Liver symposium

Question 1

Which hepatitis strains are enteric and which are parenteral?

Answer 1

• Hepatitis A and E are enteric viruses (food water, faeco-oral)
• Hepatitis B,C and D are parenteral viruses (blood/blood products)

Question 2

Which hepatitis strains are self-limiting and which cause chronic infections?

Answer 2

• Hepatitis A and E cause self limiting acute infections

* Hepatitis B,C and D cause chronic disease

Question 3

Whats the most common cause of acute viral hepatitis?

Answer 3

Hepatitis A infection

Question 4

How do patients with hepatitis A infections present?

Answer 4

Nausea, anorexia and distaste for cigarettes early on
Jaundice and very unwell in later stages
Disease is self-limiting and runs course in 3-6 weeks

Question 5

How is acute hepatitis A diagnosed?

Answer 5

IgM antibodies detected in serum tests

Viral particles excreted in faeces 2 weeks before and after infection

Question 6

Who is offered hepatitis A immunisation?

Answer 6

• Travellers
• Patients with chronic liver disease
• Injecting drug users (especially with HCV or HBV)
• Haemophiliacs
• Occupational exposure e.g. health workers
• Lab workers
• Men who have sex with men (MSM)

Question 7

What is the most common means of transmission of hepatitis B?

Answer 7

Mother to child vertical transmission

Question 8

What is the Dane particle?

Answer 8

Whole hepatitis B virus, includes:

• inner nucleocapsid core
• core contains incomplete dsDNA, reverse transcriptase or DNA polymerase and HBcAg and HBeAg
• outer envelope of HBsAg

Question 9

What are the core proteins found in hepatitis B?

Answer 9

HBcAg - core protein

HBeAg - secreted as immune defence mechanism

Question 10

How can we detect the 3 different antigens involved in hepatitis B infections and what do they tell us?

Answer 10

• Hepatitis surface antigen (HBsAg) - Presence of virus, detected in blood, check for DNA for replication
• Hepatitis e antigen (HBeAg) - Active replication, detected in blood
• Hepatitis core antigen (HBcAg) - Active replication, not detected in blood, only in liver biopsy

Question 11

What antibody type is typical of an acute infection?

Answer 11

IgM

Question 12

What antibody type is typical of a chronic infection?

Answer 12

IgG

Question 13

What is the most clinically important consequence of hepatitis B infection?

Answer 13

Liver cirrhosis or fibrosis

Question 14

How do you treat hepatitis B infections?

Answer 14

Pegylated interferon – enhances immune response to virus

Oral antiviral drugs

Question 15

What are some clinical sign of chronic liver disease?

Answer 15

ascites
haematemesis
gallstones
jaundice

Question 16

What are some clinical signs of cirrhosis?

Answer 16

fatigue
bleed easily
jaundice
ascites
loss of appetite/nausea