Liver Symposium - Viruses Flashcards
What are the 5 main viruses affect the liver
Hepatitis:
A,B,C,D
What Hepatitis viruses are enteric (Viruses that take the faecal-oral route)
Hepatitis A, E
What Hepatitis viruses are Parenteral viruses - occur outside alimentary canal
Hepatits B,C,D
What type od hepatits infection results in self limiting acute infections and chronic disease
Acute - Hep. A,E
Chronic- Hep B,C,D
What is the clinical course of Hepatitis A
in regard to antibodies
Vireamia presents and IgM antibodies increase
People initially feel unwell experiencing flu like symptoms
IgG antibodies increase above IgM around 8 weeks and clinical illness begins to disappear
When does Hepatitis A occur
Sporadically
or an epidemic
How is Hepatitis A transmitted
Faecal -oral route
Sexual
Blood
What is a very common case for hepatitis A infection
Patient can present asymptomatic
What is the demographic of Hepatitis A
Age - common 5-14 Years
Countries -
Who are vaccinated against hepatitis A
Travellers
Patients with chronic liver disease
Haemophiliacs
Occupational exposure
Men who have sex with men (MSM)
What is the structure of Hepatitis B
There is a inner protein core containing genetic material and is surrounded by outer lipid envelop that has a surface antigen
What is the antigen present in the protein core of hepatitis B that is not detected in the blood
Hepatits B c antigen
What antigen is released from the core of the hepatitis B virus and can be detected in the blood
Hepatitis B e antigen
What is the surface antigen present on the Hepatitis B virus
what does this indicate
Hepatitis B s Antigen
Indicating that the virus is present
What antigens present from Hepatitis B indicated active replication is occurring
Hepatits B c/e antigen
What antibody is present when hep B first appears,
How long does it take to clear
IgM
6 months
What antibody In hepatitis B when the infection becomes chronic
IgG
Chronic > 6months
What antibody presence shows that the hepatitis B infection is now inactive
Antibody Hepatitis B e
What dies the presence of antibody HB s indicate in a hepatic B infection
The presence of anti-HBs is generally interpreted as indicating recovery and immunity from hepatitis B virus infection
So what are the overall steps in diagnosis Hepatitis B infection
Is Hepatits B antigen present?
Is there
Clinical evidence of infection
If no = chronic infection
If yes –> Test for IgM
If Igm is positive = acute infection
If IgM infection negative = Chronic infection
What is the pathology of chronic hepatitis B if further progression occurs
Liver Cirrhosis
which Further leads to Liver cancer and end stage liver disease
What is the treatment options for Hepatitis B
Pegylated Interferon
Oral antiviral drugs
What are examples of Oral antiviral drugs used to treat Hep B
Entecavir
Adenofovir
Lamivudine, telbivudine, Tenofovir
What is Pegylated interferon
3 drug therapy of
alpha 2a, alpha 2b, beta 1a
targeting intracellular signalling
Hepatitis C is mostly asymptomatic till what progression occurs
Liver cirrhosis
- have normal liver function tests
What is the natural history and pathology of hepatis C infection
Exposure Resolved - 15% Chronic - 85% Cirrhosis - 20% Liver cancer - 25%
What further intervention occurs with an hepatitis C infection to result in Liver caner
HIV infection and alcohol
What is the percentage of people that present with acute jaundice due to hepatitis C
10%
What is the structure of Hepatitis C
Genetic material located at the core of virus, surrounded by a protective shell of protein encased in a lipid envelope with 2 glycoprotein embedded in envelope
When do you know recovery is happening in hepatitis C
When Hepeptisi C RNA decreases
ALT tests decrease
When there is an increased presence of antibody hepatic C
What does ALT test for
Liver damage
What is the treatment plan for hepatitis C
IFN free combination of direct acting antiviral drugs
e.g ledipasvir, simeprevir, sofosbuvir
giver for 3 months
What is the structure of Hepatitis D
Smalll RNA virus
doesn’t have protein coat
How does Hepatitis D envelope itself
Envelopes itself with hebatits B antigen in a co-infection/superinfection
What affect does treatment have on hepatitis D
very resistant
What is the biggest source of infection is Hepatitis D
Pigs eg infected pork meat
What hepatitis virus is the commonest cause of acute hepatitis in NHS grampian
Hep E
What is the treatment for Hep E
Non specific and there is a vaccine yet
self limiting g- resolves itself without medicine
What are other viruses causing potentially damage to the liver
Hepatitis F Hepatitis G Hepatitis GB EBV CMV Herpes simplex
