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Gastrointestinal (LECTURE NOTES) > Viral Hepatitides > Flashcards

Viral Hepatitides Flashcards

1
Q

How is Hep A spread

A

Faeco-oral route

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2
Q

Where are there high rates of Hep A

A

In communities with low standards of sanitation

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3
Q

Where are there outbreaks of Hep A

A

Daycare centres
association with sewage contaminated shellfish
Homosexual men
IV drug abusers

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4
Q

What is the incubation period for Hep A

A

15-50 days

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5
Q

What are the clinical features in symptomatic individuals

A 
Acute febrile illness with jaundice 
anorexia
nausea
abdominal discomfort
malaise 
dark urine
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6
Q

What happens to the severity of Hep A as age increases

A

The severity increases

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7
Q

How is Hep A diagnosed

A

It relies on the detection of serum antibodies to HAV

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8
Q

What does high IgM indicate

A

Recent infection

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9
Q

What is the management of Hep A

A

Largely symptomatic

Vaccination is effective in preventing infection and disease

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10
Q

What is the vaccine for Hep A

A

Inactivated hepatitis A vaccines

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11
Q

Who is the Hep A vaccine recommended for

A 
Those at high risk of infection 
Those infected with Hep B and C
Travellers to countries with high rates of Hep A 
Employees of early childhood services 
Healthcare workers exposed to faeces 
Men who have sex with men 
Injecting drug users
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12
Q

How many people are estimated to be carriers of the Hep B virus

A

400 million worldwide

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13
Q

What are the risk factors for HBV infection

A 
Transfusion
Needle sharing 
sexual transmission
perinatal transmission
men who have sex with men 
promiscuous heterosexuals 
immunosuppressed patients 
patients on haemodialysis 
transplantation
health care transmission
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14
Q

How many genotypes are recognised for Hep B

A

8

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15
Q

What immune response is initiated in Hep B

A

Adaptive

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16
Q

What are the clinical manifestations of HBV in the acute phase

A

Most are asymptomatic or demonstrate mild fatigue

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17
Q

What are the clinical manifestations of HBV in the chronic phase

A

Some are asymptomatic,
Abnormal LFTs
Cirrhosis
HCC

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18
Q

What does the severity of the acute disease determine

A

The progression to chronicity

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19
Q

What are the 3 phases of Hep B

A
  1. Replicative, during which aminotransferases are largely normal and there is little liver damage
  2. Inflammatory - where the aminotransferases become elevated, liver biopsy shows chronic hepatitis and viral replication declines
  3. Patients may enter the inactive phase where viral replication has stopped, the amino transferases normalise and there is no ongoing liver inflammation
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20
Q

How is a diagnosis of Hep B made

A

The hepatitis B surface antigen (HBsAg) must be positive for 6 months

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21
Q

What does the level of HBV-DNA correlate with

A

The amount of virus in the circulation and has prognostic implications

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22
Q

What is the management for Hep B

A

Prevention is the cornerstone!
Safe sex
Avoidance of sharing of IV drug use
Use of gloves
Careful cleaning of blood or body fluid spills
Disposal or adequate sterilisation of surgical instruments (tattoo and piercing)
Careful disposal of sharps
Use of goggle where there is a risk of infected material splashing into the eye
Immunisation

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23
Q

Who is the Hep B vaccination recommended for in the UK

A

Those exposed to blood or blood born products
Travellers who plan to spend long periods in high prevalence areas or with pre-existing medical conditions that place them at a higher risk of requiring medical procedures abroad
Haemophiliacs
Prisoners and prison officers

24
Q

What is the treatment for Hep B

A

Oral nucleoside and nucleotide analogues (lamivudine)

IFN-alpha: used for a finite period with durable response in a subset of patients

25
Q

What is Hep D

A

A subviral agent, dependent for its life cycle on HBV

26
Q

What is it called when an individual receives both viruses

A

Co infection

27
Q

What is superinfection

A

When a person chronically infected with HBV then contracts HDV

28
Q

What is a requirement for the replication of HDV

A

The presence of HBV

29
Q

What is the association with liver damage and HDV infection

A

Chronic HDV results in much more rapid progressing liver damage

30
Q

What are the investigations for HDV

A

Should be considered in patients diagnosed with HBV.
HDAg-S is produced early and is required for viral replication
HDA-L is produced later and is an inhibitor of viral replication but is required for viral particle assembly

31
Q

What is the management fo HDV

A

Antivirals such as lamivudine do not reduce HDV titres
Extensive IFN alpha therapy or
Liver transplantation

32
Q

What is Hep C

A

The most common of the chronic blood-borne infections

33
Q

How many genotypes does Hep C have

A

6

34
Q

What are the risk factors for Hep C

A 
Blood transfusions
IV drug use, tattos , ear or body piercing
Secual promiscuity
An HCV positive partner 
Incarceration
35
Q

What is HCV often coinfected with

A

HIV

36
Q

What is enhanced in HCV infection

A

Hepatocyte apoptosis (programmed cell death_

37
Q

What are the clinical features of Hep C

A

Often asymptomatic

mild complaints - fatigue, abdominal pain, anorexia, itching and flu-like symptoms

38
Q

What is an acute infection

A

The first 6 months following initial infection

39
Q

What percentage of patients with acute infection go on to become chronically infected

A

75%

40
Q

What are the investigations for Hep C

A

Anti HCV antibodies - positive in 80% within 3 months of infection
RNA testing is necessary when antibody tests are negative but the clinical suspicion is high

41
Q

What is the management for Hep C

A

Prevention - avoid sharing IV needles

42
Q

What is the treatment for Hep C

A

Pegylated IFN-alpha which gives increased and sustained duration of activity due to longer serum half-life than conventional IFN -alpha
Ribavirin, the nuceloside antimetabolite

43
Q

What are some of the adverse affects of IFN-alpha and PEG-IFNs

A 
Fatigue 
Flu-like symptoms 
GI disturbances 
haematological abnormalities 
neuropsychiatric effects
throid dysfunction
dermatological effects
44
Q

Why should dose reductions or discontinuing ribavirin not be an option

A

Treatment success is directly related to adherence to treatment

45
Q

What is Hep E

A

A distinct agent, unrelated to HAV which causes epidemics of largely waterborne enterically transmitted, acute hepatitis

46
Q

Where are the most common outbreaks of Hep E

A

South-East Asia and Northern Africa

47
Q

How is Hep E transmitted

A

Primarily faecal oral route
food borne
vertical transmission in pregnant women
Parenteral transmission seems to be low

48
Q

What are the clinical features of HEV

A

Asymptomatic

Acute viral febrile illness without any characteristic features

49
Q

What are the two divisions of symptomatic disease

A

Pre-icteric phase (1-10days) with GI symptoms
Icteric phase - beginning abrupty with jaundice, dark urine and clay coloured stools
arthralgia
rise in serum bilirubin
marked elevation in aminotransferases

50
Q

What are the investigations for Hep E

A

HEV RNA in stool
Anti-HEV IgM in serum
Anti-HEV IgG increases promptly after IgM

51
Q

What is the management for HEV

A

Improving hygiene conditions in endemic areas and detecting contaminated sources
improving sanitation and providing clean drinking water and proper sewage disposal

52
Q

What are some other viral hepatitides

A

EPstein-Barr virus
Cytomegalobirus
Varicella zoster virus
Herpes Simplex virus

53
Q

What are the clinical features of EBV

A

Fever
sore throat
adenopathy

54
Q

What are some of the investigations for EBV

A

Liver enzyme elevations
Transmainases are elevated to two or three times the upper normal limit
Alkaline phosphatase is elevated in 60%
Bilirubin is elevated in 45% and is self-limited

55
Q

How is the diagnosis of EBV infection made

A

Revolves around the typical symptoms in association with postiive EBV IgM antibody

56
Q

What is the management of EBV infection

A

Supportive

steroids and antiviral medications

Gastrointestinal (LECTURE NOTES) (29 decks)

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