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Pathology > Mi - Viral Hepatitis > Flashcards

Mi - Viral Hepatitis Flashcards

1
Q

what is hepatitis

A

inflammation of liver

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2
Q

causes of hepatitis

A

ischaemia
AI
toxic
metabolic
infection
- viruses
- bacteria
- parasites

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3
Q

bacterial causes of hepatitis

A

sepsis
leptospira
syphilis

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4
Q

parasitic causes of hepatitis

A

amoeba
fasciola
toxoplasma
opisthorchis

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5
Q

primary viral hepatitis causes

A

A, B, C, D, E

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6
Q

name some secondary viral hepatitis causes

A

EBV **key one
CMV **key one
HIV
adenovirus
parvovirus b19
rubella
coxsackie B
Dengue
Yellow fever
VHF
enteroviruses

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7
Q

where is hep A prevelant

A

Africa
Central / South America
South east asia

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8
Q

what type of virus is hep A

A

pucornaviridae

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9
Q

transmission of hep A

A

faecal oral route
person to person contact
food / drink that has been contaminated

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10
Q

incubation period of hep a

A

2-6 weeks but usually 4 weeks

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11
Q

sx of acute hepatitis

A

non specific
- fever, malaise, fatigue, loss of appetite, abdo pain
specific (due to BR)
- jaundice, dark urine, pale stools, pruritis

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12
Q

acute Ix for hep a

A

anti-HAV IgM

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13
Q

what is important to remember with anti-HAV IgM

A

may be negative in first week of Sx

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14
Q

how do you test for immunity to hep A

A

anti - HAV IgG

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15
Q

is anti HAV IgG raised post infection / vaccination / both

A

BOTH

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16
Q

what marker must be elevated for you to request anti HAV IgG and why

A

ALT > 500
- impossible to have hepatitis if ALT isn’t raised, so no point requesting it (may be super early phase, so false negative)

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17
Q

infectious period of hep A

A

2 weeks pre Sx to 1 week after jaundice onset

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18
Q

when should pt self isolate with hep a

A

7 days post Sx onset

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19
Q

tx for hep A

A

mainly supportive

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20
Q

who is most likely to die from hep a

A

old people

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21
Q

is hep A a notifiable disease?

A

YES - report to UKHSA

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22
Q

when is hep a vaccine indicated

A

travel to endemic countries
chronic liver disease
chronic hep B/C
haemophillia
IVDU
MSM
occupational risk - labs / sewage workers

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23
Q

what causes death in hep a

A

fulminant hepatic necrosis

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24
Q

how many doses are needed for hep a vaccine

A

2

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25
Q

prevalence of hep B carriers

A

250 million carriers worldwide

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26
Q

areas with high prevalence of hep B

A

africa
south east asia
increasing in europe - migration

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27
Q

what type of virus is hep b

A

DNA (ONLY HEP VIRUS THAT IS DNA)

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28
Q

transmission of hep b

A

blood products
sex
vertical mother to baby

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29
Q

incubation period of hep b

A

2-6 months

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30
Q

sx of acute hep b infection <5 y/o

A

none

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31
Q

complication of acute hep b infection in <5 y/0

A

90% go to chronic hep B infection

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32
Q

what % of adults are Sx-atic with hep B

A

20-40%

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33
Q

what % of adults progress to chronic hep b infection after acute infection

A

10%

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34
Q

define chronic hep B infection

A

HBsAg reactivity >6 months

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35
Q

Sx of chronic hep B

A

usually none

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36
Q

complications of chronic hep b infection

A

cirrhosis
hepatocellular carcinoma
extra hepatic manifestations - rashes / arthritis

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37
Q

what does HBsAg + mean

A

CURRENT HBV infec

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38
Q

what does HBeAg + mean

A

high viral replication / highly infectious

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39
Q

what does HBcIgM + mean

A

ABs produced to ACUTE infection (<3 months)

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40
Q

what does anti HBc + mean

A

ABs produced due to EXPOSURE to HBV - can be past or present

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41
Q

what is anti HBc

A

total / IgG core AB

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42
Q

what does anti HBe + mean

A

ABs produced. shows IMMUNE CONTROL ie imminent / already achieved eAg clearance

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43
Q

what does anti HBs + mean

A

ABs produced as IMMUNE to HBV. past infection or vaccination

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44
Q

what is this person’s HBV status:
HBsAg -
anti HBc IgG -
anti HBc IgM -
anti HBs -

A

never been infected or vaccinated - therefore susceptible to HBV

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45
Q

what is this person’s HBV status:
HBsAg +
anti HBc IgG +
anti HBc IgM +
anti HBs -

A

ACUTE infection

46
Q

what is this person’s HBV status:
HBsAg -
anti HBc IgG -
anti HBc IgM -
anti HBs +

A

VACCINATED - immune

47
Q

what is this person’s HBV status:
HBsAg +
anti HBc IgG +
anti HBc IgM -
anti HBs -

A

CHRONIC infection

48
Q

what is this person’s HBV status:
HBsAg -
anti HBc IgG +
anti HBc IgM -
anti HBs +

A

PAST INFECTION - cleared therefore immune

49
Q

complications of hep B

A

cirrhosis
hepatocellular carcinoma

50
Q

how do you assess cirrhosis

A

child-pugh score

51
Q

radiology of cirrhosis

A

coarse, echotexture, nodularity

52
Q

what Ix is specific for HBV cirrhosis

A

transient elastography

53
Q

gold standard for cirrhosis Ix

A

histopathology after biopsy
(rarely done due to invasiveness)

54
Q

Ix for ?HCC

A

AFP
Imaging - USS every 6 months if risk

55
Q

what is the main indicator for Tx for HBV

A

high viral load

56
Q

2 Tx strategies for HBV

A

pegylated IFNa (++SEs, rarely done)
nucleoside / nucleotide analogues (main)

57
Q

eg of nucleoside/nucleotide analogues used to treat HBV

A

entecavir
tenofovir

58
Q

when does Tx stop for HBV

A

once HbsAg lost
(usually Tx for life)

59
Q

how is HBV prevented

A

vaccination
screening in preg
blood screening from blood donors

60
Q

when is hbv vaccination given

A

2 months
3 months
4 months

61
Q

if mother is HbsAg + but eAg -, what Tx is given to baby

A

vaccine at birth then routine HBV vaccines on top

62
Q

if mother is HbsAg + AND eAg +, what Tx is given to baby

A

vaccine at birth
HBV IG within 48 hours
routine vaccines

63
Q

prevelance of hep C

A

1% of population

64
Q

deaths from hep c

A

400,000 / year

65
Q

what type of virus is hep c

A

flaviviridae
RNA virus

66
Q

transmission of hep C

A

blood products
sharing needles
sharing bank notes to snort drugs

67
Q

incubation period of hep c

A

2 weeks to 6 months

68
Q

sx of acute hep c infection

A

mostly none

69
Q

what % of acute infections with hep c spontaneously clear it

A

20-40%

70
Q

what % of acute infections with hep c progress to chronic infection

A

40-60%

71
Q

how is chronic hep c diagnosed

A

usually incidentally
from screen after derranged LFTs

72
Q

complications of chronic hep c

A

chronic liver disease
cirrhosis
hepatocellular carcinoma

73
Q

what increases the chances of getting complications from chronic hep C, especially hepatocellular carcinoma

A

co-infection with hep B / HIV

74
Q

when does anti HCV AB become + after HCV infection

A

> 4 weeks after

75
Q

if acute infection with hep C is suspected, what Ix should be requested

A

HCV RNA

76
Q

Tx of HCV

A

direct acting antivirals (DAA)

77
Q

is HCV curable

A

YES - now it is, thanks to DAA

78
Q

who should get Tx for HCV

A

EVERYONE with hcv

79
Q

tx regime for hcv

A

daily pill for 12 weeks

80
Q

prevention of hcv

A

NO vaccine :(
screen blood
needle exchanges for IVDU

81
Q

how long does anti HCV stay reactive after infection with HCV

A

forever

82
Q

how does hep D infect

A

only with co-infection of hep B

83
Q

impact on liver of hep d

A

turns relatively benign chronic hep B into hepatocyte destructing virus

84
Q

if someone gets hep b and d at the same time, what is the prognosis / risk of chronicity

A

severe acute disease
low risk of chronic infection

85
Q

if someone gets hep d when they’re already chronicly infected with hep B what is the prognosis / risk of chronicity

A

high risk of severe liver disease chronicly

86
Q

how is hep d prevented

A

prevent HBV !
- vaccination HBV
- post exposure prophylaxis for HBV
educate hbv pts re risky behaviours ie sex / needles

87
Q

what type of virus is hep e

A

RNA
hepeviridae

88
Q

how many genotypes of hep e are there

A

4

89
Q

which genotypes of hep e infect humans vs animals

A

1 and 2 = humans
3 and 4 = animals

90
Q

how is hep e transmitted

A

faeco-oral

91
Q

what animals are the natural host of hep e genotypes 3 and 4

A

pigs / wild boards

92
Q

how can hep e genotypes 3 and 4 be passed to humans

A

undercooked meat - zoonotic
organ transplant
blood transfusion

93
Q

incubation period of hep e

A

2-8 weeks

94
Q

sx of hep e genotypes 1 and 2

A

brief, self limiting infection

95
Q

who gets hep e genotypes 1 and 2

A

young adults going travelling

96
Q

who has a high risk of mortality with hep e genotypes 1 and 2

A

pregnant women !! 30% mortality with genotype 1

97
Q

where is hep e genotypes 3 and 4 endemic to

A

europe - esp france and italy

98
Q

sx of hep e genotypes 3 and 4

A

usually none

99
Q

who gets worse sx with hep e genotypes 3 and 4

A

older males

100
Q

who gets chronic hep e infection

A

immunocompromised

101
Q

sx of chronic hep e infection

A

none / mild
mildly derranged LFTs
some people (10%) get cirrhosis / death

102
Q

Ix for hep e

A

HEV IgG and IgM (immunocompetent)
HEV RNA (immunosuppressed)

103
Q

extra hepatic manifestations of hep e (4 groups, 2 examples of each)

A

haematological
- thrombocytopnaenia
- red cell aplasia
musclar
- proximal myopathy
- myositis
neuro
- encephalitis
- GBS
- ataxia
renal
- glomerulonephritis
- IgA nephropathy

104
Q

extra hepatic manifesations of hep b

A

polyarthritis nodosa
rashes
vasculitis
(exam Q +++)

105
Q

extra hepatic manifestation of hep c

A

cryoglobulinaemia

106
Q

tx of hep e

A

supportive
acute / severe - ribavirin
chronic / immunocompromised - 3 months ribavirin

107
Q

is there a hep e vaccine

A

only in china

108
Q

prevention of hep e

A

screen blood products
avoid undercooked pork / venison

109
Q

which hep viruses are non enveloped

A

A and E

110
Q

which viruses are foecal oral

A

A and E
(same as the ones that are non enveloped)

Pathology (87 decks)

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