Viral and Autoimmune Hepatitis Flashcards
how is hepatitis A transmitted
faecal-oral route through contaminated water or food
what are risk factors of hepatitis A contraction?
consumption of contaminated food/water
shellfish consumption
overseas travel (esp. Africa, Central + South America)
clinical features of hepatitis A infection
malaise low grade fever nausea abdominal pain jaundice (later in disease)
once jaundice develops in those infected with hepatitis A, what can progress?
may develop intrahepatic cholestasis which leads to darkened urine, pale stools and splenomegaly
investigations for hepatitis A and results
blood tests - viral serology and LFTs
- +IgM anti-HAV
- ⬆️ AST:ALT
management of hepatitis A
usually self limiting
- advise against sexual contact for 7 days once jaundice eases
- provide reassurance and recommend avoiding alcohol due to affected liver function
describe the vaccination process for hepatitis A
if travelling to at risk country or known to be infection free following contraction
- initial dose 4-6 weeks before travel for 12mnth protection
- booster dose 6-12mnths later for 10yr immunity
common complications of hepatitis A infection
renal failure
myocarditis
arthritis
acute fulminant liver failure
what is hepatitis B?
HBV is a DNA virus that is transmitted via direct contact with infected bodily fluid
risk factors of hepatitis B
IV drug use
unprotected sex
blood transfusions
clinical features of hepatitis B
low grade fever malaise and lethargy nausea steatorrhoea and dark urine jaundice hepatomegaly RUQ tenderness + pain pruritus
investigations for HBV
blood test - FBC, CRP, ESR, LFTs and viral serology
- ⬆️ CRP, ESR and WCC
- ⬆️ bilirubin, ALT:AST and ALP
- +ve HBsAg
describe the serology results for hepatitis B infection
HBsAg +ve = active infection
HBeAg = E antigen that indicates high infectivity
HBcAb or HBsAB = surface antibodies for either current or past infection
what are the situations that may explain the presence of HBcAB or HBsAB in serology
current infection
past infection
due to vaccination
management of HBV
screen for other blood-borne viruses and STIs
advise to stop smoking and avoid alcohol
educate about risks and transmission means
advise to undertake vaccine
management of HBV complications
provide anti-viral medication (NRTI) to slow progression and ⬇️ infectivity
investigate and manage complications appropriately
common complications of HBV
hepatic failure
cirrhosis
cholangiocarcinoma
describe hepatitis C (HCV)
an RNA virus spread through bodily fluids that can incubate for 6-9 weeks and result in lifelong infectious carrier state
describe the types of HCV
acute= asymptomatic chronic = symptomatic with severe liver disease
risk factors of HCV
IV drug use unprotected sex vertical transmission co-existing HIV haemodialysis
clinical features of HCV
most patients asymptomatic and only discovered after raised ALT but can present with
jaundice low grade fever malaise + lethargy weight loss abdominal pain nausea
lab investigations for HCV
bloods - FBC, U+E, LFTs, platelets and viral serology
⬇️ RBC, ferritin and platelets
⬆️ ALT, bilirubin and INR
+ve anti-HCV antibodies
clinical investigations for HCV
fibroscan and US liver
gastroscopy to exclude varices
bone densiometry
conservative management of HCV
screen for other blood-borne viruses and STIs
educate about transmission methods and risk factors/contact
advise safe drinking or alcohol abstinence
advise to stop smoking
refer to specialist if require more management
