Lecture: Acute Hepatitis (Prof Leon Adams)

Question 1

acute hepatitis defintion

Answer 1

Timing= acute <6mo

Histology: parenchymal inflammation and hepatocyte injury

Biochem: raised ALT and AST

Natural history: can be the precursor to chronic hepatitis (AI, Hep B and C)

Question 2

histopathological differences between acute and chronic hepatitis

Answer 2

Acute:
- Florid portal/lobular inflammation
- Hepatocyte degeneration and necrosis

Chronic:
- Low grade portal based lymphocytic inflammation
- Fibrosis

Question 3

clinical spectrum of acute hepatitis

Answer 3

• Asymptomatic
• Mild: anorexia, malaise, fatigue
• Moderate: jaundice
• Acute liver failure with encephalopathy + coagulopathy

Question 4

biochemical spectrum of acute hepatitis

Answer 4

• Mildly raised ALT (2x ULN)
• ALT 3-5x ULN
• ALT >5xULN with raised BR
• ALT >5xULN with elevated BR and INR
• Low glucose (makes glucose with GNG etc)

Question 5

causes of acute hepatitis

Answer 5

Viral:
- Hep ABCD(needsB)E
- EBV, CMV, HSV, VZV
- Dengue, typhoid, leptospirosis

Drugs

Alcoholic

AI hepatitis

Ischaemic:
- Cardiogenic shock
- Hypotension
- Amphetamines, cocaine
- Budd-chiari

Wilson Disease

Pregnancy Related
- HELLP, acute fatty liver, pre-eclampsia

Question 6

hep A symptoms in adults and children

Answer 6

Children <6 = asymptomatic

Adults= enteric like illness
- N+V, abdo pain, jaundice, hepatomegaly, rash (1-2mo)
- 10% prolonged cholestasis or relapsing hepatitis (12mo)
- FUlminant liver failure (rare)

Question 7

how do you diagnose hep A anti-bodies

Answer 7

IgM HAV antibodies

Question 8

how do you treat hep a

Answer 8

supportive treatment

Question 9

Who should be vaccinated against hep a

Answer 9

ATSI children, chronic liver disease, institutionalised, carers

Question 10

What do you give contacts exposed to hep a

Answer 10

HAV immunoglobulin

Question 11

how does hep E present in adults and kids

Answer 11

Children <6= asymptomatic

Adults:
1. Enteric like illness: N,V,abdo pain, jaundice, hepatomegaly (1-6wks)
2. Fulminant liver failure is RARE unless pregnant
3. Chronic infection rare (immunocompromised)

Question 12

how do you diagnose hep E

Answer 12

IgM HEV and positive RNA PCR

Question 13

is there vaccination or post-exposure prophylaxis for hep E

Answer 13

nope

Question 14

what is the treatment of Hep E

Answer 14

supportive

Question 15

What is the clinical course of Hep B from peri-natal exposure

Answer 15

Asymptomatic BUT chronic in 90% (poor immune response)

Question 16

What is the clinical course of Hep B from infant/child <5yrs

Answer 16

Asymptomatic/mild and chronic in 20-30%

Question 17

What is the clinical course of hep B in adults

Answer 17

Generally symptomatic
Fulminant liver
Chronic in 5%

Question 18

What does HBsAg mean?

Answer 18

Active infection

Question 19

What does HBeAg

Answer 19

= active replication
So roughly correlates with the DNA viral load

You have this in phase 1 and 2 (up to 30 yrs post-infection) of chronic HBV infection but not phase 3 and 4 (40-60yrs post infection)

Question 20

Can you detect the core antigen in blood?

Answer 20

No

Question 21

What does HBsAb mean?

Answer 21

infection cleared

Question 22

What does HBeAb mean?

Answer 22

Partial immune response

There’s immune control/less replication happening

Question 23

What does HBcAb mean?

Answer 23

IgM = acute infection

IgG = there has been exposure to the virus either prior infection or chronic e.g. prior infection BUT vaccination doesn’t give this

Question 24

What are the phases of chronic HBV Infection?

Answer 24

Note:
- HBeAg presence vs Anti-HBe presence
- The switching between hepatitis and just HBV infection throughout disease course as the ALT levels change
- When you have an immune response you are reducing HBsAg

Question 25

What cancer does HBV increase your risk of?

Answer 25

HCC