 4

RNA virus that is transmitted via the faecal-oral route

Most cases are in developing world and are asymptomatic (TRAVEL)

Can cause acute illness and is normally self-limiting. Less than 1% will cause fulminant liver disease and require transplant

Testing relies on anti-bodies

Question 5

HBV?

Answer 5

Partially DS DNA virus with bloodborne transmission but uses reverse transcriptase for viral replication

Worldwide, extremely contageous with most cases being asymptomatic but some causing acute illness (usually in children it causes chronic illness from vertical transmssion from mother)

ALL damage is immune mediated (none directly from the virus) - cytotoxic T cell response causes liver damage

Long incubation period of 2-4 months

Question 6

HCV?

Answer 6

Hepatitis C virus is an RNA virus that is bloodborne

More common in the developed world and generally infects adults (IVDU, sex)

Doesn’t cause acute hepatitis but chronic infection can lead to cirrhosis and cancer (less so than HBV)

curative treatment available

Question 7

Hepatitis B surface antigen? Latency in infection?

Answer 7

HBsAg is produced in the ribosomes and is very fast when compared to other proteins being made in the cytoplasm.

For this reason it spills out into the blood and can be measured as a diagnostic test as well as used as a vaccine given to uninfected people.

HBV DNA can sometimes integrate into chromosome and although generally doesn’t cause issues but can predispose to cancer due to increased turnover (x-gene). On immune suppression reactivation may occur.

Question 8

HCV diagnosis and treatment?

Answer 8

Lab can screen for AB against HCV = shows current or past infection or can use PCR for HVR RNA

Non-structural proteins for a viral polymerase that is easily targeted by drugs (no longer use IFN) - these new ones are specific

Question 9

Blood test results and their interpretation?

Answer 9

Can be HAV, HBV or HCV

IgM+ = Current infection

IgG+ = Past infection

HBsAg- = no current HBV infection

HBsAg+ and anti-HBC- = vaccination

anti-HBS+ = vaccinated

HBEAg = + is acute but this early antigen decays over time so - in chronic infection.