Viral hepatitis

Question 1

What type of virus is hepatitis A?

Answer 1

non-enveloped single-stranded RNA virus

Question 2

How does hepatitis A spread?

Answer 2

faeco-oral route-

ingestion of contaminated food or water

Question 3

Which demographic is hepatitis A associated with?

Answer 3

Mainly effects children and young adults

travellers to endemic areas and those engaging in higher-risk sexual activities

Question 4

Which risk factors are associated with hepatitis A?

Answer 4

Travel: those travelling to endemic areas

Sexual: high risk activities (e.g analingus, digital-rectal contact, chemsex)

Haematological disorders: factor VIII and factor IX concentrates have been implicated in transmission

Occupational risks: for example laboratory or sewage workers

Intravenous drug use

Question 5

Describe the 4 clinical phases seen in hepatitis A

Answer 5

Phase 1-
Incubation - 2-6 weeks

Phase 2
Prodromal - Fever, joint pain and rash. Flu-like symptoms may be present

Phase 3
Icteric - jaundice, anorexia, abdominal pain and change in bowel habit

Phase 4
Convalescent - Recovery phase as the body returns to normal and symptoms subside. Symptoms like malaise may last months.

Usually a self limiting disease

Question 6

List the signs and symptoms associated with hepatitis A

Answer 6

cause a mild illness characterised by a flu-like illness and GI upset.

Symptoms 
Abdominal discomfort
Nausea
Anorexia
Diarrhoea
Flu-like illness
Pruritus
Dark urine, pale stool
Rash

Signs 
Jaundice
RUQ tenderness
Hepatomegaly (85%)
Splenomegaly (15%)
Lymphadenopathy (5%)

Question 7

Which investigations are used to diagnose hepatitis A and what would they show? (non including serology)

Answer 7

ALT/AST: Tends to be significantly elevated, between 500 and 10,000 IU/L

Bilirubin: Tends to be moderately elevated, between 50 and 200 micromols/L

Prothrombin time (INR): Tends to be normal, may be elevated in complicated disease