Mi - Viral Hepatitis Flashcards
what is hepatitis
inflammation of liver
causes of hepatitis
ischaemia
AI
toxic
metabolic
infection
- viruses
- bacteria
- parasites
bacterial causes of hepatitis
sepsis
leptospira
syphilis
parasitic causes of hepatitis
amoeba
fasciola
toxoplasma
opisthorchis
primary viral hepatitis causes
A, B, C, D, E
name some secondary viral hepatitis causes
EBV **key one
CMV **key one
HIV
adenovirus
parvovirus b19
rubella
coxsackie B
Dengue
Yellow fever
VHF
enteroviruses
where is hep A prevelant
Africa
Central / South America
South east asia
what type of virus is hep A
pucornaviridae
transmission of hep A
faecal oral route
person to person contact
food / drink that has been contaminated
incubation period of hep a
2-6 weeks but usually 4 weeks
sx of acute hepatitis
non specific
- fever, malaise, fatigue, loss of appetite, abdo pain
specific (due to BR)
- jaundice, dark urine, pale stools, pruritis
acute Ix for hep a
anti-HAV IgM
what is important to remember with anti-HAV IgM
may be negative in first week of Sx
how do you test for immunity to hep A
anti - HAV IgG
is anti HAV IgG raised post infection / vaccination / both
BOTH
what marker must be elevated for you to request anti HAV IgG and why
ALT > 500
- impossible to have hepatitis if ALT isn’t raised, so no point requesting it (may be super early phase, so false negative)
infectious period of hep A
2 weeks pre Sx to 1 week after jaundice onset
when should pt self isolate with hep a
7 days post Sx onset
tx for hep A
mainly supportive
who is most likely to die from hep a
old people
is hep A a notifiable disease?
YES - report to UKHSA
when is hep a vaccine indicated
travel to endemic countries
chronic liver disease
chronic hep B/C
haemophillia
IVDU
MSM
occupational risk - labs / sewage workers
what causes death in hep a
fulminant hepatic necrosis
how many doses are needed for hep a vaccine
2
prevalence of hep B carriers
250 million carriers worldwide
areas with high prevalence of hep B
africa
south east asia
increasing in europe - migration
what type of virus is hep b
DNA (ONLY HEP VIRUS THAT IS DNA)
transmission of hep b
blood products
sex
vertical mother to baby
incubation period of hep b
2-6 months
sx of acute hep b infection <5 y/o
none
complication of acute hep b infection in <5 y/0
90% go to chronic hep B infection
what % of adults are Sx-atic with hep B
20-40%
what % of adults progress to chronic hep b infection after acute infection
10%
define chronic hep B infection
HBsAg reactivity >6 months
Sx of chronic hep B
usually none
complications of chronic hep b infection
cirrhosis
hepatocellular carcinoma
extra hepatic manifestations - rashes / arthritis
what does HBsAg + mean
CURRENT HBV infec
what does HBeAg + mean
high viral replication / highly infectious
what does HBcIgM + mean
ABs produced to ACUTE infection (<3 months)
what does anti HBc + mean
ABs produced due to EXPOSURE to HBV - can be past or present
what is anti HBc
total / IgG core AB
what does anti HBe + mean
ABs produced. shows IMMUNE CONTROL ie imminent / already achieved eAg clearance
what does anti HBs + mean
ABs produced as IMMUNE to HBV. past infection or vaccination
what is this person’s HBV status:
HBsAg -
anti HBc IgG -
anti HBc IgM -
anti HBs -
never been infected or vaccinated - therefore susceptible to HBV
what is this person’s HBV status:
HBsAg +
anti HBc IgG +
anti HBc IgM +
anti HBs -
ACUTE infection
what is this person’s HBV status:
HBsAg -
anti HBc IgG -
anti HBc IgM -
anti HBs +
VACCINATED - immune
what is this person’s HBV status:
HBsAg +
anti HBc IgG +
anti HBc IgM -
anti HBs -
CHRONIC infection
what is this person’s HBV status:
HBsAg -
anti HBc IgG +
anti HBc IgM -
anti HBs +
PAST INFECTION - cleared therefore immune
complications of hep B
cirrhosis
hepatocellular carcinoma
how do you assess cirrhosis
child-pugh score
radiology of cirrhosis
coarse, echotexture, nodularity
what Ix is specific for HBV cirrhosis
transient elastography
gold standard for cirrhosis Ix
histopathology after biopsy
(rarely done due to invasiveness)
Ix for ?HCC
AFP
Imaging - USS every 6 months if risk
what is the main indicator for Tx for HBV
high viral load
2 Tx strategies for HBV
pegylated IFNa (++SEs, rarely done)
nucleoside / nucleotide analogues (main)
eg of nucleoside/nucleotide analogues used to treat HBV
entecavir
tenofovir
when does Tx stop for HBV
once HbsAg lost
(usually Tx for life)
how is HBV prevented
vaccination
screening in preg
blood screening from blood donors
when is hbv vaccination given
2 months
3 months
4 months
if mother is HbsAg + but eAg -, what Tx is given to baby
vaccine at birth then routine HBV vaccines on top
if mother is HbsAg + AND eAg +, what Tx is given to baby
vaccine at birth
HBV IG within 48 hours
routine vaccines
prevelance of hep C
1% of population
deaths from hep c
400,000 / year
what type of virus is hep c
flaviviridae
RNA virus
transmission of hep C
blood products
sharing needles
sharing bank notes to snort drugs
incubation period of hep c
2 weeks to 6 months
sx of acute hep c infection
mostly none
what % of acute infections with hep c spontaneously clear it
20-40%
what % of acute infections with hep c progress to chronic infection
40-60%
how is chronic hep c diagnosed
usually incidentally
from screen after derranged LFTs
complications of chronic hep c
chronic liver disease
cirrhosis
hepatocellular carcinoma
what increases the chances of getting complications from chronic hep C, especially hepatocellular carcinoma
co-infection with hep B / HIV
when does anti HCV AB become + after HCV infection
> 4 weeks after
if acute infection with hep C is suspected, what Ix should be requested
HCV RNA
Tx of HCV
direct acting antivirals (DAA)
is HCV curable
YES - now it is, thanks to DAA
who should get Tx for HCV
EVERYONE with hcv
tx regime for hcv
daily pill for 12 weeks
prevention of hcv
NO vaccine :(
screen blood
needle exchanges for IVDU
how long does anti HCV stay reactive after infection with HCV
forever
how does hep D infect
only with co-infection of hep B
impact on liver of hep d
turns relatively benign chronic hep B into hepatocyte destructing virus
if someone gets hep b and d at the same time, what is the prognosis / risk of chronicity
severe acute disease
low risk of chronic infection
if someone gets hep d when they’re already chronicly infected with hep B what is the prognosis / risk of chronicity
high risk of severe liver disease chronicly
how is hep d prevented
prevent HBV !
- vaccination HBV
- post exposure prophylaxis for HBV
educate hbv pts re risky behaviours ie sex / needles
what type of virus is hep e
RNA
hepeviridae
how many genotypes of hep e are there
4
which genotypes of hep e infect humans vs animals
1 and 2 = humans
3 and 4 = animals
how is hep e transmitted
faeco-oral
what animals are the natural host of hep e genotypes 3 and 4
pigs / wild boards
how can hep e genotypes 3 and 4 be passed to humans
undercooked meat - zoonotic
organ transplant
blood transfusion
incubation period of hep e
2-8 weeks
sx of hep e genotypes 1 and 2
brief, self limiting infection
who gets hep e genotypes 1 and 2
young adults going travelling
who has a high risk of mortality with hep e genotypes 1 and 2
pregnant women !! 30% mortality with genotype 1
where is hep e genotypes 3 and 4 endemic to
europe - esp france and italy
sx of hep e genotypes 3 and 4
usually none
who gets worse sx with hep e genotypes 3 and 4
older males
who gets chronic hep e infection
immunocompromised
sx of chronic hep e infection
none / mild
mildly derranged LFTs
some people (10%) get cirrhosis / death
Ix for hep e
HEV IgG and IgM (immunocompetent)
HEV RNA (immunosuppressed)
extra hepatic manifestations of hep e (4 groups, 2 examples of each)
haematological
- thrombocytopnaenia
- red cell aplasia
musclar
- proximal myopathy
- myositis
neuro
- encephalitis
- GBS
- ataxia
renal
- glomerulonephritis
- IgA nephropathy
extra hepatic manifesations of hep b
polyarthritis nodosa
rashes
vasculitis
(exam Q +++)
extra hepatic manifestation of hep c
cryoglobulinaemia
tx of hep e
supportive
acute / severe - ribavirin
chronic / immunocompromised - 3 months ribavirin
is there a hep e vaccine
only in china
prevention of hep e
screen blood products
avoid undercooked pork / venison
which hep viruses are non enveloped
A and E
which viruses are foecal oral
A and E
(same as the ones that are non enveloped)
